Thyroid Nodule Symptom # : A Sense That You Need To Swallow Something
- What to do about it?
Like all thyroid nodules that cause symptoms, these patients need a thyroid ultrasound to look at the size, location, and characteristics of the thyroid, how many noduls are present, and where they are located. Often thyroid glands that are big won’t have any ultrasound characteristics that are worrisome for cancer, so most of theses do not need a FNA thyroid needle biopsy. Thus big thyroids comprised of lots of nodules often don’t need a biopsy, which is in direct contrast to nodules that are single, or those that can be seen or felt . However, if a thyroid is big enough that it is causing the patient to be aware of it, and it is causing symptoms of something stuck in the throat, then surgery is probably necessary. Remember, thyroid surgery isn’t just for nodules that we think may be thyroid cancer, surgery is often necessary for benign, non-cancerous thyroid glands which are large and causing the patient symptoms. This situation is quite common. It is also important to know that large thyroid goiters, and nodules that are on the back side of the thyroid are often required to have a CAT scan, since these bigger thyroid glands are not seen as well with ultrasound. This is why you need a good endocrinologist who know which scan to order and which scans are not necessary. Remember, a large thyroid is called a goiter and we have an entire page on thyroid goiters.
Thyroid Nodules: Potential Causes
Several conditions may cause or predispose to the development of thyroid nodules including:
Diets deficient in iodine can predispose individuals for the development of thyroid nodules. Portions of the world continue to lack iodine in their diets however in the United States, the presence of iodine in our daily diets makes this an unlikely cause for thyroid nodules.
Overgrowth of normal thyroid tissue
The reason why these thyroid nodules occur is not well understood. These thyroid nodules are commonly called follicular adenomas or thyroid adenomas. . Follicular adenomas are clearly not cancerous and are not worrisome and do not require removal except if they are symptomatic due to their size. The rare follicular adenoma or thyroid adenoma will overproduce thyroid hormone and be the cause of hyperthyroidism. For some reason these excessive thyroid hormone producing adenomas lose their ability to be regulated by the pituitary glands production of Thyroid Stimulating Hormone .
Thyroid cysts are fluid filled cavities caused by degenerating thyroid adenomas, congenital cysts, or overproduction of a fluid produced by the thyroid called colloid.
Inflammatory diseases of the thyroid Multinodular disease of the thyroid Thyroid Cancer
Although the likelihood that a thyroid nodule is a cancer is quite low, the following are associated with an increased malignant risk:
How Does Thyroid Disease Affect Pregnancy
Pregnancy-related hormones raise the level of thyroid hormones in the blood. Thyroid hormones are necessary for the baby’s brain development while in the womb.
It can be harder to diagnose thyroid problems during pregnancy because of the change in hormone levels that normally happen during pregnancy. But it is especially important to check for problems before getting pregnant and during pregnancy. Uncontrolled hyperthyroidism and hypothyroidism can cause problems for both mother and baby.
Hyperthyroidism that is not treated with medicine during pregnancy can cause:
- Premature birth
- a serious condition starting after 20 weeks of pregnancy. Preeclampsia causes high blood pressure and problems with the kidneys and other organs. The only cure for preeclampsia is childbirth.
- Thyroid storm
- Fast heart rate in the newborn, which can lead to heart failure, poor weight gain, or an enlarged thyroid that can make it hard to breathe
- Low birth weight
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How Are They Diagnosed
If your doctor thinks you have a nodule, he or she will do a physical exam and will ask you if you have symptoms or about any changes in how you’ve been feeling.
You may have tests to see how well your thyroid is working. Possible tests include:
- A blood test to check the level of thyroid hormone in your body.
- A thyroid scan to get information about your thyroid gland and nodules. Another test called an uptake scan can be done at the same time to see how well your thyroid gland is working.
- A thyroid ultrasound to see the number and size of nodules.
You may have a fine-needle aspiration to remove a small amount of material from the nodule to check for cancer.
If your nodule is not cancerous, your doctor will see you regularly to monitor the size of your nodule.
Are Thyroid Nodules Serious
Most often the answer is no. You usually canât feel thyroid nodules. Even though they happen from an overgrowth of cells, most thyroid nodules arenât cancer.
About 1 in 10 thyroid nodules turn out to be cancer. Benign thyroid nodules are common. Lots of people get them as they get older. If a thyroid nodule isnât cancerous, it may not need any treatment. Doctors might just watch to make sure it doesnât keep growing or begin to cause other problems.
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I Have Thyroid Nodules Should I Be Worried
A thyroid nodule is a growth within the thyroid a butterfly shaped gland located just below the Adams apple in the neck. The thyroid sends out hormones that help control the bodys metabolism. Thyroid nodules are very common and occur in 30% of all people in the United States. Like most thyroid conditions, nodules are more common among women than men. They are also more common with older age. By the age of 60, more than half of women will have a thyroid nodule. Sometimes nodules go undetected, other times you or a health care provider may feel them in the neck, or they may be seen on ultrasound or CT scan that you have for another reason.
