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What If A Thyroid Nodule Is Cancerous

Risk Factors For Thyroid Nodules

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

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

  • Being female

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Comparable Results To Pathology

Traditional pathology reports on the surgically removed nodules determined that, out of 257 nodules , 72% were benign, 24% were malignant, and 4% were a type of borderline malignancy that should be surgically removed.

Overall, the ThyroSeq test carried out on the biopsy samples taken before surgery classified 61% of the nodules as benign and 39% as cancerous. ThyroSeq correctly identified 94% of the nodules that were shown to be cancerous after surgery. The test performed about as well in all subtypes of thyroid cancer found in the study, including rare Hurthle cell neoplasms.

Of the 152 biopsy samples that were classified as benign by ThyroSeq, 3% turned out to be false-negative results: that is, the nodules were actually cancerous. This is about the same rate of false-negative results found among standard biopsies, explained Dhaval Patel, M.D., a thyroid surgeon in NCIs Center for Cancer Research, who was not involved with the study.

Sometimes when we biopsy nodules, if its a large nodule, we can miss the area that is cancerous. So up to 3% of the time the biopsy is negative, but it is cancer, he said.

All the nodules that produced false-negative results on ThyroSeq were low-risk tumors that were nonaggressive and had not spread outside the thyroid, explained Dr. Nikiforov.

Will I Need To Take A Thyroid Pill After My Operation

The answer to this depends on how much of the thyroid gland is removed. If half thyroidectomy is performed, there is an 80% chance you will not require a thyroid pill UNLESS you are already on thyroid medication for low thyroid hormone levels or have evidence that your thyroid function is on the lower side in your thyroid blood tests. If you have your entire gland removed or if you have had prior thyroid surgery and now are facing removal of the remaining thyroid then you have no internal source of thyroid hormone remaining and you will definitely need lifelong thyroid hormone replacement.

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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.

Symptoms Of Thyroid Nodules

Thyroid nodule. Causes, symptoms, treatment Thyroid nodule

Thyroid nodules usually do not cause symptoms. For this reason, theyre often found by a healthcare provider during a routine neck examination or an imaging test done for another reason .

When thyroid nodules do produce symptoms, the most common are a lump in the neck and a sense of mass while swallowing . In addition, larger nodules may cause difficulty breathing, hoarseness, and neck pain.

Rarely, the tissue in a thyroid nodule makes too much of the thyroid hormones triiodothyronine and thyroxine , which can lead to symptoms of hyperthyroidism . These include:

  • Anxiety
  • Missed or light menstrual periods

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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.
  • Bleeding.
  • Fluid collection under the skin.
  • The need for future procedures such as removal of the lymph nodes from the neck.

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:

  • Improve your gut health.
  • Optimize your iodine levels.
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    Overview Of Typical Thyroid Cancer Treatment

    • Thyroid cancer is usually diagnosed by sticking a needle into a thyroid nodule or removal of a worrisome thyroid nodule by a surgeon.
    • The thyroid nodule is looked at under a microscope by a pathologist who will then decide if the nodule is benign or malignant .
    • The pathologist decides the type of thyroid cancer: papillary, follicular, mixed papillary-follicular, medullary, or anaplastic.
    • The patient must be comprehensively evaluated with a thorough high-resolution ultrasound. Not only must the thyroid be completely examined. But the entire lymph nodes of the neck need to be examined to determine whether there is any spread to lymph nodes. Any suspicious lymph nodes must be biopsied prior to surgery so that the correct surgical procedure can be done the first time! You can find out more about the importance of high-resolution ultrasound in the evaluation of your thyroid nodule or cancer your in this video on thyroid nodules.

    The entire thyroid cancer must be surgically removed sometimes with just partial removal of the thyroid gland or total removal of the thyroid gland. With the use of high-resolution ultrasound before your operation and by expert inspection by your surgeon during your operation, the lymph nodes in the neck are examined to see if lymph nodes also need to be removed.

