How Are Goiters Treated
Depending on the test results, a goiter might not need to be treated. If it does, treating the thyroid disease causing the goiter usually will decrease or control the enlargement.
Surgery might be needed if the thyroid keeps getting bigger even with treatment and causes discomfort or a very large lump in the neck.
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 A Goiter
Goiter refers to enlargement of the thyroid gland, a butterfly shaped organ draped around the front and sides of the windpipe in the lower part of the neck.
The thyroid gland is normally about the size of two thumbs held together in the shape of a V. It can enlarge when it is inefficient in making thyroid hormones, inflamed, or occupied by tumors.
Thyroid gland enlargement can be generalized and smooth, a so called diffuse goiter or it can become larger due to growth of one or more discrete lumps within the gland, a nodular goiter.
A goitrous gland can continue producing the proper amounts of thyroid hormones, in which case it is called a euthyroid or nontoxic goiter or a goiter can develop in conditions with either overproduction of thyroid hormone, called toxic goiter, or the inability to make sufficient thyroid hormones, called goitrous hypothyroidism.
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Causes Of Thyroid Nodules
Itâs not always clear why a person gets thyroid nodules. Several medical conditions can cause them to form. They include:
Iodine deficiency: A diet that lacks iodine can result in thyroid nodules. This is uncommon in the U.S., since iodine is added to many foods.
Thyroid adenoma: This is an unexplained overgrowth of thyroid tissue. Most adenomas are harmless, but some produce thyroid hormone. This leads to an overactive thyroid .
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 surgery and thyroid surgery cancer center.
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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
So You Have A Thyroid Nodule Now What
The first thing your doctor will likely recommend, if they find a nodule during a physical exam, is they will order a thyroid ultrasound. They should also order a comprehensive thyroid panel . Asking your doctor for a comprehensive thyroid panel, including thyroid antibodies is extremely helpful because thyroid nodules can be associated with autoimmune conditions, like Hashimotos thyroiditis.
A thyroid ultrasound uses sound waves to produce images of the thyroid gland within the neck. It does not use ionizing radiation and is commonly used to evaluate lumps or nodules found during a routine physical or other imaging exam. Think of a thyroid ultrasound as a small massage on the neck. This procedure is simple, convenient and often takes no more than 20 minutes. There is no specific preparation required for your thyroid ultrasound.
Although your comprehensive thyroid panel can technically be drawn at any time of the day, since we are evaluating for a nodule, at NMD Wellness of Scottsdale we always like to follow the same guidelines for every patient so we can make sure and eliminate any false positives/ negatives, as much as possible. We general recommend patients comply with the following recommendations:
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Can Nodules Go Away On Their Own
Mostly, nodules disappear on their own or stay the same size. Nodules are not dangerous and require no treatment as long as they dont grow. Otherwise, your doctor may suggest treatments to shrink thyroid nodules.
If you want to get treated for thyroid nodules, contact us at 907-276-3676. At Far North Surgery a trusted surgery center of Anchorage, Dr. Madhu Prasad and his team of doctors have all the expertise to treat nodular growth in your thyroid gland
Majority Of Benign Thyroid Nodules Do Not Grow Over Time And Cancer Is Rarely Found
Introduction: Detection of asymptomatic thyroid nodules has become increasingly common, largely owing to detection of small incidentally discovered nodules. Consensus is lacking regarding the optimal follow-up of cytologically benign and sonographically nonsuspicious nodules.
Current guidelines from the American Thyroid Association recommend serial ultrasound examinations and repeat cytology examination if significant growth in the nodule is observed. However, no reliable predictors of nodule growth have been identified. In addition, it is unclear whether nodule growth increases the risk for malignancy.
Methods: Researchers studied the frequency, magnitude, and factors associated with changes in thyroid nodule size. The study involved 992 patients with 1 to 4 asymptomatic, cytologically or sonographically benign thyroid nodules. Patients were recruited from 8 hospital-based thyroid disease referral centers in Italy between 2006 and 2008. Data collected during the first 5 years of follow-up through January 2013 were analyzed.
Results: The majority of patients showed no significant change in nodule size. Nodules decreased in size spontaneously in 184 patients , with a mean reduction in the largest diameter of 3.7 mm and mean reduction in volume of 0.5 mL.
Thyroid cancer was diagnosed in 5 original nodules , only 2 of which had grown in size. New nodules developed in 93 patients , and cancer was detected in 2 of these new nodules.
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Why Is Thyroid Disease So Common Today
Thyroid problems are epidemic around the world, especially in the Western world, for the following reasons:
1. Stress. Stress can cause many cases of thyroid imbalance. The stress can be physical, emotional, financial, structural or other. Any of these weakens the thyroid gland.
2. Iodine antagonists in the environment. This is a very serious problem that few talk about. However, the water and food supply is loaded with halogens, which are elements that can replace iodine in the thyroid gland. They mainly include fluorides, chlorides, and bromides. These elements compete with iodine for absorption and utilization in our bodies. When they replace iodine, the thyroid gland simply stops working properly. To read more about this, read Iodine And Iodine Antagonists.
