Thyroid nodules are growths inside the thyroid gland made up of groups of abnormally reproducing cells. Although the vast majority of nodules are non-cancerous growths that don’t cause symptoms, up to 20% of thyroid nodules may contain thyroid cancer. Thyroid nodules occasionally produce excessive amounts of thyroid hormone, which can cause hyperthyroidism, but most often, thyroid nodules have no significant effect on hormone levels.
Various factors, including iodine deficiency, inflammation, or genetic predisposition can cause thyroid nodules. In many cases, they are discovered during a routine medical examination or through imaging tests like ultrasound.
Symptoms of thyroid nodules
- Neck swelling
- Difficulty swallowing
- Hoarseness
- Pain or discomfort
- Thyroid function changes
- Visible enlargement
If you're experiencing any of these symptoms, schedule an appointment with your St. Luke's Health primary care physician or endocrinologist to discover more.
How to diagnose thyroid nodules
- Your health care provider will begin by taking a detailed medical history, including any family history of thyroid disorders or cancer. They will also conduct a physical examination to assess the size and characteristics of the nodule and check for associated symptoms.
- Blood tests, such as measuring thyroid hormone levels (TSH, T3, and T4), help evaluate the overall thyroid function. Abnormal hormone levels can provide valuable information about the nodule.
- An ultrasound of the thyroid is a non-invasive imaging technique that allows your healthcare provider to visualize the nodule's size, shape, and composition. This imaging can help determine whether the nodule is solid or filled with fluid (cystic).
- If the nodule appears suspicious on ultrasound or if it's causing symptoms, your healthcare provider may recommend a fine-needle aspiration (FNA) biopsy. During this procedure, a small, thin needle is inserted into the nodule to collect a tissue sample. The sample is then examined under a microscope to determine whether the nodule is cancerous or benign.
- Thyroid scintigraphy involves the use of a small amount of radioactive material to assess how the thyroid nodule takes up iodine. It helps distinguish between "hot" nodules (overactive) and "cold" nodules (underactive), which can aid in diagnosis.
- In some cases, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be ordered to further evaluate the nodule and its impact on nearby structures in the neck.
- For certain cases, genetic testing may be considered to assess the risk of thyroid cancer and provide additional diagnostic information.
If you have nodules, your doctor will evaluate them with an ultrasound and a test to check hormone levels. They may also request a fine needle aspiration biopsy, a thyroid scan and uptake study, or a CT scan. If the thyroid nodules grow large enough or there are signs of thyroid cancer, your doctor may recommend surgery to remove a portion or all of the thyroid gland.
What are the treatment options for thyroid nodules?
- Observation: If the thyroid nodule is small, benign, and not causing any symptoms, your healthcare provider may recommend a "watch and wait" approach. This involves regular monitoring through physical exams and thyroid ultrasound to track any changes in the nodule's size or characteristics.
- Medication: In some cases, thyroid nodules can lead to overproduction of thyroid hormones (hyperthyroidism). Medications like beta-blockers or antithyroid drugs may be prescribed to manage the symptoms and hormone levels. These drugs do not typically shrink the nodule but can control related issues.
- Thyroid hormone replacement: If the nodule is causing hypothyroidism (underactive thyroid), your healthcare provider may prescribe thyroid hormone replacement therapy to maintain proper thyroid function.
- Radioactive iodine treatment: Radioactive iodine is used to treat hyperthyroidism and may be recommended when thyroid nodules are overactive (hot nodules). The radioactive iodine is taken orally and is absorbed by the overactive thyroid tissue, which can reduce nodule size and normalize thyroid function.
- Thyroid nodule aspiration: For nodules that are suspicious or have unclear characteristics, an FNA biopsy may be performed to collect a tissue sample. If the biopsy confirms cancer, further treatment options may be considered.
- Surgery (thyroidectomy): Surgical removal of the thyroid nodule or, in some cases, the entire thyroid gland (thyroidectomy) may be recommended for large nodules, nodules causing symptoms, or nodules that are cancerous. Surgical treatment is typically necessary if the nodule is compressing nearby structures or if it is malignant.
- Minimally invasive procedures: Some thyroid nodules can be treated with minimally invasive procedures, such as radiofrequency ablation (RFA) or laser ablation. These techniques use heat to shrink the nodule.
Scarless thyroid surgery to remove nodules
Baylor St. Luke’s Medical Center is the only hospital in Texas to offer scarless thyroid surgery using the transoral vestibular approach (TOVA). This minimally invasive procedure involves making small incisions in the mouth through which a surgeon uses long instruments to remove the necessary parts of the thyroid gland. If you need a partial or total thyroidectomy, ask your endocrinologist if you may be a candidate.