    Questions To Ask Your Doctor

    Thyroid Nodule Suspicious For Cancer – What Should I Do?
    • Is my thyroid nodule cancer? If it isnt now, does this mean that I am more prone to developing thyroid cancer?
    • Will my children be more likely to get thyroid nodules?
    • What is the best treatment for my thyroid nodules?
    • If I have one thyroid nodule now and it goes away, will it come back?
    • What can I do at home to prevent thyroid nodules?
    • Do you have any educational materials I can read?
    • Can you recommend any websites?

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    What Causes Thyroid Cancer

    In most cases, the cause of thyroid cancer is unknown. However, certain things can increase your chances of developing the condition.

    Risk factors for thyroid cancer include:

    • having a benign thyroid condition
    • having a family history of thyroid cancer
    • having a bowel condition known as familial adenomatous polyposis
    • acromegaly a rare condition where the body produces too much growth hormone
    • having a previous benign breast condition
    • weight and height

    Read more about the causes of thyroid cancer

    Are Thyroid Nodules Ever Surgically Removed For Reasons Other Than Cancer

    Yes. Surgery might be considered if a nodule is large and causing a visible mass in your neck, or if its pressing on your windpipe or esophagus , which can cause discomfort or difficulty breathing or swallowing. In cases where a thyroid nodule is cranking out excess amounts of thyroid hormone, surgically removing the nodule can cure the hormone overproduction.

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    What Types Of Healthcare 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.

    Papillary Thyroid Cancer Complications

    Thyroid Nodule

    Even with radioactive iodine therapy and surgery, its still possible that papillary thyroid cancer , the cancer may recur. Recurrent thyroid cancer may occur yearseven decadesafter the initial treatment for the disease. Fortunately, though, recurrent thyroid cancer is treatable.

    Patients with stages 1 or 2 thyroid cancer have an 85% chance of reaching complete remission after their initial cancer treatment. The 5-year survival rate is 80% for stage 1 patients and 55% for stage 2. Patients with stage 3 or 4 cancer have similar 5-year survival ratesbetween 15% and 35%.1

    Thyroid cancer is treated, in part, by surgically removing all or part of the thyroid gland, a procedure known as a thyroidectomy. This is followed by radioactive iodine ablation of thyroid cells that may remain after this operation.

    The most common sites where recurrent thyroid cancer appears are in the lymph nodes in your neck. Papillary thyroid cancer may also re-develop in other parts of the body, such as the bones and lungs.

    • Thyroid Cancer: Complications. Mayo Clinic Health Information Web site. Available at: April 10, 2009. Accessed February 26, 2010.


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    Thyroid Nodules And Thyroid Cancer

    The biggest concern on most people’s mind is probably whether or not their thyroid nodule is actually cancer in disguise.

    As I mentioned previously, most thyroid nodules are benign.

    But that leaves another 5-10% which can be cancerous and should be evaluated.

    There are some factors which have been evaluated which can help you understand your risk of thyroid cancer.

    The risk of thyroid cancers increases with these risk factors:

    What Happens Next

    Once the presence of nodules is confirmed, itis important to get a blood test to check the function of your thyroid gland.If your thyroid is producing too much thyroid hormone , we cando a radioactive iodine uptake and scan. This study involves swallowing a pilland taking a picture the next day to tell us whether the nodule is making toomuch thyroid hormone. If it is, then it is called a hot nodule and doesnt requirea biopsy.

    If a nodule is large or looks suspicious, wewill do a fine needle aspiration biopsy, which involves using thin needles totake tissue samples of a tiny portion of the nodule that is evaluated in thelab for cancer cells. We usually save two samples if the pathologist canttell whether cancer is present in the first sample, we can send the second formolecular testing. This is an advanced type of testing to help us assess therisk of thyroid cancer in the nodule and determine the best course of action.

