Thyroid Nodules

Thyroid nodules are either fluid-like or solid lumps that grow within the thyroid, which is a small gland found at the neck base. While there is a small percentage where thyroid nodules are cancerous, most of the cases do not cause any symptoms at all.

Most often, you won’t notice you have it unless you had yourself checked. However, some thyroid nodules grow big enough that they are too obvious not to be noticed. Depending on the thyroid nodule, treatment options may vary.

Most thyroid nodules do not cause any signs and symptoms. In some cases, though, they grow so large that you can see and feel it. It is like the base of your neck is swollen. 

It can also cause difficulty in swallowing and breathing if it is pressing against the esophagus or windpipe. Moreover, there are extremely rare cases when the nodules produce extra thyroxine, which may cause hyperthyroidism.

Some thyroid nodules are cancerous, but the symptoms alone won’t be able to tell if one is malignant or not. Malignant thyroid nodules are rare, but it is ideal to see your doctor once you notice unusual swelling around your neck or upper breast bone, particularly if you find it hard to swallow or breathe.

Additionally, if you are experiencing the symptoms of hypothyroidism -sudden weight loss without changing your diet, trouble sleeping, nervousness, irritability, and pounding heart – seek immediate medical care.

There are several factors that may cause thyroid nodules, these include:

• Iodine deficiency. Deficiency in the mineral iodine may result in development of nodules in the thyroid gland. 
• Thyroid adenoma. Or abnormal growth of the thyroid tissue may cause nodules to grow. The overgrowth is benign or non-cancerous, but could be bothersome because of its size. 
• Thyroid cyst. Usually caused by degenerating adenomas, thyroid cysts are usually non-cancerous, but in rare cases may contain malignant or cancerous components. 
• Thyroiditis. It is the chronic inflammation of the thyroid glands caused by a thyroid disorder.
• Multinodular goiter. Goiter is any kind of enlargement within the thyroid gland that is usually a cause of thyroid disorder or iodine deficiency. In multinodular goiter, the goiter contains a number of distinct nodules.
• Thyroid cancer. While most nodules are non-cancerous, you are at high risk of having malignant nodules if your family has a history of thyroid or endocrine cancers.
• Those who are aged 30 years and younger or 60 and older are more at risk, as well as men, and those who have been exposed to radiation.

A malignant nodule is usually hard and large. It may also cause discomfort and pain, which are not normal with thyroid nodules.

Making a diagnosis of thyroid nodules is done by several tests.

Although they are typically benign or non-cancerous, it is important to see a doctor once you noticed a growth in your neck, particularly in the lower middle part. 

Most often, you won’t be able to see or feel it, and nodules are usually discovered when doing a routine checkup. Imaging tests like CT scan, MRI, or ultrasound may also reveal growth of nodules in this area. 

Once your doctor detects the nodule, he or she may refer you to an endocrinologist, or a specialist in endocrine disorders. The endocrinologist will then assess your nodules by doing several tests, such as:

• Physical exam. During the physical exam, your doctor may observe your thyroid as you swallow, since thyroid nodules tend to move when swallowing. 

• Thyroid function tests. Various tests are done to measure the thyroid function. There are tests that measure the level of the hormones thyroxine and triiodothyronine, which are primarily produced by the thyroid glands. The TSH or thyroid-stimulating hormone level is also examined.

• Ultrasonography. To get the best information on the nodule’s structure and shape, the doctor may request an ultrasonography. It is a kind of imaging process, which uses sound waves to form images. 

• FNA or Fine-needle aspiration biopsy. In order to rule out cancer, nodules are biopsied through various tests. One way to find out if the nodule is benign or malignant is by the fine-needle aspiration. 
• This procedure involves pricking the nodule with a special needle, which draws out cell samples. The samples are then analyzed to see if the growth in your thyroid needs extra attention.

• Thyroid scan. To further evaluate nodules the doctor may suggest a thyroid scan. A thyroid scan is done by injecting radioactive iodine into a vein. A special camera is then used to get images of your thyroid.

The kind of treatment for thyroid nodules depends on the type of nodules you have in your thyroid gland. 

If the nodules are benign or non-cancerous, treatment options may include:

• Waiting and observation. The doctor may advise “watchful waiting” or just observing the situation thru regular thyroid function tests and physical examinations. Treatment may not be necessary if the nodule stays the same after a certain period. 

• Thyroid hormone suppression therapy. This kind of treatment involves using levothyroxine, a synthetic form of the hormone produced by the thyroid gland.  This is done to provide additional hormone, which will tell the pituitary gland to start making less of the TSH, or the hormone responsible for tissue growth in the thyroid gland. However, there is still no evidence that shows this method is reliable. 

• Surgery. A benign nodule typically requires surgery, particularly if the nodule is large and makes breathing and swallowing difficult. People affected with large, multinodular goiters, which may constrict airways, blood vessels, or the esophagus, are also a candidate for surgery. 

On the other hand, if the nodules are malignant or cancerous, surgery is usually advised. Near-total thyroidectomy or the surgical removal of the malignant nodules, along with most of the thyroid tissue, is primarily done to remove the nodules and cancer cells. 

The procedure involves certain risks, so it is important to discuss it with your doctor.

People with thyroid nodules may experience complications, such as:

• Difficulty breathing and swallowing
• Multinodular goiter
• Hyperthyroidism and its complications (irregular heartbeat, osteoporosis, thyrotoxic crisis)
• Thyroid cancer