Treatment Options of Thyroid Nodules | Endocrinology

Thyroid nodules

What are thyroid nodules?

Thyroid nodules are solid or fluid-filled lumps that form inside your thyroid, a small gland located at the base of your neck above your breastbone. Most thyroid nodules are not serious and cause no symptoms. Only a small percentage of thyroid nodules are cancerous.

The thyroid gland, which is made up of the right and left lobes connected to the isthmus (or “bridge”), makes and releases thyroid hormones. Thyroid hormones regulate functions such as body temperature, digestion, and heart function.

Oftentimes, you don’t know you have a thyroid nodule until your doctor finds it during a routine medical exam. Or your doctor may retrieve it during a scan done for another health reason. However, some thyroid nodules may become enlarged or difficult to swallow or inhale. Treatment options depend on the type of thyroid nodule you have.

Are thyroid nodules serious?

Very often the answer is no. You may not normally feel thyroid nodules. Although they are caused by cell growth, most thyroid nodules are not cancerous.

1 in 10 thyroid nodules become cancerous. Benign (non-cancerous) thyroid nodules are common. Most people get them as they age. If the thyroid nodule is not cancerous, it does not require treatment. Doctors can be seen to make sure it is not growing or starting to cause other problems.

Types of thyroid nodules

There are different types of non-cancerous thyroid nodules:

  • Toxic nodules make up a large amount of thyroid hormone. This leads to hyperthyroidism, which speeds up metabolism.
  • Multinodular goiters have many nodules. They can also make too much thyroid hormone and put pressure on other structures.
  • Thyroid cysts are filled with fluid, sometimes with other wastes. They can occur after an injury.

How do I know if I have thyroid nodules?

Most thyroid nodules do not cause any symptoms. However, if you have multiple nodules or large nodules, you will be able to see them. Although rare, the nodules can press against other structures in the neck and cause symptoms:

  • Difficulty swallowing or breathing
  • Blur or change of voice
  • Neck Pain
  • Goiter (enlarged thyroid gland)

Overfunctioning thyroid nodules lead to the overproduction of thyroid hormones, also known as hyperthyroidism. Hyperthyroidism symptoms:

  • Irritability / Fear
  • Muscle weakness/tremors
  • Mild or missed fighting periods
  • Weight Loss
  • Trouble sleeping
  • Enlarged thyroid gland
  • Vision problems or eye irritation.
  • Heat sensitivity (difficulty coping with heat)
  • Increase or decrease appetite
  • Difficulty breathing
  • Itchy skin / clammy skin
  • Hair is thinning
  • Skin flushing (sudden reddening of the face, neck, or upper chest)
  • Heart palpitations (fast or irregular heartbeats)

Thyroid nodules can be associated with low thyroid hormone levels or hypothyroidism. Symptoms of hypothyroidism:

  • Fatigue (feeling tired)
  • Often periods of high effort
  • I forget
  • Weight gain
  • Dry, rough skin and hair and hair loss
  • Rough throat
  • Difficulty dealing with low temperatures.
  • Weakness/irritability
  • Constipation
  • Depression
  • Generalized edema (swelling) 

Symptoms of a thyroid nodule

You may have a thyroid nodule and no noticeable symptoms. If the nodule is large enough, you will develop:

  • An enlarged thyroid gland called a goiter.
  • Pain at the base of your neck
  • Difficulty to swallow
  • Difficulty breathing
  • Big throat

If your thyroid nodule produces excess thyroid hormones, you may develop symptoms of hyperthyroidism,

  • Fast and irregular heartbeat
  • Unexplained weight loss
  • Muscular weakness
  • Trouble sleeping
  • Fear

In some cases, thyroid nodules develop in people with Hashimoto’s thyroiditis. It is an autoimmune thyroid condition that increases the risk of developing an ineffective thyroid (hypothyroidism). Symptoms of hypothyroidism:

  • Persistent fatigue
  • Unexplained weight gain
  • Constipation
  • Cold sensitivity
  • Dry skin and hair
  • Brittle nails

Causes of thyroid nodules

Many conditions can cause nodules to develop in the thyroid gland:

  • Normal thyroid tissue growth: An enlargement of normal thyroid tissue is sometimes called a thyroid adenoma. It is not clear why this occurs, but it is not cancerous and cannot be considered serious unless it causes embarrassing symptoms due to its size.
  • Some thyroid adenomas can cause hyperthyroidism.
  • Thyroid cyst Fluid-filled cavities in the thyroid gland are usually caused by degenerative thyroid adenomas. Solid components often mix with fluid in thyroid cysts. Cysts are generally not cancerous but occasionally contain cancerous solid components.
  • Chronic inflammation of the thyroid: Hashimoto’s disease, a thyroid disorder, causes inflammation of the thyroid and results in the formation of large nodules. It is often associated with hypothyroidism.
  • Multinodular goiter: The term goiter is used to describe any enlargement of the thyroid gland, which can be caused by iodine deficiency or by a thyroid disorder. Multinodular goiter consists of multiple different nodules within the goiter, but their cause is less clear.
  • Thyroid cancer: The chances of developing nodule cancer are small. However, a nodule that is large and stiff or that causes pain or discomfort may be of greater concern. You may want to check this with your doctor.
  • Some factors, such as a family history of thyroid or other endocrine cancers and a history of radiation exposure from medical treatment or radioactive fallout, can increase the risk of thyroid cancer.
  • Iodine deficiency: Lack of iodine in your diet can sometimes lead to the development of thyroid nodules in the thyroid gland. Iodine deficiency is rare in the United States, where iodine is generally added to table salt and other foods.

