If your doctor suspects you may have a thyroid nodule, it is normal to feel a little worried. Thankfully, most thyroid nodules are not cancerous. But any abnormal growths in the thyroid gland should be examined by a specialist, according to surgeon Ellie Maghami, M.D., the Norman and Sadie Lee Foundation Endowed Professor in Head and Neck Cancer at City of Hope® Cancer Center Duarte.
“Thyroid nodules are very common, more so in women than men,” says Dr. Maghami. “But the majority of nodules, especially in women, end up being benign.”
This article covers the basics on thyroid nodules, including:
- What is a thyroid nodule?
- Are thyroid nodules usually cancerous?
- When should you worry about thyroid nodules?
- Thyroid nodule treatment
If you’ve been diagnosed with a thyroid cancer or a thyroid nodule and are interested in a second opinion on your diagnosis or treatment plan, call us or chat online with a member of our team.
What is a thyroid nodule?
Thyroid nodules are unusual growths of tissue that develop in the thyroid gland. Located in the neck, below the Adam’s apple and in front of the voice box, the thyroid gland releases hormones that help regulate all the metabolic functions of the body.
In many cases, thyroid nodules are first detected during a medical scan for an unrelated health condition. If a medical provider sees an unusual lesion in your thyroid, they may refer you to an endocrinologist, who is a doctor specializing in hormone-related issues.
How are thyroid nodules evaluated?
“Once you suspect a thyroid nodule, the standard of care is a diagnostic ultrasound of the thyroid,” says Dr. Maghami. “Ultrasound by far is the best imaging modality. It is widely available, fast and cost-effective, with no radiation exposure and it shows detailed characteristics of the nodule.”
Ultrasound may help determine:
- How big the nodule is
- Where it is located
- Whether the nodule is solid or not
- If it has spread beyond the thyroid gland
Your doctor may also ask questions about any symptoms you have experienced, such as:
- Pressure in the neck or throat
- Difficulty swallowing
- Change of voice
- Swelling in the thyroid area
- Coughing or irritation in the throat
In some cases, a nodule may cause the thyroid gland to produce too much hormone, explains Dr. Maghami.
“This can cause a hypermetabolic response in the body, which can lead to irritability, sleeplessness, arrhythmia, sweating, weight loss and other symptoms.”
After an ultrasound, the nodule is deemed low, medium or high risk for cancer. If it is medium or high risk, your doctor may then recommend a fine-needle biopsy, which is a minimally invasive procedure that takes a small sample of tissue for analysis in a lab. This analysis can help determine whether it is likely that a nodule is cancerous.
Are thyroid nodules usually cancerous?
Less than 5 percent of all thyroid nodules are cancerous. However, around one in two people will develop a thyroid nodule by age 60. Doctors do not fully understand what causes thyroid nodules, but there are some other health issues that may make it more likely that a nodule is cancerous, such as:
- A family history of thyroid cancer
- Previous history of radiation exposure
- Thyroid disorders like Hashimoto’s disease and Graves’ disease
- Inherited disorders that affect the endocrine system
Even if you do receive a thyroid cancer diagnosis, the treatments are highly effective and the survival and cure rates are excellent.
When should you worry about thyroid nodules?
The results of a thyroid nodule biopsy rate the likelihood of cancer on a scale from 1 (non-diagnostic) and 2 (benign) up to 6 (which indicates a 99 percent chance of cancer).
If the nodule is rated 5 or 6, most patients would meet with a surgical oncologist to discuss removing the nodule. A score of 3 or 4 usually involves a discussion with your health care team about the best way to proceed, which may include surgery or alternative options, depending on factors including:
- Your treatment preferences
- Your overall health
- Family medical history
- Whether you are experiencing symptoms
- What the ultrasound revealed about the nodule’s size and location
“If it’s a small lesion in a favorable location within the thyroid gland, it may simply be observed closely with follow-up ultrasound imaging to monitor for any change in size or behavior over time,” Dr. Maghami says, adding that there are many factors to consider when deciding on a course of action.
“A patient may be elderly with other significant health problems, be at higher risk of complications from anesthesia or have other competing diagnoses warranting a more conservative approach.”
Thyroid nodule treatment
While surgery followed by radioactive iodine therapy used to be a standard treatment recommendation for many thyroid cancer patients, this is no longer the case.
Most thyroid cancers are diagnosed coincidentally at an early stage, are asymptomatic, slow-growing and have an indolent course. Decisions regarding treatment are nuanced, Dr. Maghami explains, with multiple considerations relating to both the patient and the tumor itself.
“In some patients, a more conservative approach to management can be safely carried out without risking a bad outcome," She explains. “Treatment decisions are risk-based. Over-treatment of patients with low-risk disease may lead to unwanted side effects which may negatively impact quality of life.”
Treatment for benign, or non-cancerous, thyroid nodules often includes simple monitoring every year using ultrasound. If a nodule is large or symptomatic, options include surgery to remove it or ablation techniques using radiofrequency or alcohol, which can shrink the nodule.
In the case of cancerous thyroid nodules, your cancer care team will discuss a variety of options with you. These include:
- Surgery to remove half of the thyroid (lobectomy)
- Surgery to remove all of the thyroid (total thyroidectomy)
- Dissection to remove the neck nodes, if cancer has spread outside of the thyroid gland to neck lymph nodes
- Radioactive iodine therapy, which may be helpful in higher-risk situations
- Medications to manage thyroid health after treatment
Patient outcomes often depend on the level of experience a surgeon has.
“In the hands of high-volume surgeons, it can be a simple experience with low risk of complications such as injury to the vocal nerves or parathyroid glands.”.
If you’ve been diagnosed with a thyroid cancer or a thyroid nodule and are interested in a second opinion on your diagnosis or treatment plan, call us or chat online with a member of our team.