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.
What Does A Thyroid Nodule Look Like
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How Should I Prepare
Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry quickly. The ultrasound gel does not usually stain or discolor clothing.
After an ultrasound examination, you should be able to resume your normal activities immediately.
A radiologist, a doctor trained to supervise and interpret radiology exams, will analyze the images. The radiologist will send a signed report to the doctor who requested the exam. Your doctor will then share the results with you. In some cases, the radiologist may discuss results with you after the exam.
Ultrasound examinations are very sensitive to motion, and an active or crying child can prolong the examination process. To ensure a smooth experience, it often helps to explain the procedure to the child prior to the exam. Bringing books, small toys, music or games can help to distract the child and make the time pass quickly. The ultrasound exam room may have a television. Feel free to ask for your childâs favorite channel.
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What Are The Symptoms Of Thyroid Cancer
You or your healthcare provider might feel a lump or growth in your neck called a thyroid nodule. Dont panic if you have a thyroid nodule. Most nodules are benign . Only about three out of 20 thyroid nodules turn out to be cancerous .
Other signs of thyroid cancer include:
- Difficulty breathing or swallowing.
- Swollen lymph nodes in the neck.
Living With Thyroid Nodules
Most people who have thyroid nodules lead a normal life. You might need to check in with your doctor more often, but there usually are no complications.
If you do have complications, they can include problems swallowing or breathing. You may also sustain significant weight gain or weight loss. Work with your doctor to treat these symptoms.
If your thyroid nodules are a symptom of thyroid cancer, you may need surgery. During the surgery, the doctor will remove most, if not all, of your thyroid. Following the surgery, youll take daily thyroid replacement hormones for the rest of your life.
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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 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 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.
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Types Of Subacute Thyroiditis
There are four different subtypes of subacute thyroiditis:
Subacute granulomatous thyroiditis: Thisis the most common type of subacute thyroiditis. Its mostly caused by viral infections.
Postpartum thyroiditis: This occurs in women within one year after giving birth, and usually goes away within 18 months. Women who develop this form of thyroiditis are thought to have an underlying autoimmune disease that causes the inflammation. Symptoms occur in two phases, starting with hyperthyroid symptoms and moving to hypothyroid symptoms.
Subacute lymphocytic thyroiditis: This also occurs during the postpartum period. Hyperthyroid symptoms develop earlier , and hypothyroid symptoms can last for several months after.
Palpation thyroiditis: This develops when thyroid follicles are damaged from mechanical manipulation such as repeated examination of the thyroid gland or surgery.
All of the subtypes of subacute thyroiditis follow a similar course of symptoms, with hyperthyroid developing first. The key differences are the causes.
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What Causes A Thyroid Nodule To Form
Sometimes the thyroid begins to grow , causing one or more nodules to form. Why this happens is not known. Cancer is the biggest concern when nodules form. Fortunately, cancer is very rare it is found in less than 5 percent of all nodules. Nodules develop more often in people who have a family history of nodules, and in people who dont get enough iodine. Iodine is needed to make thyroid hormone.
There are different types of thyroid nodules:
- Colloid nodules: These are one or more overgrowths of normal thyroid tissue. These growths are benign . They may grow large, but they do not spread beyond the thyroid gland.
- Thyroid cysts: These are growths that are filled with fluid or partly solid and partly filled with fluid.
- Inflammatory nodules: These nodules develop as a result of chronic inflammation of the thyroid gland. These growths may or may not cause pain.
- Multinodular goiter: Sometimes an enlarged thyroid is made up of many nodules .
- Hyperfunctioning thyroid nodules: These nodules autonomously produce thyroid hormone without regard for normal feedback control mechanisms, which may lead to the development of hyperthyroidism. Hyperthyroidism can affect the heart and cause such problems as sudden cardiac arrest, high blood pressure, arrhythmias , osteoporosis and other health problems.
- Thyroid cancer: Less than 5 percent of thyroid nodules are cancerous.
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Whats The Treatment For A Thyroid Nodule
Even a benign growth on your thyroid gland can cause symptoms. If a thyroid nodule is causing voice or swallowing problems, your doctor may recommend treating it with surgery to remove all or part of the thyroid gland.
If the doctor recommends removal of your thyroid , you may not even have to worry about a scar on your neck. Some patients are good candidates for a scarless thyroid procedure, where the surgeon reaches the thyroid through an incision made on the inside of your lower lip.
A newer alternative that the doctor can use to treat benign nodules in an office setting is called radiofrequency ablation . Radiofrequency ablation uses a probe to access the benign nodule under ultrasound guidance, and then treats it with electrical current and heat that shrinks the nodule. Its simple: Most people treated with RFA are back to their normal activities the next day with no problems.
The Johns Hopkins Thyroid and Parathyroid Center
Our thyroid experts in the head and neck endocrine surgery team diagnose and treat patients with a variety of thyroid and parathyroid conditions. Learn about what we offer at our center.