Diagnosis of thyroid nodules

You can see one by looking at yourself in the mirror. Your chin is a slightly inflated mirror face. Swallow and look at both sides of the windpipe near Adam’s apple. Gently place your fingers on the neck there and look for a lump. If you find one, ask your doctor. 90% of thyroid nodules are benign (not cancerous).

If you notice one, check with your doctor. For your thyroid problems, you may want to see a specialist called an endocrinologist. Endocrinologists specialize in health problems related to the hormone-producing glands, including the thyroid. They will do a physical exam and order one of the following tests to find out if it is cancer:

  • Blood tests for thyroid hormones
  • Ultrasound
  • Fine needle biopsy
  • Thyroid scan

With a biopsy, your doctor inserts a fine needle into your thyroid nodule to collect some cells. They are sent to the laboratory for further study. Cancer-free thyroid nodules are so large that they can still be a problem if you find it difficult to breathe or swallow.

When evaluating a lump or nodule in the neck, one of your doctor’s main goals is to rule out the possibility of cancer. Your doctor will also want to know if your thyroid is working properly. The tests include:

Physical exam: Your doctor will ask you to swallow when examining your thyroid because the nodule in your thyroid gland generally moves up and down when you swallow.

Your doctor will also look for signs and symptoms of hyperthyroidism, such as tremors, hyperactive reactions, and fast or irregular heartbeats. He will also look for signs and symptoms of hypothyroidism, such as slow heart rate, dry skin, and facial swelling.

Thyroid function tests: Tests that measure your blood levels of thyroid-stimulating hormone (TSH) and hormones made by the thyroid gland can indicate whether you have hyperthyroidism or hypothyroidism.

Ultrasound: This imaging technique uses high-frequency sound waves to create images of your thyroid gland. Thyroid ultrasound provides the best information about the shape and structure of the nodules. Doctors can use it to separate cysts from solid nodules or to find out if there are multiple nodules. Doctors can also use it as a guide to performing a fine needle aspiration biopsy.

Fine needle aspiration biopsy: The nodules are usually biopsied to confirm that there is no cancer. During the procedure, your doctor will insert a very thin needle into the nodule and remove the sample of cells.

This procedure is usually performed in your doctor’s office, takes about 20 minutes, and involves a few accidents. Often your doctor will use an ultrasound to guide you in placing the needle. Your doctor will send these samples to the laboratory for analysis under a microscope.

Thyroid scan: Your doctor may recommend a thyroid scan to help diagnose thyroid nodules. During this test, a radioactive iodine isotope is injected into a vein in your hand. You lie on the table while the special camera produces an image of your thyroid on the computer screen.

Nodules that produce high levels of thyroid hormone, called hot nodules, show up on the scan because they absorb more isotopes than normal thyroid tissue. Hot nodules are almost always cancer-free.

In some cases, nodules that take up less of the isotope, called cold nodules, are cancerous. However, a thyroid scan does not distinguish between cancer and cold nodules.

Treatment of thyroid nodules

Treatment depends on the type of thyroid nodule you have. Treatment of benign nodules

If the thyroid nodule is not cancer, treatment options include:

  • Waiting carefully: If a biopsy shows that you have a cancer-free thyroid nodule, your doctor may suggest that you look at your condition.
  • This means getting regular physical exams and thyroid function tests: It can also include an ultrasound. If the nodule is large, you may have another biopsy. If the benign thyroid nodule does not change, it will never need treatment.
  • Thyroid hormone therapy: If your thyroid function test finds that your gland is not producing enough thyroid hormone, your doctor may recommend thyroid hormone therapy.
  • Surgery: If the cancer-free nodule needs surgery, it may be difficult for you to breathe or swallow. Doctors may consider surgery for those with large multinodular goiters, especially when the goiters block the airways, esophagus, or blood vessels. Nodules that are identified indefinitely or suspiciously by biopsy may also require surgical removal so that they can be examined for signs of cancer.

Treatment of nodules that cause hyperthyroidism.

If a thyroid nodule produces thyroid hormones and your thyroid gland overloads normal levels of hormone production, your doctor may recommend that you treat your hyperthyroidism. These may include:

  • Radioactive iodine: Doctors use radioactive iodine to treat hyperthyroidism. When taken in capsules or liquid form, radioactive iodine is absorbed by the thyroid gland. It causes the nodules to shrink and the signs and symptoms of hyperthyroidism disappear, usually within two to three months.
  • Antithyroid drugs: In some cases, your doctor may prescribe antithyroid medications such as methimazole (Tapazol) to reduce the symptoms of hyperthyroidism. Treatment is often chronic and can cause serious side effects on the liver, so it is important to discuss the risks and benefits of treatment with your doctor.
  • Surgery: If treatment with radioactive iodine or antithyroid drugs is not an option, you may be a candidate for surgery to remove the overactive thyroid nodule. You will discuss the surgical risks with your doctor.

Treatment of cancerous nodules

Treatment with nodules for cancer usually involves surgery.

  • Observation: The risk of developing very small cancers is low, so it is advisable to consult your doctor closely before treating cancerous nodules. This decision is often made with the help of a thyroid specialist. The exam includes ultrasound monitoring and blood tests.
  • Surgery: A common treatment for cancerous nodules is surgical removal. Previously, removal of most of the thyroid tissue was standard; This procedure is called a total thyroidectomy. Currently, however, more limited surgery to remove only half of the thyroid is appropriate for some cancerous nodules. Total thyroidectomy can be used depending on the extent of the disease.

Thyroid Surgery Risks Damage to the nerves that control the vocal cords and damage to the parathyroid glands: The four small glands at the back of the thyroid can help regulate body-level minerals like calcium.

After thyroid surgery, you need lifelong treatment with levothyroxine to supply your body with thyroid hormone. Your thyroid specialist can help you determine the correct amount to take because it may require more than hormone replacement to control your cancer risk.

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