Nodules

1 Nodules Summary

Nodules are non-cancerous, abnormal growth of a tissue. It may form just below the tissue or deep inside or on organs. Lymph nodules, vocal cord nodules, and thyroid nodules are examples of such benign growths. Most common areas where nodule growth can be noted are armpits, groin, vocal cords, thyroid glands, and lungs.

Nodules are associated with other symptoms like:

  • Pain in the nodular region
  • Presence of a lump on the skin
  • Change in voice
  • Discomfort

Discomfort is usually noted when the nodule is present in the abdomen. Voice changes are present when the nodules develop in vocal cords. People with vocal cord nodules are unable to hold the pitch steady for a long time.

They often feel worn out after a performance, a condition called as vocal fatigue. The associated symptoms vary with the type of nodules. Wheezing, shortness of breath, fever and coughing are common in lung nodules.

Thyroid nodules may be associated with unexplained weight loss, tremors, intolerance to heat, and nervousness. In some cases, nodules may not be associated with any other symptoms.

Nodules are of different types: 

  • Lymph node nodules – lymph nodes are located throughout the body and plays and important role in the immune system. Very often lymph nodes present in the armpit, groin and neck may develop nodules.
  • Vocal cord nodules – as the name indicates these nodules develop in the vocal cords. Reflux of stomach acid that irritates the vocal cords may trigger the formation of vocal cord nodules. Overuse of vocal cords may also result in these benign growths.
  • Lung nodules – nodules formed by inflammation of lungs are called lung nodules. Lung inflammation may be caused by diseases or infection.
  • Thyroid nodules – there are different types of thyroid nodules based on the cause. This includes colloid nodules that develop from lack of iodine, multinodular goiter, and nodules caused by thyroid cancer.

The most common causes of nodules are injuries, infections, hormones and iodine deficiency. Some forms of nodules develop due to cancer.

Apart from medical history and physical examination, the doctor may recommend other tests and investigations based on the underlying cause of the nodule.

Blood test and tissue biopsy are commonly suggested to diagnose the cause of nodule formation. In some cases, particularly for nodules that form in the internal organs, imaging studies are suggested.

Benign nodules are monitored without any specific treatment. In many cases, nodules change and resolve on its own without any treatment. Prescription medications are recommended to reduce the number of thyroid hormones in the case of thyroid nodules caused by hyperthyroidism.

Surgery is another treatment option to remove the nodules that affect the functioning of an organ. For cancerous nodules, treatment options include surgery, radiation therapy, chemotherapy or a combination of different methods.

Outlook of the treatment depends on the underlying cause of nodules. Early diagnosis of the conditions helps in the successful treatment of the symptom. Understanding the associated symptoms, changes in the nodule, and pain associated with the nodule helps in prompt treatment when needed.

2 Diagnosis and Treatment

Medical history and physical examination are very important in the diagnosis of the nodules. Vocal cord nodules are diagnosed using micro laryngoscopy and bronchoscopy (MLB).

In this procedure, the doctor views the airways using a telescope and light.These two parts are contained in an endoscope. Full voice analysis is done a language therapist and an ENT specialist. 

For thyroid nodules, physical examination, thyroid function tests, ultrasonography, fine-needle aspiration biopsy and thyroid scan are used. During the physical examination, the doctor may examine the thyroid while the patient is swallowing.

In thyroid function tests, blood levels of thyroid hormones are measured. This helps to understand the functioning of the thyroid gland, which becomes abnormal with nodule formation.

Ultrasonography helps to visualize the structure of nodules. A biopsy helps to distinguish between benign and malignant nodules. Thyroid nodules are specific for evaluating the nodules in the gland.

Subcutaneous nodules are diagnosed on the basis of blood tests for ESR and other basic investigations. Urinalysis is suggested if the suspected cause of the nodule is vasculitic skin lumps.

Larger lesions are visualized with the help of ultrasound scan. Uric acid measurement helps to identify nodules. Excision biopsy is used in certain cases for investigation. Cytology is used to diagnose basal cell carcinoma.

A benign form of thyroid nodule may be monitored for some time using x-rays. Changes in nodules like size or shape need evaluation.

Other tests include: 

  • Blood tests
  • Tuberculin tests for TB
  • PET scan
  • Single-photo emission CT
  • Magnetic resonance imaging
  • Biopsy

Monitoring without specific treatment is the method followed if nodules are non-cancerous. In some cases, nodules may change and resolve on its own. In children with vocal cord nodules, non-surgical methods may be used.

Humidification and voice training are used as treatment options to control allergies or sinus problems that alleviate swelling in the cords. Controlling GERD using home treatment and medications also help in regulating the nodules. MLB may be used to remove the nodules in vocal cords.

Thyroid hormone suppression therapy involves prescription medication. In some cases, a benign nodule may be removed using surgery. This method is suggested if the nodule is large and makes swallowing hard.

Thyroid nodules that cause hyperthyroidism are treated with radioactive iodine, anti-thyroid medications, and surgery. Cancerous nodules in the thyroid are treated with surgery.

A biopsy may be suggested for removal of the entire nodule in the case of benign lung nodules. Invasive surgery may also be used to remove the nodule.

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