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Is A 1.3 Cm Thyroid Nodule Large

Signs Of Thyroid Cancer

Thyroid Nodules: Biopsy Results & Treatment Recommendations

Most thyroid nodules are asymptomatic, non-palpable and only detected on ultrasound or other anatomic imaging studies. The following characteristics increase the suspicion of cancer:

  • Swelling in the neck
  • Trouble breathing
  • A constant cough that is not due to a cold

An FNAB helps determine if a nodule is malignant or benign. But about 30 percent of the time, the results are inconclusive or indeterminate unable to determine if cancer is present. In this case, the recommended follow-up is a repeat FNAB, a core needle biopsy or a lobectomy/thyroidectomy surgery to remove part or all of the thyroid gland. Once removed, the thyroid nodule is thoroughly evaluated by a pathologist to diagnose or dismiss thyroid cancer.

In large thyroid nodules, 4 cm or bigger, the FNAB results are highly inaccurate, misclassifying half of all patients with reportedly benign lesions. Additionally, Inconclusive FNAB results display a high-risk of differentiated thyroid carcinoma. Diagnostic lobectomy is strongly considered in patients with a significant thyroid nodule regardless of FNAB results.

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But What If Its Thyroid Cancer

A cancer diagnosis is always worrisome, but even if a nodule turns out to be thyroid cancer, you still have plenty of reasons to be hopeful.

Thyroid cancer is one of the most treatable kinds of cancer. Surgery to remove the gland typically addresses the problem, and recurrences or spread of the cancer cells are both uncommon. People who undergo thyroid gland surgery may need to take thyroid hormone afterward to keep their body chemistry in balance.

Whether its benign or not, a bothersome thyroid nodule can often be successfully managed. Choosing an experienced specialist can mean more options to help personalize your treatment and achieve better results.

Patient And Nodule Characteristics

Chart review identified a total of 85 patients with 101 thyroid nodules meeting the inclusion criteria. Seventy-two patients were female. The mean age was 55 . Patient ages ranged from 23 to 76, with a median age of 55. Fifty-four patients underwent total thyroidectomy, 27 underwent hemithyroidectomy, and four underwent completion thyroidectomy. Fifteen patients had thyroid cancer on final pathology .

Forty-nine nodules were located in the left lobe, 51 in the right lobe, and one in the isthmus. The mean nodule size was 53.6 mm . The median nodule size was 52 mm . Information on nodule consistency was available for 94 nodules. Of these, 40 nodules were solid, 53 were complex, and one was cystic. FNAB was performed on 90 patients . The distribution of the FNAC was 7.8% nondiagnostic , 68.9% benign , 10% AUS/FLUS , 10% suspicious for follicular neoplasm/follicular neoplasm , 2.2% suspicious for malignant disease , and 1.1% malignant .

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Thyroid Nodule: When Is A Radioiodine Scan Ordered

Only in instances where the blood test to examine the thyroid nodule patient demonstrates that hyperthyroidism is present in addition to the presence of the thyroid nodule, is a radioiodine scan indicated. In these cases, the thyroid stimulating hormone will be very low. The thyroid nodule patient may or may not have recognized symptoms of hyperthyroidism. If the TSH level is normal, there is absolutely no contemporary indication for a thyroid scan.

During the thyroid scan, the patient will be given a small amount of radioactive iodine in their vein and a special imaging camera is utilized to determine how much iodine is taken up by the thyroid gland and if the nodule takes up iodine relative to the remainder of the thyroid gland . If the nodule has less iodine uptake than the rest of the thyroid gland, then the thyroid nodule is called a âcold noduleâ.

Hot nodules are almost always non-cancerous but the preferred management of hot nodules is frequently surgery since it is a clear, safe and 100% effective therapy for the hyperthyroidism. Cold nodules have a higher incidence of malignancy than hot nodules but still most are benign.

ThyroidCancer.com is an educational service of the Clayman Thyroid Center, the world’s leading thyroid cancer surgery center.

Histopathological Results Of Nodules Classified According To The Maximal Diameter

Fig 3.

There were 540 nodules < 1 cm, 2,413 nodules 1-1.9 cm, 1,600 nodules 2-3.9 cm and 1008 nodules 4 cm . Malignancy rates were 25.6%, 10.6%, 9.7% and 8.5% in nodules < 1 cm, 1-1.9 cm, 2-3.9 cm and 4 cm, respectively. When the nodule group of 1-3.9 cm was evaluated separately, the malignancy rate was 10.2%. The malignancy rates were 12.0% and 8.5% for the nodules < 4 cm and 4 cm, respectively .