If you learn that you have a thyroid nodule the first thing to do is see your primary care provider to obtain more information. Does your thyroid function normally or is it overactive a condition called hyperthyroidism? Symptoms of hyperthyroidism include nervousness, feeling hot, weight loss or tremor. Does the thyroid not produce enough hormone? This condition, called hypothyroidism, has the opposite symptoms including fatigue, sleepiness, weight gain, and thinning hair. Your doctor can determine if you have either of these with a simple blood test called thyroid stimulating hormone, or TSH. Your doctor will also obtain an ultrasound of your neck to see more detail of your thyroid if you have not had this already.
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What Does A Thyroid Fine Needle Aspiration Or Biopsy Entail
In some situations this is performed with local anesthesia in the clinic. Your child will be awake. In very young children the FNA is done in the operating room under general anesthesia. The pathologist will look at the tissue to determine what they thyroid nodule is composed of and if additional workup or surgery is needed. It often takes about one to two weeks to get the results.
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From Causes And Symptoms To Diagnosis And Treatment The Information You Need About These Common Growths
Thyroid nodules are abnormal overgrowths of tissue in the thyroid gland that are most often benign, though in some cases they can be cancerous. Some people have one nodule, while others have many. Thyroid nodules may be solid tissue or filled with blood or other fluid.
Thyroid nodules are quite common, with as many as half of all people having at least one nodule by the age of 60. Theyre particularly prevalent in women, though men can get them too, especially as they age.
Who Gets Thyroid Nodules
The people who get thyroid nodules parallel percent and decade by age quite conveniently. What we see with women is that their age and their decade corresponds quite clearly with their risk for developing nodules.
Key Insight: If you are 30, there is about a 30% risk of you developing thyroid nodules. If you are 50, there is a 50% chance of you developing thyroid nodules. The same applies for being 60 and 70 . Pretty simple to remember, but absolutely crucial to not forget.
Overall, developing thyroid nodules is three times more common to occur in women over men1.
This means that for women especially, getting to know more about the status of your thyroid is important.
For men, we need to be aware of the chances of developing thyroid problems and how it changes between genders.
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What To Think About
Hypothyroidism occurs in some people after being treated with radioactive iodine for thyroid nodules. For this reason, your doctor will check your thyroid hormone levels regularly after you have this treatment.
If a thyroid nodule is not cancerous but is making too much thyroid hormone, causing hyperthyroidism, antithyroid medicines may be used before radioactive iodine treatment. For more information on treating hyperthyroidism, see the topic Hyperthyroidism.
How Is A Thyroid Nodule Evaluated And Diagnosed
Once the nodule is discovered, your doctor will try to determine whether the rest of your thyroid is healthy or whether the entire thyroid gland has been affected by a more general condition such as hyperthyroidism or hypothyroidism. Your physician will feel the thyroid to see whether the entire gland is enlarged and whether a single or multiple nodules are present. The initial laboratory tests may include measurement of thyroid hormone and thyroid-stimulating hormone in your blood to determine whether your thyroid is functioning normally.
Since its usually not possible to determine whether a thyroid nodule is cancerous by physical examination and blood tests alone, the evaluation of the thyroid nodules often includes specialized tests such as thyroid ultrasonography and fine needle biopsy.
The report of a thyroid fine needle biopsy will usually indicate one of the following findings:
- This result is obtained in up to 80% of biopsies. The risk of overlooking a cancer when the biopsy is benign is generally less than 3 in 100 tests or 3%. This is even lower when the biopsy is reviewed by an experienced pathologist at a major medical center. Generally, benign thyroid nodules do not need to be removed unless they are causing symptoms like choking or difficulty swallowing. Follow up ultrasound exams are important. Occasionally, another biopsy may be required in the future, especially if the nodule grows over time.
NUCLEAR THYROID SCANS:
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Thyroid Nodule: Evaluation And Tests
The following are a list of tests that are required in the evaluation of a patient with a thyroid nodule.
- Complete Medical History and Physical Examination
- T3 and T4
- Thyroglobulin Antibody
Medical history and physical examination is required for all patients with a thyroid nodule
If there is a suspicion that you may have a thyroid nodule, your health care professional will want to know your complete medical history. You will be asked questions about your possible risk factors, symptoms, and any other health problems or concerns. If someone in your family has had a diagnosis of thyroid cancer or other endocrine cancer, these are important factors.
