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Is A 2 Cm Thyroid Nodule Large

Searching For An Answer About Larger Thyroid Nodules

What Is A Thyroid Nodule?

The Chicago Medical School researchers conducted what is known as a meta-analysis, which involves looking at already published studies and considering the findings based on cumulative data to determine whether there are solid trends. For this systematic review of the literature,2 Dr. Cipriani and her team looked for studies published on or before December 8, 2017. They identified 352 citations and then pared them down to 35 articles that fit their focus most closely.

The studies they reviewed involved thyroid nodules that were classified by sizefrom 3 to 5 centimeters ; a thyroid nodule less than 1 centimeter is considered small. The team also looked at which nodules were classified as cancerous; all of the nodules in these studies were removed surgically.2

What they found is that the rate of malignancy was not substantially different relative to the size of the thyroid nodule. In fact, the cancer rate for nodules that were 3 cm and greater was 13.1% as compared to the rate of malignancy for thyroid nodules less than 3 cm was 19.6%. And for thyroid nodules over 4 cm, the cancer rate was 20.9%, nearly the same as that for thyroid nodules for similar nodules less than 4 cm.2

“Size alone is not a risk factor for malignancy,” Dr. Cipriani tells EndocrineWeb. “You do not have an increased risk of cancer with increasing size.”

“If your biopsy is benign, the risk of it being cancer if it is resected is not different for large versus small nodules,” she says.1

Gema Lpez Gallardo1 Julia Sastre2 Abel Gonzlez3 Sandra Arranz4 Julia Silva5 Miguel Angel Valero6& Jaime Aranda7

1Hospital Santa Bárbara, Puertollano/Ciudad Real, Spain; 2Hospital Virgen de la Salud, Toledo, Spain; 3Hospital General, Ciudad Real, Spain; 4Hospital General, Albacete, Spain; 5Hospital Mancha Centro, Alcázar/Ciudad Real, Spain; 6Hospital General, Talavera, Spain; 7Hospital General, Cuenca, Spain.

Introduction: Most thyroid nodules are benign. Some studies have shown largest nodule size, specially >4 cm, can predict malignancy and reduce fine needle aspiration accuracy. Recent studies, however, have shown conflicting results as to whether nodule size may be used to distinguish at risk-lesions. We attempt to determine whether nodule size predicts thyroid malignancy and to examine accuracy of fine needle aspiration by size.

Material and methods: A multicenter, retrospective analytical study was performed on a total of 882 patients with thyroid solitary nodules and put underwent partial or total thyroidectomy between 2010 and 2013. We compared nodules by size cutoffs using Chi-squared and Fisher exact test where appropriate. Binary logistic regression analysis was used to identify the independent factors associated with thyroid malignancy. All data were analyzed using SPSS software for Windows .

Volume 49

What Is A Moderately Suspicious Thyroid Nodule

TR4 nodules, or moderately suspicious, are 4 to 6 points, and TR5 nodules, or highly suspicious, are 7 points or more. For TR4 nodules, the guidelines recommend fine-needle aspiration if the nodule is 1.5 centimeters or greater and follow-ups if it is 1 centimeter or greater.

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When To Biopsy: A Taller

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Two patients were sent to the endocrine clinic for the evaluation of a thyroid nodule. A 67-year-old female was sent for an asymptomatic 1-cm thyroid nodule found during an MRI for neck pain. A 28-year-old female was referred because of a 2-cm thyroid nodule felt during an initial evaluation for infertility.

They had no history of head and neck radiation and no family history of thyroid disease, including thyroid cancer.

The patients were unaware of the thyroid nodule and had no symptoms of dysphagia, change in voice or anterior neck pressure. The 1-cm nodule could not be felt, whereas the larger 2-cm nodule was easily palpable in the left lobe. The nodule was mobile and nontender. Neither woman had palpable adenopathy in the neck. Laboratory testing showed both women had normal thyroid-stimulating hormone values <1.9 mU/L.

Stephanie L. Lee

Both women had a thyroid ultrasound, including a nodal survey of the neck. There were no abnormal or enlarged nodes seen in the bilateral neck in levels 2, 3, 4, 5 or 6.

Nodule features

Characteristics of concern

The generally accepted sonographic characteristics of thyroid nodules that are concerning for malignancy include solid composition, hypoechogenicity, intranodular vascular flow, micro- and macro-calcification, blurred margins, capsular invasion and hypermetabolic rate on F-18 fluorodeoxyglucose PET scan.

How Are Thyroid Nodules Diagnosed

Role of Sonographic Diagnosis in Managing Bethesda Class ...
Fine Needle Biopsy

A;thyroid fine needle biopsy;is a simple procedure that can be performed in the physician’s office. Some physicians numb the skin over the nodule prior to the biopsy, but it is not necessary to be put to sleep, and patients can usually return to work or home afterward with no ill effects.