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    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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    The Diagnosis Meaning And Treatment Of Thyroid Nodules

    Thyroid Nodules, Cancers & Treatment

    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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    Optimize Iodine Levels To Improve Thyroid Nodules

    Thyroid hormone is made up in large part by iodine, which has led some clinicians to recommend iodine supplementation to support thyroid health. However, we need to get just the right amount of iodine. The American Thyroid Association states, Iodine deficiency, which is very uncommon in the United States, isknown to cause thyroid nodules. However, too much dietary iodine can increase the risk of goiter, multinodular goiter, nodules, and thyroid autoimmunity, especially in Hashimotos thyroiditis. [20

    Thyroid Nodules Are Usually Benign And Not Cancerous

    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 dont 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:

    Its 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, its 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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    Thyroid Nodule Symptoms: Uncommon But Can Happen

    Thyroid nodule patients usually have no symptoms, but when they do have symptoms they are most commonly:

    • A lump in the neck
    • Uncomfortable pressure sensation on the breathing tube
    • A sense of feeling like they need to swallow something or difficulty swallowing
    • Discomfort in the neck

    Thyroid nodules may also rarely produce the thyroid hormone, thyroxine, in excess. This is uncommon but the reason why all patients with thyroid nodules should have a blood test for thyroid stimulating hormone . Thyroid nodules that produce extra thyroid hormone can cause symptoms of hyperthyroidism which include:

    • Unexplained weight loss
    • Nervousness
    • Rapid or irregular heart rate

    How Does Thyroid Cancer Affect Pregnancy

    Causes and Types of Thyroid Cancer

    Thyroid cancer is the second most common cancer diagnosed in pregnant women . Approximately 10% of thyroid cancers develop during pregnancy or within the first year after childbirth. Experts believe fluctuating hormone levels during pregnancy may trigger the cancer.

    If you receive a thyroid cancer diagnosis during pregnancy, your healthcare provider can discuss treatment options. Depending on the cancer type and severity, your provider may recommend delaying treatment until after you deliver your baby. If treatment cant wait, most women can safely undergo surgery to remove the cancerous gland. You shouldnt have radioactive diagnostic tests or treatments when youre pregnant or breastfeeding.

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    When To Get Medical Advice

    See a GP if you have symptoms of thyroid cancer. The symptoms may be caused by less serious conditions, such as an enlarged thyroid , so it’s important to get them checked.

    A GP will examine your neck and can organise a blood test to check how well your thyroid is working.

    If they think you could have cancer or they’re not sure what’s causing your symptoms, you’ll be referred to a hospital specialist for more tests.

    Find out more about how thyroid cancer is diagnosed.

    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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    I Have Thyroid Nodules Should I Be Worried

    A thyroid nodule is a growth within the thyroid a butterfly shaped gland located just below the Adams apple in the neck. The thyroid sends out hormones that help control the bodys metabolism. Thyroid nodules are very common and occur in 30% of all people in the United States. Like most thyroid conditions, nodules are more common among women than men. They are also more common with older age. By the age of 60, more than half of women will have a thyroid nodule. Sometimes nodules go undetected, other times you or a health care provider may feel them in the neck, or they may be seen on ultrasound or CT scan that you have for another reason.

    If you learn that you have a thyroid nodule the first thing to do is see your primary care provider to obtain more information. Does your thyroid function normally or is it overactive a condition called hyperthyroidism? Symptoms of hyperthyroidism include nervousness, feeling hot, weight loss or tremor. Does the thyroid not produce enough hormone? This condition, called hypothyroidism, has the opposite symptoms including fatigue, sleepiness, weight gain, and thinning hair. Your doctor can determine if you have either of these with a simple blood test called thyroid stimulating hormone, or TSH. Your doctor will also obtain an ultrasound of your neck to see more detail of your thyroid if you have not had this already.

    To schedule an appointment at Nebraska Medicine, call 800.922.0000.


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