How Are Thyroid Nodules Diagnosed
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.
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.
What To Think About
Hypothyroidism occurs in some people after being treated with radioactive iodine for thyroid nodules. For this reason, your doctor will check your thyroid hormone levels regularly after you have this treatment.
If a thyroid nodule is not cancerous but is making too much thyroid hormone, causing hyperthyroidism, antithyroid medicines may be used before radioactive iodine treatment. For more information on treating hyperthyroidism, see the topic Hyperthyroidism.
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.
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Types Of Thyroid Nodules
There are different types of thyroid nodules that arenât cancerous:
Toxic nodules make too much thyroid hormone. This can lead to hyperthyroidism, which makes the metabolism speed up.
Multinodular goiters have several nodules. They may also make too much thyroid hormone and may press on other structures.
Thyroid cysts are full of fluid, sometimes with other debris. They may happen after an injury.
What Are The Symptoms Of A Thyroid Nodule
Most thyroid nodules do not cause symptoms. Often, thyroid nodules are discovered incidentally during a routine physical examination or on imaging tests like CT scans or neck ultrasound done for completely unrelated reasons. Occasionally, patients themselves find thyroid nodules by noticing a lump in their neck while looking in a mirror, buttoning their collar, or fastening a necklace. Abnormal thyroid function tests may occasionally be the reason a thyroid nodule is found. Thyroid nodules may produce excess amounts of thyroid hormone causing hyperthyroidism . However, most thyroid nodules, including those that cancerous, are actually non-functioning, meaning tests like TSH are normal. Rarely, patients with thyroid nodules may complain of pain in the neck, jaw, or ear. If a nodule is large enough to compress the windpipe or esophagus, it may cause difficulty with breathing, swallowing, or cause a tickle in the throat. Even less commonly, hoarseness can be caused if the nodule invades the nerve that controls the vocal cords but this is usually related to thyroid cancer.
The important points to remember are the following:
- Thyroid nodules generally do not cause symptoms.
- Thyroid tests are most typically normaleven when cancer is present in a nodule.
- The best way to find a thyroid nodule is to make sure your doctor checks your neck!
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How Can My Doctor Tell If I Have A Thyroid Nodule That Is Cancerous
Your doctor can do several different tests. One test is called fine-needle aspiration. Your doctor will take a;tissue;sample from your thyroid gland and examine it under a microscope to see if its cancerous. The tissue sample is taken with a very small needle.
Another test your doctor may do is an ultrasound. This test uses sound waves to make a picture of the thyroids shape and the size of the nodules. It can help your doctor determine whether the nodule is a solid;tumor;or a;cyst;filled with fluid.
A third test is a thyroid scan. Your doctor will inject harmless radioactive iodine into a;vein;in your arm. The iodine is absorbed by your thyroid gland and makes it glow as your doctor takes a special picture. Your doctor can learn about the nodule depending on how much or how little of the iodine shows in the picture.
Is It Cancer Or Just A Benign Nodule
This page is written assuming you have read the introductory page on thyroid nodules first. If you have not, please do so because it will make this page easier to understand.
Thyroid nodules increase with age and are present in almost 10% of the adult population. Autopsy studies reveal the presence of thyroid nodules in 50% of the population, so they are fairly common. 95% of solitary thyroid nodules are benign, and therefore, only 5% of thyroid nodules are malignant.
Common types of the benign thyroid nodules are adenomas , thyroid cysts, and Hashimoto’s thyroiditis.
Uncommon types of benign thyroid nodules are due to subacute thyroiditis, painless thyroiditis, unilateral lobe agenesis, or Riedel’s struma. As noted on previous pages, those few nodules that are cancerous are usually due to the most common types of thyroid cancers that are the differentiated thyroid cancers. Papillary carcinoma accounts for 60%, follicular carcinoma accounts for 12%, and the follicular variant of papillary carcinoma accounts for 6%. These well differentiated thyroid cancers are usually curable, but they must be found first. Fine needle biopsy is a safe, effective, and easy way to determine if a nodule is cancerous.Thyroid cancers typically present as a dominant solitary nodule that can be felt by the patient or even seen as a lump in the neck by his/her family and friends. This is illustrated in the picture above.
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What Happens In A 5
1Division of Endocrinology, V. Fazzi Hospital, Piazza F. Muratore, 73100 Lecce, Italy
To determine an optimal time for follow-up of benign thyroid nodules, we retrospectively evaluated 249 euthyroid patients with uni-multinodular goiter, who underwent annual visit, and significant events that occurred in 5 years time were registered. A significant event occurred in 26.1% of patients, with more than one event occurring in the same patient in 27.7% of cases. The majority of events were observed at 24- and 36-month follow-up visit. These results suggest that a patient diagnosed with benign nodular goiter may be safely followed-up at a 2-3-year interval time.
Given the high prevalence of thyroid nodules and the number of patients with cytologically benign nodules with a normal thyroid function that periodically should be checked by ultrasound and thyroid function tests, it is easy to understand the global impact on the health care system deriving from such disease.
The aim of this study is to ascertain an optimal time interval of consultations, in order to guarantee an effective monitoring, but avoid an excessive and useless execution of consultations, function test, and ultrasound, for a benign disease that is also often asymptomatic.