Your doctor will examine you to get more information about possible signs of thyroid cancer and other health problems. During the exam, the doctor will pay special attention to the size and firmness of your thyroid and any enlarged lymph nodes in your neck. Examination of your voice box is part of the physical examination obtained by the surgeon for any thyroid lump. A small lighted microscope is used to look at the voice box to determine how the vocal cords of the voice box are functioning. Even though a patient does not report change in their voice does not insure that the vocal cords are working normally. A vocal cord that is paralyzed greatly increases the concern that a thyroid nodule may be a cancer.
What Is The Thyroid
The thyroid is a small gland below the skin and muscles at the front of the neck, at the spot where a bow tie would rest.
It’s brownish red, with left and right halves that look like a butterfly’s wings. It weighs less than an ounce, but helps the body do many important things, such as grow, regulate energy, and go through sexual development.
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Who Is At Risk For Thyroid Cancer
About three times as many women get thyroid cancer as men. The number of women with thyroid cancer is also going up. By 2020, the number of women with thyroid cancer is expected to double, from 34,000 women to more than 70,000 women.
Thyroid cancer is more common in women who:
- Are between the ages of 25 and 65
- Had radiation therapy to the head or neck, especially in childhood, to treat cancer
- Have a history of
- Have a family history of thyroid cancer
Are Thyroid Nodules Common
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Workup And Surgical Recommendations
We have proposed the algorithm in for the thyroid surgeonâs workup of a thyroid nodule. It is based upon the 2006 ATA guidelines for the workup of a thyroid nodule with incorporation of mutational analysis . One indication for surgery is whether the nodule is symptomatic due to compression of nearby structures. These patients are typically evaluated with CT or MRI and loop spirometry, and a lobectomy is typically performed to remove the compressive lesion. In rare instances, a total thyroidectomy is indicated if both lobes of the thyroid are problematic. Any asymptomatic thyroid nodule should be evaluated with a diagnostic ultrasound and a TSH level. Often times, these tests have been completed prior to a patientâs arrival in the surgeonâs office. Nodules smaller than 1 cm in diameter should be followed with a yearly ultrasound, with FNAB indicated for any concerning changes in appearance or growth. A biopsy of subcentimeter nodules may be indicated if there is a significant history of radiation exposure, a strong family history of thyroid carcinoma, or worrisome sonographic features.
Workup of a thyroid nodule
What Are The Risk Factors For Thyroid Nodules
Risk factors for developing thyroid nodules include:
- Family history. Having parents or siblings who have had thyroid nodules or thyroid or other endocrine cancers increases your chance of developing nodules.
- Age: The chance of developing nodules increases as you get older.
- Gender: Women are more likely than men to develop thyroid nodules.
- Radiation exposure: A history of radiation exposure to the head and neck increases your risk of developing nodules.
Risk factors for developing cancerous thyroid nodules include:
- Family history of thyroid cancer
- A nodule that is hard or is stuck to a nearby structure
- Male gender
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What Can I Do To Help
Taking iodine supplements can be dangerous for some patients with thyroid nodules.
Before starting any dietary supplementation, discuss this with your doctor. Your doctor will advise whether you need supplements or which supplements will be best for you. An iodine enriched diet is the most effective way of reaching a daily iodine intake, so please speak to your doctor.
The chance of having a thyroid nodule is increased with cigarette smoking and being overweight.5 The best way to maintain good health is to engage in healthy lifestyle behaviours. This includes having a good diet, avoiding excess weight gain and not smoking. It is also important to take any prescribed medications as advised by your doctor.
For help with giving up smoking, go to Quitline.
For practical advice and tips with losing weight, go to
For current information about a healthy diet, see the Australian dietary guidelines.
Computed Tomography And Magnetic Resonance Imaging
Both of these imaging modalities have almost no role in the initial evaluation of a thyroid nodule, and are rarely indicated in the initial workup. However, they are both excellent for evaluating the extent of large substernal goiters which may be compressing nearby structures . Of note, iodinated contrast material utilized for CT scan should be avoided because its use prevents scintigraphy or administration of radioactive iodine therapy for a period of 1 to 2 months. Gadolinium contrast used with MRI does not interfere with thyroid uptake of radiotracer, but it is significantly more expensive than CT or ultrasound.
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What Is Postpartum Thyroiditis
Postpartum thyroiditis, or inflammation of the thyroid after giving birth, affects 10% of women. It often goes undiagnosed because symptoms are much like the “baby blues” that may follow delivery. Women with postpartum thyroiditis may feel very tired and moody.
Postpartum thyroiditis typically happens in two phases, though not everyone with the condition goes through both phases:
- The first phase starts 1 to 4 months after giving birth and typically last 1 to 2 months. In this phase, you may have because the damaged thyroid leaks thyroid hormones out into the bloodstream.
- The second phase starts about 4 to 8 months after delivery and lasts 6 to 12 months. In this phase, you may have because the thyroid has lost most of its hormones or because the immune attack is over and the thyroid may recover later.