An Overview of Thyroid Nodules

Symptoms, Causes, Diagnosis, and Treatment

In This Article

Table of Contents

Thyroid nodules are lumps made up of abnormal clusters of thyroid cells that form in your thyroid gland. The lumps can be solid, a fluid-filled, or a mixture of both. Most thyroid nodules are benign, meaning that they are harmless and generally have no negative effect. In rare cases, however, thyroid nodules can be cancerous.

Thyroid nodules are very common—studies estimate that when ultrasonography is used, they detect nodules present in about 20 percent to 70 percent of adults. They are a lot more common in women than men—women are four times more likely to have them.

Symptoms of thyroid nodules
Illustration by Emily Roberts, Verywell  

Symptoms

The majority of thyroid nodules are asymptomatic, meaning that you may not even know you have them (you have no symptoms). When they do 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 additional symptoms.

Symptoms of Thyroid Nodules

  • Difficulty swallowing (dysphagia)
  • Pain
  • Shortness of breath
  • Hoarseness

In rare cases, thyroid nodules can cause symptoms of hyperthyroidism or hypothyroidism to develop as well.

Symptoms of hyperthyroidism include unexplained weight loss, fever, unusually high blood pressure, and heart palpitations.

Symptoms of hypothyroidism include fatigue, changes in your mood, unexpected weight gain, your hair and skin becoming dry and coarse, and difficulty concentrating.

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.

When you don’t get enough iodine from your diet, your thyroid gland becomes progressively larger and becomes a goiter. Thyroid nodules can then develop in this goiter.

In addition, Thyroiditis, or the inflammation of your thyroid gland can cause thyroid nodules. Thyroid cancer, as well as thyroid cysts, can also be precipitating factors in the development of thyroid nodules.

In addition, there are some risk factors associated with thyroid nodules. Your chances of developing thyroid nodules are higher than that of the average person due to the following factors:

  • advanced age.
  • being exposed to radiation on your neck or head, especially if this happened when you were below the age of 20 or over the age of 70.
  • being female.
  • being iodine deficient.
  • having Hashimoto’s Thyroiditis.

Diagnosis

Thyroid nodules are usually discovered when you’re undergoing a totally unrelated test. Sometimes the nodule has grown large enough for it to be seen or felt by hand by your doctor. Other times, it's found when you're doing an ultrasound or CT Scan.

Once a thyroid nodule has been discovered, your doctor 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.

Serum Thyroid Stimulating Hormone (TSH) Test

This test measures the amount of TSH in the blood. Higher serum TSH levels are associated with an increased risk of thyroid cancer in patients with thyroid nodules. Using TSH levels as an adjunctive diagnostic test for stratifying the risk of thyroid cancer associated with a thyroid nodule may help to define the best therapeutic approaches. 

However, TSH should not be used for diagnostic decision-making in isolation. In addition, it is not recommended to screen for thyroid cancer in patients with chronic TSH elevations. This test takes place in form of a blood test, and your drawn blood will then be taken to a lab for analysis.

Ultrasonography

Ultrasounds for thyroids are particularly useful in finding out more information about the thyroid nodule. It involves using sound waves to obtain an image of the nodule. The test is fast and noninvasive. There are certain features of the nodule your doctor will look out for that may signify whether it is cancerous or not.

Some of them are the shape of the nodule, it’s activity, its composition (solid, cystic or a mixture), and how many nodules there are.

Ultrasounds are usually not used to make a definitive diagnosis of malignancy. So once your doctor suspects that the nodule is cancerous, other tests will be ordered.

Fine Needle Aspiration

According to studies, this test is 95 percent accurate in diagnosing whether a nodule is cancerous or not. The test allows important information and details about the thyroid nodules to be discovered. It’s a form of biopsy which involves a needle being placed into the nodule and some cells being drawn out through the needle. 

The cells are then sent to a pathologist who will examine them under a microscope to determine their malignancy or otherwise. Fine needle aspiration is usually conducted with the assistance of ultrasound and is not painful in most cases. The results of a fine needle aspiration 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 doctor.
  • the fine needle aspiration tests biopsy was inadequate. This means that not enough cells were collected for a definite diagnosis to be made. Your doctor may order a second fine needle aspiration test or prescribe that you go ahead with surgery to remove the nodule.
  • elastography, or ultrasound elastography. This test is used to measure the elasticity and stiffness of thyroid nodules, as well as its response to pressure.

Treatment

Treatment for thyroid nodules depends on whether the nodules are benign or malignant.

Benign thyroid nodules

If the thyroid nodules are non-cancerous and not causing any symptoms, your doctor 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 doctor 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. A single toxic module is when just one thyroid nodule grows on your 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 the 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 side effect of this treatment.

Cancerous Thyroid Nodule

If the thyroid nodules are cancerous, your doctor will prescribe the 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 in which the nodules live.

Cancerous thyroid nodules could also be treated with radioiodine and chemotherapy.

If you are pregnant when the nodule is diagnosed as cancerous, your doctor 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 doctor should schedule for you. Thyroid nodules rarely disappear on their own, so you can expect to have them permanently. Sometimes, they do change in size and may become smaller on their own.

A Word From Verywell

Once you discover anything resembling a thyroid nodule on your neck, you should see a doctor for further diagnosis. In the rare instance that your thyroid nodule is cancerous, 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 if you prefer. Many hospitals provide this sort of support counseling to patients that have been diagnosed with cancer.

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