This test provides information that no other test can offer short of surgery.;A thyroid needle biopsy will provide sufficient information on which to base a treatment decision more than 85 percent of the time if an ultrasound is used.

Use of fine needle biopsy has drastically reduced the number of patients who have undergone unnecessary operations for benign nodules. However, about 10-20 percent of biopsy specimens are interpreted as inconclusive or inadequate, that is, the pathologist cannot be certain whether the nodule is cancerous or benign.

In such cases, a physician who is experienced with thyroid disease can use other criteria to make a decision about whether to operate.

Thyroid Scan

A;thyroid scan;is a picture of the thyroid gland taken after a small dose of a radioactive isotope normally concentrated by thyroid cells has been injected or swallowed. The scan tells whether the nodule is hyperfunctioning . Because cancer is rarely found in hot nodules, a scan showing a hot nodule eliminates the need for fine needle biopsy. If a hot nodule causes hyperthyroidism, it can be treated with radioiodine or surgery.


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Diagnosis Of Solitary Or Single Thyroid Nodule Based On Symptoms And Signs

In most cases patients suffering with solitary or single thyroid nodule are asymptomatic3. Solitary or single thyroid nodule is occasionally found during routine examination of thyroid gland and neck. Asymptomatic single, soft and painless thyroid nodule is considered benign nodule. Benign single, small or large thyroid lumps, may or may not secrete excessive thyroid hormone. Thyroid nodule or swelling in few cases may cause symptoms of hyperthyroidism when nodule secretes excessive amount of thyroid hormone. Similarly single large thyroid nodule may not secrete any thyroid hormone and may cause relatively low thyroid hormone resulting in hypothyroidism. Such condition is known as hypothyroidism or goiter.

Symptomatic Classification of Solitary or Single Small and Large Thyroid Nodule is as follows-

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What Are The Signs And Symptoms Related To Thyroid Nodules

Most thyroid nodules do not cause any symptoms.; Some thyroid nodules show up as a painless lump in the neck that you can feel or see. Thyroid nodules usually move up and down with swallowing.;

When thyroid nodules become large they may cause symptoms by pressing on the airway or esophagus. These are also called compressive symptoms. Compressive symptoms include:

  • discomfort with swallowing

At the UCLA Endocrine Center in Los Angeles, multiple layers of evaluation are designed to help you avoid invasive tests and surgery whenever possible. Consultation, ultrasound, and FNA can all be performed in a single;visit.

Initial evaluation of a newly discovered thyroid nodule begins with:

  • Assessment by an endocrinologist or endocrine surgeon
  • Thyroid function tests
  • Neck ultrasound performed by your doctor

An ultrasound is a highly accurate tool to visualize your nodule. There is no associated radiation with ultrasounds and it is non-invasive. Ultrasounds are cost-effective as most patients really don’t need any other imaging because the ultrasounds are the best way to look at the thyroid, all present nodules, and the lymph nodes in the neck.

Our cytopathologists evaluate over 1000 samples per year, so we are confident in the accuracy of our biopsies. When biopsy does not give a clear answer, we automatically use molecular profiling to refine the diagnosis.

Thyroid Nodules Are Usually Benign And Not Cancerous

Thyroid 2.6 cm nodule/mass on the right side.

The good news is that most people with thyroid nodules do not and will not get thyroid cancer.;

The bad news is that a thyroid nodule is not normal and may be associated with other conditions of your thyroid gland.;

So, even if you don’t have thyroid cancer, you should still have your thyroid nodule evaluated and tested for other conditions which are associated with thyroid nodules.;

Conditions in this category include:

It’s important to realize that many thyroid nodules are just run-of-the-mill nodules which are not associated with thyroid disease of any kind.;

But, in order to be on the safe side, it’s ideal that every patient who has a thyroid nodule undergoes certain tests to ensure that this is the case.;

Tests such as a comprehensive history and physical, palpation of the thyroid gland, tests of your thyroid function through blood work, and even an ultrasound may all be warranted.;

Your doctor should be walking you through these steps but you can also ask for them if you are worried.;

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Treatment Of Benign Nodules

Benign thyroid nodules may be treated with thyroid hormone to shut off TSH and thereby hopefully shrink the nodule. Patients treated in this way must be examined every six months. As long as the nodule does not enlarge, there is no concern. However, if the nodule enlarges despite treatment with thyroxine, this would suggest that it may have become malignant and should be removed . It should also be emphasized that most benign nodules do not shrink with thyroxine therapy, and fewer such nodules are treated in this fashion. Cysts never respond to thyroxine.

