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What Percent Of Solid Thyroid Nodules Are Cancerous

What Are The Signs And Symptoms Related To Thyroid Nodules

590: Thyroid Swelling & Thyroid Nodules When to worry?

Most thyroid nodules do not cause any symptoms.; Some thyroid nodules show up as a painless lump in the neck that you can feel or see. Thyroid nodules usually move up and down with swallowing.;

When thyroid nodules become large they may cause symptoms by pressing on the airway or esophagus. These are also called compressive symptoms. Compressive symptoms include:

  • discomfort with swallowing

At the UCLA Endocrine Center in Los Angeles, multiple layers of evaluation are designed to help you avoid invasive tests and surgery whenever possible. Consultation, ultrasound, and FNA can all be performed in a single;visit.

Initial evaluation of a newly discovered thyroid nodule begins with:

  • Assessment by an endocrinologist or endocrine surgeon
  • Thyroid function tests
  • Neck ultrasound performed by your doctor

An ultrasound is a highly accurate tool to visualize your nodule. There is no associated radiation with ultrasounds and it is non-invasive. Ultrasounds are cost-effective as most patients really don’t need any other imaging because the ultrasounds are the best way to look at the thyroid, all present nodules, and the lymph nodes in the neck.

Our cytopathologists evaluate over 1000 samples per year, so we are confident in the accuracy of our biopsies. When biopsy does not give a clear answer, we automatically use molecular profiling to refine the diagnosis.

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.

References

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

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Key Issues In Goiter & Thyroid Nodule

Whenever a person has a goiter or thyroid nodule, three questions must be answered.;

  • Is the gland, or a portion of it, so large that it is stretching, compressing, or invading nearby structures?; Thyroid swelling can cause a sensation of tightness or, less commonly, pain in the front of the neck.;;A goiter or nodule can compress the windpipe causing cough or shortness of breath, while pressure on the swallowing tube can cause discomfort with swallowing or even the inability to get things down.;;When a goiter extends down into the chest, blood returning from the neck and head can be partially obstructed, causing neck veins to bulge.;;When a goiter or nodule is due to cancer, the tumor may actually grow into nearby structures, causing pain, hoarseness when nerves to the voice box are invaded, or coughing up blood when the trachea is penetrated.; ;;;
  • Third, is the goiter or thyroid nodule due to malignancy?;;Fortunately, most patients with a goiter or thyroid nodule do not have thyroid cancer.;;Often other findings in a patient with a goiter, such as the features of hyperthyroid Graves disease, make it unnecessary to do additional tests to rule out cancer.;;On the other hand, almost everyone with a thyroid nodule larger than 1.0 to 1.5 cm in diameter must be investigated for the possibility of thyroid cancer.;;The approach to these diagnostic evaluations is discussed below.;
  • ;Table 2.; Key Issues to Evaluate in a Person with a Goiter or Thyroid Nodule

    Thyroid Nodules And Treatment: Get The Facts

    Figure 1 from Differentiation of benign and malignant ...

      For many patients, being told they have athyroid nodule instantly raises red flags. DoI have cancer? Will I need surgery? Should I be worried?

      The answer to these questions is usually, butnot always, no. Thyroid nodules are lumps that form within your thyroid, abutterfly shaped gland located at the base of your neck. Nodules can be solidor contain a variable amount of fluid. If they are completely fluid-filled,they are called thyroid cysts.;

      Thyroid nodules are more common in womencompared to men and more likely to occur as you get older. The exact reason whysome people get thyroid nodules and others dont is not known, but nodules tendto run in families.;

      Most thyroid nodules are benign and cause no problems if left untreated. However, approximately 5 to 10 percent of thyroid nodules are cancerous but even then, a patient might not need surgery right away because most;thyroid cancers;grow slowly.

      If you have been diagnosed with a thyroid nodule, the first step is to see an endocrinologist a doctor who specializes in conditions of the endocrine glands, such as the thyroid.;

      Most thyroid nodules are benign and cause no problems if left untreated. However, approximately 5 to 10 percent of thyroid nodules are cancerous but even then, a patient might not need surgery right away because most thyroid cancers grow slowly.

      Iram Hussain, M.D.

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      What Is A Thyroid Nodule

      A thyroid nodule is a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding tissue. Nodules are common and found in 10 percent of the adult population. Luckily, most of them are benign. The clinical importance of thyroid nodules is the need to rule out thyroid cancer, which occurs in 7-15 percent of cases depending on age, sex, radiation exposure, family history and other factors. For the U.S. population, the lifetime risk of developing thyroid cancer is 1.1 percent. When a thyroid nodule is suspicious meaning that it has characteristics that suggest thyroid cancer the next step is usually a fine needle aspiration biopsy .

      Thyroid Molecular Markers Allow Patients To Avoid Surgery

      We want to help patients find that perfect balance between under-treatment and over-treatment. The people-gram shows how molecular testing can help patients avoid unnecessary surgery.

      Left Path: Before the use of molecular markers, everyone with an indeterminate biopsy went to surgery. Of those who went to surgery, cancer was found in only 25% of those cases . 75% of the surgical patients turned out not to have needed surgery at all because their nodules were benign .