Thyroid cytology categories followed the British Thyroid Association system .
Characteristics of study population are described in Table 1.
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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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
Ultrasound Testing & Manual Exams
There are really three different ways to test or evaluate your thyroid nodule.;
The first is with a manual exam, usually performed by your doctor.;
This is an easy way to test whether or not you need further testing.;
Your doctor can do this when you visit him/her in the office.;
This test is usually done by manually feeling or palpating the thyroid gland while the patient is taking a drink of water.;
The second is with ultrasound testing, usually performed by an ultrasound technician and read by a radiologist.;
Ultrasound testing can help you to understand if your thyroid nodule looks suspicious or not.;
There are certain factors, or characteristics, which, if present, may increase your risk of having thyroid cancer.;
These factors include:;
- The presence of absence of calcification – Microcalcifications found within thyroid nodules may suggest the presence of thyroid cancer.;
- The shape of the nodule – If your thyroid nodule is taller than it is wide then that is a risk factor for thyroid cancer.;
- The vascularity of the nodule – The presence of vascularity by Doppler ultrasound is also suspicious for thyroid cancer.;
- The margins of the nodule – Nodules which have irregular borders, which look ‘infiltrative’ , or which have speculated margins are all suspicious.;
Your ultrasound report should include this information and you can request this information from your primary care doctor or your radiologist.;
The third is with a biopsy, usually guided by an ultrasound.;
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Damaged Vs Destroyed Thyroid Gland Tissue
Very few organs in the body have the natural capacity or ability to grow back.;
One such organ that does have regenerative capacity is the liver.;
In fact, we know that civilizations from long ago knew of the liver’s ability to regenerate because they included it in some of their myths;!
In Greek Mythology, Prometheus was doomed to eternal punishment for giving fire to mankind and part of that punishment included his liver being eaten repeatedly by an eagle.;
Unfortunately, there is no such myth or story about a regenerating thyroid gland !;
Tissues such as your heart cell tissue and brain cell tissues do not have regenerative capacity like the liver.;
Think about what happens to someone after a stroke.;
A stroke occurs if the brain has been starved of oxygen. The result is that a portion of brain cells are permanently damaged from this oxygen deprivation.;
I know what you are already thinking.;
What about people who have had a stroke and experience something like the inability to move their right arm but then slowly regain that ability over time.
Doesn’t this mean that their brain tissue is regenerating?
Well, yes and no.;
And this is where we must draw a distinction between DAMAGED thyroid gland tissue and DESTROYED thyroid gland tissue.;
In the case of stroke, there will be portions of brain tissue that are permanently destroyed and those which are only slightly damaged.;
Damaged brain tissue have the ability to recover and this explains why some people can recover post stroke.;
Treatment If The Condition Gets Worse
If your thyroid nodule gets bigger, your doctor may recommend another fine-needle aspiration to see whether the nodule has become cancerous. If your nodule has become cancerous or appears to be cancerous, your doctor will probably recommend surgery to remove some or all of your thyroid gland. You may also need radioactive iodine.
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Ways To Improve Thyroid Nodules
Conventional treatment for thyroid nodules may include thyroid-damaging treatments, such as radioactive iodine or surgery. However, you may be able to reduce or eliminate your thyroid nodules;by addressing their root cause.
If your thyroid nodule;is benign, there are two main treatment options;that may help:
What Is The Thyroid
The thyroid is a small gland below the skin and muscles at the front of the neck, at the spot where a bow tie would rest.
It’s brownish red, with left and right halves that look like a butterfly’s wings. It weighs less than an ounce, but helps the body do many important things, such as grow, regulate energy, and go through sexual development.
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Thyroid Nodule Symptom # 6: A Feeling Like Things Get Stuck In Your Throat Sometimes When Eating
- What to do about it?
A thyroid nodule that causes any symptom of swallowing will need to be removed with surgery. The vast majority of these are simply large, benign goiters and only very few are cancerous. But like almost all thyroid nodules that cause symptoms, surgery will be necessary for this group. Many of these goiters won’t need a biopsy because it can be hard to get all the way to the back of the neck with a needle. Almost all of these will need a CAT scan to give the surgeon a better understanding of how big the goiter is and where it goes.
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A thyroidectomy may also be recommended if you have a single toxic nodule. A single toxic module is when just one thyroid nodule grows on your thyroid gland, making it larger than normal and causing it to produce excess thyroid hormones. This may cause hyperthyroidism.
Another instance where thyroidectomy may be recommended is if you have a toxic multinodular goiterthis is a condition similar to a single toxic nodule, only multiple nodules are present instead.
Another potential treatment is radioiodine therapy, which involves infusing the thyroid with radioactive iodine. The radioactive iodine destroys the thyroid gland cells, reducing the thyroid gland size and the amount of thyroid hormone it produces.
This therapy can be used to treat a single toxic nodule or toxic multinodular goiter. It uses a small amount of radioactivity and is considered safe. It should not, however, be used to treat pregnant or lactating women. Hypothyroidism is a common side effect of this treatment.
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Key Issues In Goiter & Thyroid Nodule
Whenever a person has a goiter or thyroid nodule, three questions must be answered.;
;Table 2.; Key Issues to Evaluate in a Person with a Goiter or Thyroid Nodule