Reduce Thyroid Nodules By Improving Gut Health

One of the most common reasons for thyroid nodules;is thyroid autoimmunity, especially Hashimotos thyroiditis. Research indicates thyroid health;is closely connected to your gut health. [2

Trusted SourcePubMedGo to source]

Though the American Thyroid Association;states, Iodine deficiency, which is very uncommon in the United States, isknown to cause thyroid nodules, its important to only supplement with iodine if you are certain you are deficient. In some cases, you may need to decrease your iodine intake by using a low-iodine diet.

For more on how to assess and optimize your iodine, see How Should I Use Thyroid Supplements?

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Should I Have My Thyroid Removed For Nodules

Your doctor may recommend that you consider thyroid surgery for 4 main reasons: You have a nodule that might be thyroid cancer. You have a diagnosis of thyroid cancer. You have a nodule or goiter that is causing local symptoms compression of the trachea, difficulty swallowing or a visible or unsightly mass.

Fine Needle Aspiration Biopsy For Diagnosis Of Solitary Or Single Thyroid Nodule

Fig 3.
  • The Fine Needle Biopsy involves needle placement within the solitary or single thyroid nodule under CT Scan or MRI or Ultrasound guidance.
  • The tissue removed from solitary or single thyroid nodule is examined to differentiate benign and malignant nodule.5 Histological studies of biopsy samples are performed to identify signs of malignancy.
  • Endocrinologist, oncologist and surgeon will carefully evaluate the findings of histological study prior to surgical removal of small or large nodule.
  • In many cases FNAB is repeated after 3 months when prior study was negative for cancer.

    Frozen Section Analysis-

  • Frozen section analysis is performed during surgery.
  • Surgeon will send biopsy samples of nodule once the nodule is surgically exposed. The biopsy sample is frozen and the thin section of frozen sample is examined under microscope.
  • The results are available in 15 to 30 minutes.
  • Presence of malignant activities indicates necessity of removing entire thyroid gland and lymph node. If biopsy results suggest absence of malignant cells then surgeon will remove only nodule.6

    Also Read:

  • Arch Endocrinol Metab. 2016 Aug;60:402-4.

  • Radioactive iodine scanning is not beneficial but its use persists for euthyroid patients.Panneerselvan R1, Schneider DF, Sippel RS, Chen H.J Surg Res. 2013 Sep;184:269-73.

  • Written, Edited or Reviewed By:Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc.This article does not provide medical advice. See disclaimerLast Modified On: April 6, 2018

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    Roc Analysis Of The Independent Factors For Malignancy

    The ROC curve analysis showed that the AUC of age in predicting malignancy was 0.638 , with a sensitivity of 57.7% and a specificity of 69.9% at a cut-off value of 54.5 years. The AUC of maximal nodule diameter in predicting malignancy was 0.645 , with a sensitivity of 58.5% and a specificity of 70.6% at a cut-off value of 3.59 cm. When age, HT, maximal nodule diameter, and punctate echogenic foci were combined, the optimal AUC had a favorable value of 0.783 , with a sensitivity of 70.0% and a specificity of 73.5%. For patients with ACR TI-RADS <4 nodules, the ROC curve analysis showed that the AUC of age in predicting malignancy was 0.651 , with a sensitivity of 54.9% and a specificity of 75.2% at a cut-off value of 54.5 years . For patients with ACR TI-RADS <4 nodules, the ROC curve analysis showed that the AUC of TPOAb in predicting malignancy was 0.649 , with a sensitivity of 53.9% and a specificity of 75.9% at a cut-off value of 31.4 mIU/L . Multivariate variable logistic regression analysis showed that patients age and diameter of the maximum nodule were independently associated with risk factors for malignancy .

    Figure 2 Receiver operating characteristic curve analysis of the age for predicting thyroid carcinoma in patients with ACR TI-RADS <4 nodules . The results showed that the cut-off value of age was 54.5. At this value, sensitivity was 54.9%, and specificity was 75.2%.

    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.;

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    Is A 2 Cm Thyroid Nodule Large

    The risk of cancer increased to 15% of nodules greater than 2 cm. In nodules that were larger than this 2 cm threshold, the cancer risk was unchanged. However, the proportion of rarer types of thyroid cancer such as follicular and Hurthle cell cancer did progressively increase with. increasing nodule size.

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

    How do you determine if a thyroid nodule is benign or cancerous? – Susan J Mandel, MD, MPH

    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

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    The Diagnosis Meaning And Treatment Of Thyroid Nodules

    Thyroid nodules are most commonly found when a doctor examines a patient’s neck, feeling the thyroid gland. Sometimes thyroid nodules are found when a patient gets x-rays or scans of the neck for some other reason. Sometimes it is a screening x-ray or scan for carotid arteries or neck pain that shows nodules in the thyroid. Thyroid nodules that are large, develop in women with thin necks, or are present in the middle portion of the thyroid gland may be visible and discovered as a lump in the neck.


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