      Right Path: Today, if you have an indeterminate biopsy, you also undergo molecular testing.50% of patients were categorized as benign from the molecular test and safely avoided surgery. Of the surgical patients who received a suspicious molecular test result , cancer was found in 50% of those patients .

      It is very rare that patients end up having cancer because of a false negative test. Still, it is UCLAs standard of care to have a safety net and follow every patient after molecular testing, regardless of their result. Those patients will get ultrasounds every 12 months to ensure that nodules do not grow or change in appearance.

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      Thyroid Nodules: When To Worry

      Suppose you go to your doctor for a check-up, and, as shes feeling your neck, she notices a bump. Then, suppose she tells you theres a nodule on your thyroid. Is it time to panic?

      No, say experts at Johns Hopkins Department of Otolaryngology and Head and Neck Surgery. Thyroid nodules even the occasional cancerous ones are treatable.

      Heres what you need to know about thyroid nodules and how concerned you should be if you develop one.;

      Whats The Treatment For A Thyroid Nodule

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

      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.

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      Irradiation Of The Thyroid And Neck Region

      In the 1940s and early 1950s, many children were given X-ray treatment for a variety of benign conditions of the thymus, adenoids, tonsils, and skin.

      It was later realized that this irradiation affected the thyroid gland. In some studies up to 25% of such people eventually developed thyroid nodules, one third of whom developed thyroid cancer.

      Thyroid nodules which appear following irradiation should be investigated by clinical examination, thyroid ultrasound and biopsy just like other nodules. However if there is a suspicion of malignancy, the thyroid nodule should be removed and the rest of the gland examined carefully for the presence of thyroid cancer.

      What about people who received irradiation but who do not have a nodule? It is important that such people be carefully examined because of the high likelihood of a nodule developing.

      What Do You Do When Your Child Has A Thyroid Nodule

      The first step if your child has a thyroid nodule is to get an ultrasound. This will help your healthcare provider assess the quality of your childs nodule and determine if additional workup is needed. In some cases a repeat ultrasound is needed, and in some cases a biopsy. This all depends on what it looks like on the ultrasound. Some nodules require labs to look at how the thyroid is functioning.

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      What Are The Symptoms Of Thyroid Nodules

      Changes in the thyroid may be seen or felt, but most thyroid nodules dont cause symptoms. They are often discovered during a routine physical exam or via medical imaging, like ultrasound or computed tomography exams, performed for unrelated reasons. Sometimes the tissue in a nodule makes too much of the thyroid hormones causing hyperthyroidism, which can be seen by performing a thyroid-stimulating hormone blood test. However, most thyroid nodules, including those that are cancerous, are actually non-functioning, meaning tests like TSH are normal.

      Its important to see your doctor if you have:

      • Swelling or a lump in the neck.
      • Hoarseness or other voice changes.
      • Difficulty swallowing or persistent sore throat.
      • Difficulty breathing.
      • Pain in the front of the neck
      • A persistent cough.

      At What Size Should A Thyroid Nodule Be Biopsied

      To biopsy or not

      According to the Society of Radiologists in Ultrasound, biopsy should be performed on a nodule 1 cm in diameter or larger with microcalcifications, 1.5 cm in diameter or larger that is solid or has coarse calcifications, and 2 cm in diameter or larger that has mixed solid and cystic components, and a nodule that has

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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.

      What Is The Thyroid Isthmus

      The thyroid is located at the front of the lower part of the neck. The gland is shaped like a butterfly, with “wings,” or lobes, located on each side of the windpipe. These lobes are joined by a bridge of tissue known as the isthmus, which spans across the windpipe.

      The thyroid makes hormones that travel in the blood to tissues throughout the body.

      The hormones produced by the thyroid help the body produce energy, stay warm, and keep vital organslike the heart and brainworking properly.

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      What Does A Thyroid Fine Needle Aspiration Or Biopsy Entail

      In some situations this is performed with local anesthesia in the clinic. Your child will be awake. In very young children the FNA is done in the operating room under general anesthesia. The pathologist will look at the tissue to determine what they thyroid nodule is composed of and if additional workup or surgery is needed. It often takes about one to two weeks to get the results.

      What Is A Goiter

      Causes of Thyroid Nodules

      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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      Should I Worry About Thyroid Nodules

      Youve just been told by a primary care physician you have thyroid nodules. It might sound like a worrisome thing, but it isnt that unusual. Nearly one-half of the U.S. population has them and most of the time they are benign. However, you should still have an expert evaluate them. We asked endocrinologist Dr. Dev Abraham at the University of Utah Thyroid Clinic to tell us more about thyroid nodules, how he evaluates them and one important thing to keep in mind even if they do turn out to be cancerous.

      Interviewer:

      A lot of times, Dr. Abraham, from what I understand, people find out about these thyroid nodules while the doctor was looking for something else and then theyre told, You have thyroid nodules. Should that person worry at that point?

      Dr. Abraham:

      Interviewer:

      Dr. Abraham:

      So now we know that what we call this microscopic, or sub-clinical, thyroid cancer is literally common in general population that we cannot even use sometimes an ultrasound to diagnose. And these cancers coexist with us and we die of something else. And simply diagnosing these causes more harm is what came out of that study.

      Announcer:

      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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      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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