Thyroid Nodules

Dr. Nicholas Kaloudis

The Thyroid Gland is located in the lower front of the neck, below the larynx, and above the collarbone.

A thyroid nodule is a lump on the thyroid gland. Thyroid nodules are common and detected in about 7% of women, and 1.5% of men. Sometimes several nodules will develop in the same person. Any time a lump is discovered in thyroid tissue, the possibility of malignancy must be considered. Fortunately, the vast majority of thyroid nodules are benign.

Many patients with thyroid nodules have no symptoms whatsoever, and are found by chance to have a lump in the thyroid gland on a routine physical exam or an imaging study of the neck done for unrelated reasons. However a minority of patients may become aware of a gradually enlarging lump in the front portion of the neck, and may experience a vague pressure sensation or discomfort when swallowing.

Nodules can be caused by a simple overgrowth of normal thyroid tissue, fluid filled cysts, inflammation, or a tumor. Most nodules were surgically removed until the 1980’s. In retrospect, this approach led to many unnecessary operations, since fewer than 4% of the removed nodules proved to be cancer. Most removed nodules could have simply been observed.

It is not possible for an endocrinologist to determine whether a thyroid nodule is cancerous on the basis of a physical exam, or blood tests.

A thyroid fine needle aspiration (FNA) is a simple procedure that is used to find out if a nodule is cancerous or not. The procedure is performed in the doctor’s office. Most physicians numb the skin over the nodule prior to the biopsy, but it is not necessary to be put to sleep, and patients usually return home, or to work afterward with no ill effects. The test provides specific information about a particular patient’s nodule, information that no other test can offer short of surgery.

Use of FNA has drastically reduced the number of patients who have undergone unnecessary operations for benign nodules. However, about 10% of biopsy specimens are interpreted as inconclusive. This situation is particularly common with cystic nodules, which contain very few thyroid cells to examine, and where initial attempts failed to yield enough material to make a diagnosis. In those cases, an FNA should be repeated. Many physicians use thyroid ultrasonography to guide the needle’s placement.

When a thyroid biopsy sample is reported as benign, there is no specific treatment required other than monitoring the size of the nodule with a thyroid ultrasound yearly.

If cancer is diagnosed, surgical removal of the entire thyroid gland is advised, along with any abnormal lymph nodes, and then proper post-op treatment and care with your endocrinologist.