3. Copper and mercury toxicity in almost everyone. According to the research of Dr. Paul Eck and many others, copper and mercury can easily interfere with the functioning of the thyroid gland. They may do this by antagonizing or opposing the action of zinc, manganese and selenium, or perhaps by other mechanisms. Unfortunately, copper and mercury toxicity are almost universal today. Mercury gets into our bodies due to mercury in dental fillings, mercury in all fish except perhaps very small fish like sardines, and in some cases other sources of mercury. To read more about this, read Mercury Toxicity.
What Kind Of Follow
You will see your childs endocrinologist and head and neck surgeon one week after surgery. Expect to have labs done to assess calcium levels. Thyroid function labs will be drawn four weeks after surgery. Depending on the pathology, additional imaging may be obtained to see if radioactive iodine is needed. Some types of thyroid cancer will require regular blood work screening and scheduled ultrasounds.
Last reviewed by a Cleveland Clinic medical professional on 07/30/2018.
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What Are The Longer
The long-term implications of a toxic thyroid nodule or adenoma depend on the treatment option used. Patients taking carbimazole tablets will likely need to take them daily for life. Blood tests should be carried out regularly to monitor thyroid hormone levels and to adjust the dose of carbimazole accordingly. The majority of patients are able to find a medication regime that works for them and go on to live full, active lives.
If untreated, besides feeling poorly and unwell, the patient is also at risk of heart dysfunction or failure due to the increased heart rate and raised metabolic state. This irregular heart rate can result in strokes and dizziness. Long-standing toxic nodules can also affect the patients bones and cause osteoporosis, which results in weak bones that are more likely to fracture.
The patient may also develop symptoms due to the enlarged thyroid gland such as difficulty with breathing or swallowing . If patients have any concerns about this condition, they should discuss them with their doctor.
Labs + Thyroid Ultrasound Complete Now What
Once your thyroid ultrasound, as well as, your comprehensive thyroid labs have been completed, your doctor will review the results to determine if additional work up is necessary. Since thyroid nodules can be benign, your doctor will evaluate recommendations provided by the radiologist based on the size, color, consistency, blood flow and texture to make specific recommendations. The radiologist will evaluate nodules based on a scoring system known as the TI-RADS. Scoring is determined from five categories of ultrasound findings. The higher the cumulative score, the higher the TR level and the likelihood of concern, including malignancy.
One score is assigned from each of the following categories:
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What Are The Symptoms Of Thyroid Nodules
Most children with thyroid nodules feel fine and have no symptoms.
While symptoms may vary from child to child, the most common include:
- a visible lump in the neck
- a sensation of a lump in the throat when swallowing
- unexplained hoarseness
A rare type of thyroid nodule called an autonomous nodule can produce too much thyroid hormone. This can cause symptoms like:
- weight loss
- feeling too hot or sweaty
- heart palpitations
- tremor of the hands
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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What Types Of Health Care Professionals Treat Thyroid Nodules
Endocrinologists and thyroid specialist surgeons deal with these problems on a regular basis. But many family practice physicians, general internists, general surgeons, and otolaryngologists are also adept at addressing thyroid nodules. The important thing is that the physician be experienced with and comfortable evaluating and treating this condition.
What Causes Thyroid Goiters And Thyroid Nodules
The most common cause of goiters and soft nodules today is the hormone estrogen.
In hypothyroidism, excess estrogen accumulates in your body for two reasons:
As estrogen accumulates within your body, it tends to affect your thyroid gland in two ways:
Think of your thyroid gland like a balloon.
The effects of estrogen are such that air is being continuously added to the balloon , without any air being allowed to escape.
The balloon will just continue to get bigger and bigger.
The solution to the problem is to stop adding more air to the balloon while at the same time, letting air out, allowing the balloon to shrink and normalize in size.
Well cover this in more detail in just a second.
First, lets cover where most people go wrong
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What Are The Risks Of Removing The Thyroid Gland
Behind your childs thyroid gland runs the recurrent laryngeal nerves that help to move the vocal folds and the parathyroid glands which help regulate their bodys calcium levels.
Some of the major risk factors following the removal of the thyroid gland are:
- A hoarse/breathy voice.
- Low calcium levels.
After surgery your child will need to take a medication to supplement the thyroid function and in some cases a medication to keep calcium levels elevated.
Other risk factors include:
- A scar on the neck.
- Fluid collection under the skin.
- The need for future procedures such as removal of the lymph nodes from the neck.
What Is A Toxic Thyroid Nodule
Ultrasound scan in transverse section of the thyroid gland of a 73-year-old female patient, showing a hot nodule in one thyroid lobe corresponding to a toxic adenoma.
A toxic thyroid nodule causes hyperthyroidism . This occurs when a single nodule grows on the thyroid gland causing it to become enlarged and produce excess thyroid hormones. If the increased hormone production is coming from a single nodule in the gland, this is called toxic adenoma. If there are many nodules causing the hyperthyroidism, this is referred to as multinodular goitre.
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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 nodules 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.