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 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
What Is The Thyroid Gland
The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroids job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.
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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:
How Is A Thyroid Biopsy Performed
A thyroid biopsy, also called a fine needle aspiration , uses a small needle to take a little sample of the cells in the thyroid nodule. The possible outcomes from a biopsy are:
Non-diagnostic: Non-diagnostic is a technically failed biopsy. There were not enough cells taken during the biopsy so the cytologist was not able to determine anything. These usually need to be repeated.
Benign: Most thyroid nodule biopsies come back benign, meaning your doctor is highly re-assured that it’s not cancerous. Patients can almost always avoid surgery unless the nodule is large and pushing on adjacent structures like the airway.
Indeterminate:; Indeterminate means there was enough cells taken during the biopsy, but the cytopathologist was not sure if it is benign or malignant. Indeterminate results occur in about 20% of thyroid biopsies. This is a gray zone and means that the risk of cancer is about 10-30%. These nodules require additional work-up such as a repeat biopsy, molecular marker test, or surgical removal.
Suspicious for Malignancy or Malignant: Results categorized in these two categories are a strong indicator that there is cancer present and usually require surgical removal.
Patients usually wait one week for the cytopathologist to examine the cellular characteristic of the biopsy sample. If your doctor is reassured that it’s benign based on the biopsy result, further work-up is stopped and serial ultrasound surveillance is recommended usually once a year.
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Thyroid Nodule Symptom # : A Cough That Just Wont Go Away Frequent Coughing And A Need To Keep Clearing Your Throat
- What to do about it?
Thyroid nodules that cause the patient to cough should always be evaluated with an ultrasound scan. Occasionally a CAT scan is required because it is better at looking at big thyroid goiters than ultrasound is . Sometimes it just cant be known for sure if the thyroid nodule is actually causing the coughing. Often these patients undergo a laryngoscopy . If the thyroid nodule is causing the coughing, or there is a high liklihood it is the cause, then surgery is indicated. Of course, it is now very important for you to chose your surgeon wisely. The nerves to the vocal cords are occasionally damaged by a surgeon removing a thyroid and this will cause severe horseness and a loss of voice for months or even forever. We have an entire page dedicated to helping you chose a surgeon wisely!
What Are The Limitations Of An Ultrasound Of The Thyroid
If one or more nodules are detected within the thyroid gland, the radiologist will examine the features of the nodules. Some features are strongly suggestive that a nodule is benign;in nature, and some raise concern that the nodule may be a true tumor. In other cases, the radiologist cannot distinguish between benign andmalignant;lumps with complete certainty. A fine needle biopsy and review of tissue under a microscope may be recommended for further evaluation, but in some cases surveillance and a repeat sonogram after a few months looking for stability may suffice.
It is not possible to determine thyroid functionthat is, whether the thyroid gland is underactive, overactive, or normalwith ultrasound. For that determination, your doctor may order a blood test or a radioactive iodine uptake test.
What Else To Watch For
As thyroid cancer gets more advanced, you might notice symptoms like:
- Lump or swelling in your neck that’s especially fast-growing
- Pain at the front of your neck or moving up to your ears
- Constant cough or hoarseness, with no obvious cause
- Trouble breathing or swallowing
These could suggest a number of different illnesses besides thyroid cancer, so talk to your doctor about all your symptoms.
Other Causes Of Nodules
Other causes of thyroid nodules include:
- a benign overgrowth known as a colloid adenoma, which is usually harmless
- a cyst, which may contain fluid or blood
People often cannot see or feel a thyroid nodule. They may learn that they have one when they have an imaging test for another condition.
Tests to investigate unusual thyroid activity include:
- an ultrasound to see if a nodule is present, how big it is, and if it contains fluid
- a blood test to assess hormone levels and other factors
- a biopsy to remove and test a small piece of tissue
- a nuclear thyroid scan
A fine needle biopsy or aspiration can show whether a nodule is malignant or not. The doctor will insert a thin needle into the thyroid gland and suction out a few cells for testing.
If biopsy results suggest cancer, the doctor may recommend surgery to remove the nodule and to examine the tissue more closely.
A nuclear thyroid scan can show whether the thyroid gland is working properly. For this test, the individual takes radioactive iodine by mouth or intravenously. They then undergo a scan to see how well the thyroid gland is working and if there are any nodules.
Thyroid Nodules Are Common But Usually Are Not Cancer
When a thyroid nodule is found, an ultrasound of the thyroid and a fine-needle aspiration biopsy are often done to check for signs of cancer. Blood tests to check thyroid hormone levels and for antithyroid antibodies in the blood may also be done to check for other types of thyroid disease.
Thyroid nodules usually dont cause symptoms or need treatment. Sometimes the thyroid nodules become large enough that it is hard to swallow or breathe and more tests and treatment are needed. Only a small number of thyroid nodules are diagnosed as cancer.
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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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Looking For More Of An Introduction
If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net:
- ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to thyroid cancer. This free fact sheet is available as a PDF, so it is easy to print.
Thenext section in this guide is Statistics. It helps explain the number of people who are diagnosed with thyroid cancer and general survival rates. Use the menu to choose a different section to read in this guide.
What The Thyroid Gland Does
To understand why some types of goiter develop, it is first important to know what the normal function of the thyroid gland is and how it is regulated.;;The thyroid gland makes and releases into blood two small chemicals, called thyroid hormones:;thyroxine ;and;triiodothyronine .;;Each of them is comprised of a pair of connected tyrosine amino acids to which four or three iodine molecules, respectively, are attached.
The iodine needed for thyroid hormone production comes from our diet in seafood, dairy products, store bought bread, and iodized salt.;;Once absorbed, iodine in blood is trapped by a special pump in thyroid cells, called the sodium-iodide symporter.;;The thyroid also has several specialized biochemical ‘fastening machines,’ called enzymes, that then carry out the steps needed to attach iodine to particular parts of a very big protein called thyroglobulin, which is made only by thyroid cells.
Some of this thyroglobulin with iodine molecules attached is stored in the gland in the form of a gooey paste called;colloid, which is normally located in the center of follicles, which are balls of thyroid cells with a hollow center.;;
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Rank Order By Size Of Benign And Malignant Nodules
The rank order of the largest malignant nodule was determined for each case. Excluded from this analysis were the patients whose benign nodules and/or the largest cancer was of an unknown size, except for nine individuals in whom it was possible to determine how many benign nodules, if any, were larger than the largest malignant one. Also excluded were the 33 patients whose largest focus of cancer was in a lymph node. Those with a solitary nodule were included. Thyroid cancer was reported to be the largest nodule in 153 patients, the second largest in 66, and the third largest or greater in 45 patients .). In other words, in retrospect, if a strategy of aspirating only the largest nodule had been adopted, 111 of the cancer cases would have been missed, including 25 that were 10 mm or greater. If the two largest nodules were aspirated, 45 of the thyroid cancer cases would have been missed, although none with cancers 10 mm or greater.
Follow Up Of Thyroid Nodules
For patients that do not need surgery , discuss with your clinician the best surveillance schedule for your nodules.
This will vary depending on if you had a biopsy, how long you have had the nodules, and what they look like on ultrasound. For the most part, you should not need a repeat biopsy if you had a benign biopsy once, and you should not have to follow thyroid nodules yearly for the rest of your life.
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Types Of Thyroid Cancer
There are 4;main types of thyroid cancer. They are:
- papillary carcinoma this is the most common type, accounting for about 6 out of 10; cases; it usually affects people under the age of 40, particularly women
- follicular carcinoma accounts for around;3 out of 20 cases of thyroid cancer and tends to affect older adults
- medullary thyroid carcinoma accounts for between 5 and 8 out of every 100 diagnosed cases ; unlike the other types of thyroid cancer, medullary thyroid carcinoma;can run in families;
- anaplastic thyroid carcinoma this is the rarest and most aggressive type of thyroid cancer, accounting for less than 1;in 20 thyroid cancers; it usually affects older people over the age of 60;
Papillary and follicular carcinomas are sometimes known as differentiated thyroid cancers, and theyre often treated in the same way.
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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.
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What Is The Likelihood Of Thyroid Cancer Recurrence
The recurrence rate of thyroid cancer depends upon whether the cancer remains localized within the thyroid gland or whether it has spread or metastasized to local structures in the neck or to distant sites in the body.
In general, the recurrence risk of a cancer that has not spread is very low. For example, Italian researchers found that among patients with papillary cancer of the thyroid gland, those with a low risk of disease had a recurrence rate of about 1.4% at eight years.
Researchers from the Mayo Clinic followed patients for up to 15 years and concluded that low risk patients had a recurrence rate of 3%-5%. However, they noted that more recently, thyroid cancer was being diagnosed much earlier and with the appropriate surgery, cure was much more likely and survival rate after surgery was very high.
Thyroid Tumors In Dogs: Life Expectancy Survival And Prognosis
Surgical removal of thyroid tumors has the best outcome if the mass is freely movable, less than 4cm in size, has not spread and can therefore be completely removed. Long-term survival may be achieved in both dogs. It is common for medications to be needed after surgery.;If both thyroid glands are removed, your veterinarian may also need to check your pets calcium levels several times during recovery. This is because some parathyroid tissue is removed with the thyroid glands, and parathyroid glands play a role in calcium regulation. If surgery is not possible, then SRS may be a viable and successful option.
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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.
Thyroid Goiter: When Is A Radioiodine Scan Ordered
If you have a thyroid goiter and your blood tests also demonstrate that your thyroid hormone level is too high , this is the only instance that a radioiodine scan is indicated. In these cases, the thyroid stimulating hormone will be very low and in cases of Grave’s disease, the thyroid stimulating immunoglobulin will be very high. The thyroid goiter patient may or may not have recognized symptoms of their hyperthyroidism.
During the thyroid scan, the patient will be given a small amount of radioactive iodine in a pill and a special imaging camera is utilized to determine how much iodine is taken up by the thyroid gland and if the thyroid goiter takes up iodine throughout the thyroid gland or whether there is a single “hot” area in the thyroid , relative to the remainder of the thyroid gland . If a thyroid nodule has less iodine uptake than the rest of the thyroid gland, then the thyroid nodule is called a “cold nodule”. In patients with multinodular goiter, frequently several of the nodules of the thyroid will be cystic and filled with fluid. These cystic areas of a multinodular goiter are expected to take up less iodine than the rest of the gland and appear “cold”.
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.