Table 1

In the group of nodules < 1 cm, the mean diameter was 0.86 ± 0.11 cm in histopathologically benign and 0.81 ± 0.12 cm in malignant groups . In this group, volumes of benign and malignant nodules were similar . In the group of nodules 1-1.9 cm, the mean diameter was 1.4 ± 0.28 cm in histopathologically benign and 1.33 ± 0.27 cm in malignant groups . In this group, volumes of benign and malignant nodules were similar. In the group of 2-3.9 cm, mean diameters and volumes were similar for benign and malignant nodules . For the nodules 4 cm, the mean diameter was 5.29 ± 1.48 cm in benign and 5.46 ± 1.41 cm in malignant nodules , and the mean volume of benign nodules was significantly lower than that of malignant nodules .

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Large Thyroid Nodule: Firm To Hard

  • Solitary or single large thyroid nodule .
  • Predominant symptoms are hoarseness of voice or difficulties in swallowing.
  • In few cases enlarged thyroid gland is active and secretes thyroid hormone resulting in symptoms of hyperthyroidism.
  • Single firm to hard tender large thyroid nodule is felt during palpation.
  • The blood level of thyroid hormone is normal or increased.
  • Large firm to hard swelling often causes compression of trachea or esophagus.
  • Radiological study indicates presence of cyst, calcification and fibrotic tissue within the nodule.
  • A Crash Course In Thyroid Nodule Evaluation To Ease Your Mind

    The two most common methods that your doctor uses to evaluate thyroid nodules are ultrasound imaging and fine needle aspiration biopsy. When a biopsy is done, a sample of tissue from the nodule is obtained and sent to the lab for analysis.

    The thyroid cells are then classified according to the Bethesda System,4 which assesses thyroid findings based on six categoriesfrom nondiagnostic or unsatisfactory to benign, abnormal but of undetermined significance, suspicious for neoplasm , suspicious for malignancy, and malignant. The categories reflect estimated cancer risk from 0% in the first category to 100% for confirmed cancer for the sixth group.

    Categories III and IV, reflecting nodules that are abnormal but of unknown concern and those that are suspicious for abnormal growth, ”are the ones that drive the patient and the doctor nuts,” as has been unclear about what to do, Dr. Cipriani says, since we dont want to treat too aggressively without sufficient benefit.

    To date, studies have shown mixed results, she says, with some evidence suggesting that larger nodules may be more likely to become cancerous while other data finding that size is not linked with malignancies. So Dr. Cipriani and her team set out to find a more certain answer to give patients and their doctors a clearer idea of when and if it is necessary to treat bigger thyroid nodules more aggressively than small nodules.2

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    Thyroid Nodules: When To Worry

    Suppose you go to your doctor for a check-up, and, as shes feeling your neck, she notices a bump. Then, suppose she tells you theres a nodule on your thyroid. Is it time to panic?

    No, say experts at Johns Hopkins Department of Otolaryngology and Head and Neck Surgery. Thyroid nodules even the occasional cancerous ones are treatable.

    Heres what you need to know about thyroid nodules and how concerned you should be if you develop one.

    How Are Thyroid Nodules Treated

    Thyroid Nodules – When to Worry? (Signs your nodule could be something more)

    Most patients who appear to have benign nodules require no specific treatment. Some physicians prescribe the hormone levothyroxine with hopes of preventing nodule growth or reducing the size of cold nodules. Radioiodine may be used to treat hot nodules.

    • Being male under age 40

    Tips to help you get the most from a visit to your healthcare provider:

    • Know the reason for your visit and what you want to happen.
    • Before your visit, write down questions you want answered.
    • Bring someone with you to help you ask questions and remember what your provider tells you.
    • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
    • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
    • Ask if your condition can be treated in other ways.
    • Know why a test or procedure is recommended and what the results could mean.
    • Know what to expect if you do not take the medicine or have the test or procedure.
    • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
    • Know how you can contact your provider if you have questions.

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    Youve Been Diagnosed With A Large Thyroid Noduleshould You Be Concerned

    The findings from this meta-analysis should prompt you to have a frank discussion with your physician, Dr. Cipriani tells EndocrineWeb.

    Many other factors come into play in deciding whether to choose to have surgery to remove a nodule, she says. Certainly If after hearing all the pros and cons of having surgery, and still feeling too unsettled with the idea of active surveillance , then this discomfort must be addressed in the discussion about treatment options and options for next steps, for instance.

    On the other hand, for patients who are older and at greater risk of complications from surgery for a thyroid nodule that poses no issues and isnt bothering them, that too should be considered, she says.

    What was not known from the studies that Dr. Cipriani’s team evaluated is the interval between the biopsy and the surgery? When surgery is done, she says, the usual procedure is to remove at least one of the two thyroid lobes. To surgically remove just a nodule is more complicated, she says, but this means that the patient may not need thyroid replacement hormone, which, if necessary, must be taken for the remainder of the patients life.

    Less Need for Surgury Is Good News for Patients Long-Term

    I do not recommend thyroidectomy based on thyroid nodules size only, she says. Patients have to be symptomatic or the biopsy should show evidence of thyroid cancer in order for me to recommend surgery.

    Thyroid Nodules And Thyroid Cancer

    The biggest concern on most people’s mind is probably whether or not their thyroid nodule is actually cancer in disguise.

    As I mentioned previously, most thyroid nodules are benign.

    But that leaves another 5-10% which can be cancerous and should be evaluated.

    There are some factors which have been evaluated which can help you understand your risk of thyroid cancer.

    The risk of thyroid cancers increases with these risk factors:

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    How Big Is Too Big

    When it comes to thyroid nodules, the size matters quite a bit.

    Studies have shown time and time again that larger thyroid nodules tend to turn into thyroid cancer at a higher rate compared to smaller thyroid nodules.

    The magic number in terms of size is 1 cm or 10mm.

    But size isn’t the only thing that matters.

    For instance:

    It has been shown that even small thyroid nodules can be cancerous if they have certain and specific findings on thyroid ultrasound.

    The number of nodules and their size are not predictive of malignancy, as a nodule smaller than 1 cm is as likely as a larger nodule to harbor neoplastic cells in the presence of suspicious US features.

    Thyroid Nodules by Popoveniuc and Jonklaas

    For this reason, you never want to judge the risk of thyroid cancer based on the size of your nodule alone.

    You will notice that while the size is certainly a risk factor, you should also look at other risk factors including whether or not the nodule is causing symptoms, your age, and what the nodule looks like on ultrasound.

    As a patient, though, you can use the size of your nodule as a quick and dirty way to assess whether or not you should be worried.

    Thyroid Cancer Presenting As Autonomous Thyroid Nodule

    The 5 US categories for solid Bethesda class III nodules ...

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    A 32-year-old woman was referred to the endocrine clinic for abnormal thyroid function, fatigue and depression. Her primary care provider had obtained thyroid function tests to investigate the patients depression and inability to lose weight. Results indicated abnormal thyroid function with a suppressed thyroid-stimulating hormone level of 0.02 µU/mL and a low-normal free thyroxine level of 0.81 ng/dL.

    An endocrinologist ordered a radioactive iodine thyroid scan, which showed normal uptake of 20.1% at 23 hours . The uptake was localized in the lower two-thirds of the right lobe and was suppressed in the left lobe, consistent with an autonomously functioning thyroid nodule . An ultrasound was performed at an outside hospital showing a complex, hypoechoic nodule that measured 1.3 cm x 1.3 cm x 0.9 cm.

    Reprinted with permission from: Stephanie L. Lee, MD, PhD, ECNU.

    The patient was started on methimazole 20 mg daily. She was referred because she was told the antithyroid medication would not help her depression or problems with weight loss. She had no prior or family history of thyroid disease or thyroid cancer, and no history of head and neck radiation.

    Imaging, diagnosis

    Screening, confirming malignancy

    • References:

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    Most Thyroid Nodules Are Benign But Some Thyroid Nodules Are Thyroid Cancer

    A small percentage of thyroid nodules are malignant . You can not tell if a thyroid nodule is malignant due to symptoms or lack of symptoms. Those thyroid nodules that are cancer, tend to be very slow growing. The very rare thyroid nodule that is an aggressive thyroid cancer may present with a large thyroid mass, firm or non-mobile mass or even change in vocal quality. Only in these very rare circumstances, when the thyroid nodule is an aggressive thyroid cancer, is there an urgent need for prompt evaluation and thyroid cancer surgery by the most highly experienced thyroid cancer surgeon. Otherwise, thoughtful evaluation and consultation by an expert thyroid cancer surgeon is required for thyroid nodules. In other words, the vast majority of thyroid nodules can be worked up without a sense of urgency. Don’t make rash, quick decisions–thyroid nodules in almost all cases provide plenty of time to get figured out. So chill if you are here because you just found out you have a thyroid nodule. Read and understand what this means. And realize that in almost all cases, you have time to figure this out! We have created a Thyroid Nodule and Cancer Guide app to help, you can to better understand your thyroid nodule, determine what you “next steps” are, and examine your risk of thyroid cancer.

    Watch a video at https://www.youtube.com/embed/92gv34o-46A

    What Is Molecular Profiling

    At UCLA, thyroid nodules with indeterminate biopsies are sent out for an additional molecular marker test. An indeterminate biopsy result is the gray zone where the risk of cancer is intermediate but cannot be ignored.

    Sometimes the biopsy result is reported as indeterminate. This means the cells are not normal, but there are not definite signs of cancer. When biopsies are indeterminate, the risk of thyroid cancer is 15-30%.

    In the past, to avoid missing a cancer, we recommended thyroid lobectomy to establish a definitive diagnosis. Now, we use molecular profiling. This refers to commercial DNA or RNA tests made specifically for indeterminate thyroid nodules. If the genetic profile appears benign, patients can avoid surgery and we simply watch the nodule over time with neck ultrasound.

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    Does Nodule Size Predict Compressive Symptoms In Patients With Thyroid Nodules

    Oliver S. Eng1, Lindsay Potdevin1, Tomer Davidov1, Shou-En Lu2, Chunxia Chen2, Stanley Z. Trooskin1

    1 Departments of Biostatistics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA

    Correspondence to:

    Background: Thyromegaly and thyroid nodules are known to cause compressive symptoms, but the exact relationship between nodule size and development of compressive symptoms is unclear. We sought to determine whether compressive symptoms are directly related to nodule size.

    Methods: A retrospective analysis of 99 patients who underwent thyroidectomy by a single surgeon was performed. Patients were placed into one of two cohorts: those who experienced preoperative compressive symptoms and those who did not . Compressive symptoms were defined as experiencing neck fullness, dysphagia, choking, or dyspnea. Nodule size, thyroid lobe size, and the presence of visible thyromegaly were compared between the two groups.

    Thyroid nodule size and lobe size appear to directly correlate with compressive symptoms. Of patients with compressive symptoms and a thyroid nodule > 1.5 cm, 97% experienced improvement in symptoms postoperatively.

    Keywords: Thyroid nodule compressive symptoms predict

    Submitted Jul 04, 2014. Accepted for publication Aug 21, 2014.

    doi: 10.3978/j.issn.2227-684X.2014.08.03

    Us Characteristics Of Thyroid Nodules: Malignant Versus Benign

    Radiofrequency Ablation Therapy for Large Benign Thyroid Nodule

    There is considerable overlap between the appearance of benign and malignant nodules and no single imaging feature can be considered pathognomonic. However, the simultaneous presence of 2 or more suspicious sonographic findings increases the risk of thyroid malignancy. The following discussion comments on the relative value of the various US features of thyroid nodules in suspecting thyroid malignancy.

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    Key Issues In Goiter & Thyroid Nodule

    Whenever a person has a goiter or thyroid nodule, three questions must be answered.

  • Is the gland, or a portion of it, so large that it is stretching, compressing, or invading nearby structures? Thyroid swelling can cause a sensation of tightness or, less commonly, pain in the front of the neck. A goiter or nodule can compress the windpipe causing cough or shortness of breath, while pressure on the swallowing tube can cause discomfort with swallowing or even the inability to get things down. When a goiter extends down into the chest, blood returning from the neck and head can be partially obstructed, causing neck veins to bulge. When a goiter or nodule is due to cancer, the tumor may actually grow into nearby structures, causing pain, hoarseness when nerves to the voice box are invaded, or coughing up blood when the trachea is penetrated.
  • Third, is the goiter or thyroid nodule due to malignancy? Fortunately, most patients with a goiter or thyroid nodule do not have thyroid cancer. Often other findings in a patient with a goiter, such as the features of hyperthyroid Graves disease, make it unnecessary to do additional tests to rule out cancer. On the other hand, almost everyone with a thyroid nodule larger than 1.0 to 1.5 cm in diameter must be investigated for the possibility of thyroid cancer. The approach to these diagnostic evaluations is discussed below.
  • Table 2. Key Issues to Evaluate in a Person with a Goiter or Thyroid Nodule

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