What Is A Swollen Thyroid
Anatomically speaking, the thyroid gland, located at the front portion of the neck, is part of the endocrine body system. A swollen thyroid or medically termed as goiter is an enlargement of the thyroid gland. Furthermore, people who suffer from a swollen thyroid are occasionally battling against hypothyroidism. However, there are actually a lot of reasons which cause the thyroid gland to swell. These reasons will be explained later in the discussion on the causes for a swollen thyroid.
What Is A Thyroid Nodule
The thyroid is a small gland located at the base of your throat that regulates body functions such as heart rate, metabolism, and the rate at which your body burns calories. A thyroid nodule is a lump in the thyroid gland in your neck. More than 90% of all thyroid nodules are benign . Some are actually cysts filled with fluid.
Thyroid nodules are more common in women than in men. They also tend to run in families.
Risk Factors For Thyroid Nodules
Thyroid nodules are actually quite common. By the age of 60, half of all people have them. Theyâre often very small. You might only learn you have a thyroid nodule when your doctor feels for one during an examination or if you have an ultrasound of your thyroid.
Still, several things can increase your chances of developing a thyroid nodule. They include:
Living in a part of the world where the diet doesnât include iodine
Having a family history of thyroid nodules
Having a history of radiation exposure to head or neck
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Where Thyroid Cancer Starts
The thyroid gland is in the front part of the neck, below the thyroid cartilage . In most people, the thyroid cannot be seen or felt. It is shaped like a butterfly, with 2 lobes the right lobe and the left lobe joined by a narrow piece of gland called the isthmus.
The thyroid gland has 2 main types of cells:
- Follicular cells use iodine from the blood to make thyroid hormones, which help regulate a persons metabolism. Having too much thyroid hormone can cause a fast or irregular heartbeat, trouble sleeping, nervousness, hunger, weight loss, and a feeling of being too warm. Having too little hormone causes a person to slow down, feel tired, and gain weight. The amount of thyroid hormone released by the thyroid is regulated by the pituitary gland at the base of the brain, which makes a substance called thyroid-stimulating hormone .
- C cells make calcitonin, a hormone that helps control how the body uses calcium.
Other, less common cells in the thyroid gland include immune system cells and supportive cells.
Different cancers develop from each kind of cell. The differences are important because they affect how serious the cancer is and what type of treatment is needed.
Many types of growths and tumors can develop in the thyroid gland. Most of these are benign but others are malignant , which means they can spread into nearby tissues and to other parts of the body.
Nodule On Your Thyroid
Thyroid cancer may not cause any symptoms early on. The first sign is often a small bump, or “nodule,” on your thyroid gland. It’s not something you’re likely to notice on your own. Your doctor usually feels it in a physical exam. They might spot it in an X-ray or CT scan, often after you get one for another problem. About 90% of the time, these nodules are benign and need little or no treatment.
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What Is A Thyroid Goiter
Thyroid goiter is a condition where there is an abnormal enlargement of your thyroid gland. The photo here shows how many thyroid goiters look, which is like the neck is swolen and fat. When you touch it, you can tell it isnât fat since it is firm and doesnât move much. Most thyroid goiters are painless, but they may produce symptoms due to their size itself. The most common symptom from a thyroid goiter is a lump in the neck. Other symptoms from a large thyroid goiter may include a sense of a lump in the throat, difficultly swallowing, difficulty breathing and even in extreme cases, voice changes and even vocal cord paralysis.
World wide, the most common cause of thyroid goiter is in locations where iodine in the diet is low or non-existent. This was similarly the case in the United States where thyroid goiter was commonplace until the contemporary iodination of table salt. Since then, the incidence of thyroid goiters have drastically been reduced in the United States.
Today, in the United States, thyroid goiter is more commonly associated with too much production of thyroid hormone , too little production of thyroid hormone , or multiple nodules within the thyroid gland itself .
There are two autoimmune conditions that can be causes of thyroid goiter.
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How Do I Know If I Have Thyroid Nodules
Most thyroid nodules do not produce any symptoms. However, if you have several nodules, or large nodules, you may be able to see them. Although rare, nodules can press against other structures in the neck and cause symptoms, including:
Hyperfunctioning thyroid nodules can lead to overproduction of thyroid hormones, also known as hyperthyroidism. Symptoms of hyperthyroidism include:
What Causes Thyroid Nodules And How Common Are They
We do not know what causes most thyroid nodules but they are extremely common. By age 60, about one-half of all people have a thyroid nodule that can be found either through examination or with imaging. Fortunately, over 90% of such nodules are benign. Hashimotos thyroiditis, which is the most common cause of hypothyroidism , is associated with an increased risk of thyroid nodules. Iodine deficiency, which is very uncommon in the United States, is also known to cause thyroid nodules.
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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: