An Overview of Thyroid Nodules

Thyroid nodules are lumps made up of abnormal clusters of thyroid cells that form in the thyroid gland. The lumps can be solid, fluid-filled, or a mixture of both. Most thyroid nodules are benign, meaning that they are not cancerous. In some cases, however, thyroid nodules can be cancerous.

Thyroid nodules are very common—studies estimate that ultrasonography detects nodules in about 20% to 70% of adults. They are a lot more common in women than men—women are four times more likely to have them.

Symptoms

The majority of thyroid nodules are asymptomatic (don't cause symptoms), so you may not even know you have them. When they become very large, however, you may be able to see or feel them at the base of your neck. In this case, you may experience symptoms.

In rare cases, thyroid nodules can cause symptoms of hyperthyroidism to develop as well. Symptoms of hyperthyroidism include unexplained weight loss, fever, unusually high blood pressure, and heart palpitations.

Causes

Many times, the cause of thyroid nodules can’t be identified; however, there are some medical conditions that can cause them, including iodine deficiency. Iodine is necessary for the production of the thyroid hormone.

In addition, thyroiditis, or the inflammation of your thyroid gland can cause thyroid nodules. Thyroid cancer and thyroid cysts are types of thyroid nodules.

There are some risk factors associated with thyroid nodules:

• Advanced age
• Being exposed to radiation on your neck or head, especially if this happened when you were below the age of 20
• Being female
• Being iodine deficient
• Having Hashimoto’s Thyroiditis

Diagnosis

Thyroid nodules are usually discovered during a totally unrelated test. Sometimes the nodule has grown large enough for it to be seen or felt by hand by a healthcare provider. Other times, it's found during an ultrasound or CT Scan.

If you are diagnosed with a thyroid nodule, your healthcare provider may carry out one of several tests to discover whether the nodule(s) are benign or malignant and to determine the best course of action to take.

Ultrasonography

A thyroid ultrasound involves using sound waves to obtain an image of the nodule. The test is fast and noninvasive.

Your healthcare provider would look out for certain features that may signify whether a nodule is cancerous or not:

• The shape of the nodule
• The nodule's activity
• The nodule composition (solid, cystic or a mixture)
• How many nodules there are

Fine Needle Aspiration

According to studies, this test is 95% accurate in diagnosing whether a nodule is cancerous or not. A fine needle aspiration (FNA) is a type of biopsy. It involves drawing out some cells through a thin needle that's placed into the nodule. 

FNA is usually conducted with the assistance of ultrasound and is not painful in most cases.

The cells are then sent to a pathologist who will examine them with a microscope.

The results of an FNA test can be one of the following:

• The nodule is benign (non-cancerous)
• The nodule is malignant (cancerous)
• It can’t be determined if the nodule is benign or cancerous. When this happens, further tests may be directed by your healthcare provider.
• The biopsy was inadequate. This means that not enough cells were collected for a definite diagnosis to be made. Your healthcare provider may order a second FNA test or recommend that you go ahead with surgery to remove the nodule.

Elastography or ultrasound elastography can be used as well. This test is used to measure the elasticity and stiffness of thyroid nodules, as well as their response to pressure.

Treatment

Treatment for thyroid nodules depends on whether the nodules are causing symptoms, and whether they are benign or malignant.

Benign thyroid nodules

If you have thyroid nodules that are non-cancerous and not causing any symptoms, your healthcare provider will likely advise that you simply monitor them. You may be scheduled to come in for ultrasounds, physical examinations, and tests to check for changes in your thyroid hormone levels at regular intervals.

Thyroidectomy

If the thyroid nodules are causing symptoms such as shortness of breath, hoarseness of voice, and pain, your healthcare provider may recommend that you undergo a thyroidectomy. This is a surgical procedure that involves the removal of part or all of the thyroid gland.

A thyroidectomy may also be recommended if you have a single toxic nodule. This is when just one thyroid nodule grows on the thyroid gland, making it larger than normal and causing it to produce excess thyroid hormones. This may cause hyperthyroidism.

Another instance where thyroidectomy may be recommended is if you have a toxic multinodular goiter—this is a condition similar to a single toxic nodule, only multiple nodules are present instead.

Radioiodine Therapy

Another potential treatment is radioiodine therapy, which involves infusing the thyroid with radioactive iodine. The radioactive iodine destroys the thyroid gland cells, reducing the thyroid gland size and the amount of thyroid hormone it produces.

This therapy can be used to treat a single toxic nodule or toxic multinodular goiter. It uses a small amount of radioactivity and is considered safe. It should not, however, be used to treat pregnant or lactating women. Hypothyroidism is a common consequence of this treatment.

Another new potential treatment is radiofrequency ablation (RFA) of a toxic nodule. This is a minimally invasive treatment option, and it is an alternative to surgery in some patients with thyroid nodules. During this procedure, a small needle electrode is inserted into the thyroid nodule using ultrasound guidance. The heat generated at the needle tip destroys the target tissue.

Cancerous Thyroid Nodule

If the thyroid nodules are cancerous, your healthcare provider will prescribe removal of the thyroid gland. If the nodules are very small and aren't showing signs of spreading much, a lobectomy may be performed. A lobectomy involves removing only the lobe of the thyroid gland where nodules are present.

If you are diagnosed with a cancerous thyroid nodule while pregnant, your healthcare provider may want to postpone the surgery until after you have delivered. However, if the cancer is growing aggressively, you may have to undergo surgery while pregnant.

Coping

If you have to undergo a thyroidectomy to treat your thyroid nodules, there will be some lifestyle changes you will need to make. If your thyroid gland is taken out completely (or most of it is) you will need to take thyroid hormone replacement drug every day for the rest of your life.

After the surgery, you can expect to experience some changes to your voice, but those these are usually temporary. You will also have a small scar at the front of your neck which may fade over time.

If you don't have surgery for your thyroid nodules, you most likely have nothing to worry about. However, you should always make sure to go in for the routine check-ups that your healthcare provider recommends for you. Thyroid nodules rarely disappear on their own, so you can expect to have them permanently. Sometimes, they change in size and may become smaller on their own.

A Word From Verywell

If you discover any lumps or growths on your neck, you should see a healthcare provider for further diagnosis. If you have a cancerous thyroid nodule, keep in mind that most thyroid cancers respond well to treatment. Such a diagnosis, however, can be a lot to take in. Speak to your friends and family about your diagnosis if you feel it would help you to cope better. You can also speak to a licensed professional therapist, who can help you cope with your feelings about your diagnosis and treatment.