What is a thyroid nodule?
Thyroid nodules are solid or fluid-filled lumps or bumps that develop in your thyroid gland (located in the front of your neck). Thyroid nodule can be single or in the form of a group of nodes. Thyroid nodules are relatively common and rarely become cancerous. However, in cases where nodules severely affect thyroid function, thyroid surgery may be necessary.
What are the types of thyroid nodules?
There are different types of thyroid nodules, the most common ones are discussed below.
Thyroid adenoma means a benign growth of normal thyroid tissue and has different forms and names. This type of thyroid nodules usually do not require treatment if they do not cause pain and pressure in the front of the neck. In cases where thyroid adenoma is completely asymptomatic, it is usually diagnosed during a simple ultrasound.
Toxic adenomas are those thyroid adenomas that secrete excess thyroid hormone and cause hyperthyroidism. Toxic thyroid adenomas are mostly benign and only in very rare cases (between 1 and 8%) may be diagnosed as malignant.
A thyroid cyst is a fluid-filled nodule that develops inside the thyroid itself. Pure thyroid cysts are usually benign (non-cancerous).
Any enlargement of the thyroid gland is known as a goiter. Goiter can be caused by Hashimoto’s thyroiditis (an autoimmune disease) and iodine deficiency. These cases usually do not need treatment; Unless the goiter is causing severe pressure or symptoms of hyperthyroidism.
Multi-nodular goiter means enlargement of the thyroid gland due to the presence of multiple nodules. In most cases, these nodules are benign. As mentioned, this condition only needs treatment if you are experiencing symptoms of pressure or hyperthyroidism or if one or more nodules are suspected to be thyroid cancer.
Thyroid cancer occurs when normal thyroid cells undergo genetic changes that lead to their abnormal growth. In very rare cases, you may develop thyroid cancer due to the presence of malignant thyroid nodules.
Thyroid nodule symptoms
Most thyroid nodules do not cause symptoms. However, if you have multiple nodules or large nodules, you may experience some of the following symptoms.
In rare cases, nodules can become large enough to cause the following symptoms:
- Difficulty swallowing or breathing
- Hoarseness or voice change
- Pain in the front of the neck
Enlargement of the thyroid gland (goiter)
Overactive (hyperactive) thyroid nodules can lead to overproduction of thyroid hormones, also known as hyperthyroidism. Symptoms of hyperthyroidism include:
Rapid heartbeat (palpitations)
- Feeling shaky or anxious
- Weight Loss
- Increased appetite
- Diarrhea and frequent bowel movements
- Difficulty sleeping
- Enlargement of the thyroid gland (goiter)
- Decreased menstrual bleeding or delayed menstruation
Thyroid nodules may also be associated with low thyroid hormone levels (hypothyroidism). Symptoms of hypothyroidism include:
- Fatigue
Numbness and tingling in the hands
- Weight Gain
- Dry and rough skin and hair
- Constipation
- Depression
- Early and heavy menstruation
What is the cause of thyroid nodule?
Most thyroid nodules are caused by overgrowth of normal thyroid tissue. The cause of this excessive growth is usually unknown, but in most cases, genetics and family history are involved.
In rare cases, thyroid nodules may be associated with:
- Hashimoto’s thyroiditis; An autoimmune disease that leads to hypothyroidism.
- Thyroiditis or chronic thyroid inflammation
- Thyroid cancer
- Iodine deficiency
- Performing X-ray tests on the thyroid during infancy or childhood
Which people are more at risk of thyroid nodules?
Anyone of any age (children and adults) can develop a thyroid nodule. However, the thyroid nodule is approximately four times more common in females than in males. Also, the incidence of thyroid nodules is much higher in countries that do not enrich their food with iodine. (The thyroid gland needs enough iodine to produce hormones).
Other factors that increase the risk of thyroid nodules include:
- History of thyroid radiation therapy
- Having a family history of thyroid nodule or thyroid cancer
- Increasing age (over 60 years old)
- Iron deficiency anemia
- smoking
- Obesity
- Metabolic syndrome
- alcohol consumption
- Increase in the level of insulin-like growth factor 1 (a type of hormone)
- Uterine fibroids
What is the normal size of thyroid nodule?
Most thyroid nodules are small enough to cause no health problems. However, when they grow beyond a certain size, they may cause symptoms or adverse conditions such as hyperthyroidism or hypothyroidism. A small nodule less than 1 cm in diameter is often benign, but if its size exceeds 2 cm, the risk of cancer increases.
According to a study cited by the American Thyroid Association, the probability of thyroid nodules with a diameter greater than 4 cm being cancerous is about 15%.
How to diagnose a thyroid nodule
In most cases, you will not notice thyroid nodules; Unless your doctor can feel them during a physical exam of your neck. If your general practitioner suspects a thyroid nodule, he will refer you to an endocrinologist. The endocrinologist can use one or more of the following methods to diagnose thyroid nodules:
Physical examination:
The doctor asks you to swallow during the thyroid examination; Because if there is a nodule in your thyroid, it usually goes up and down when you swallow.
The doctor will also look for signs and symptoms of hyperthyroidism such as tremors, fast or irregular heartbeat, etc. He also examines signs and symptoms of hypothyroidism, such as slow heart rate, dry skin, and facial swelling.
Thyroid function tests:
Tests that measure the level of thyroid-stimulating hormone (TSH) and the hormones produced by the thyroid gland can show whether you have hyperthyroidism or hypothyroidism.
Thyroid ultrasound:
This imaging technique uses high-frequency sound waves to produce images of your thyroid gland. Thyroid ultrasound provides the best information about the shape and structure of the nodules. Your doctor may use ultrasound to distinguish cysts from solid nodules or to determine if you have multiple nodules in your thyroid.
Thyroid ultrasound can also be used as a guide in fine needle aspiration biopsy.
Fine needle aspiration biopsy:
In some cases, the doctor may recommend a biopsy or sampling of thyroid nodules to make sure there is no cancer. During this procedure, the doctor inserts a very thin needle into the nodule and removes a sample of cells.
This procedure is usually done in the doctor’s office, takes about 20 minutes, and has little risk. The doctor then sends the samples to a laboratory to be analyzed under a microscope.
Thyroid scan:
Your doctor may recommend a thyroid scan to help evaluate thyroid nodules. During this test, radioactive iodine is injected into a vein in your arm. Then you lie on a bed and a special camera displays an image of your thyroid gland on a computer screen.
Treatment of thyroid nodule
Treatment for a thyroid nodule depends on the type of nodule and the effect it has on your thyroid function, and may include:
Clinical supervision:
Thyroid nodules that are diagnosed by benign thyroid biopsy or are too small for biopsy should be closely monitored by a physician with an ultrasound every 6 to 12 months and an annual physical examination. Even a benign thyroid nodule may require surgery if it continues to grow or causes worrisome signs on ultrasound during the follow-up period.
Thyroid hormone therapy:
If thyroid function tests show that thyroid nodules are causing hypothyroidism and insufficient thyroid hormone production, your doctor will recommend thyroid hormone therapy (levothyroxine).
Thyroid surgery:
Almost all cancerous thyroid nodules should be removed by an experienced thyroid surgeon. Most thyroid cancers are treatable and rarely cause serious health problems. Fortunately, by performing thyroid surgery by Dr. Ahmed Fanaei, due to his high skill and experience, the use of advanced equipment and devices, the complications of thyroid surgery are minimized.
Dr. Ahmad Fanaei is a thyroid and parathyroid surgeon and a member of the American Thyroid Association (ATA). To schedule an appointment and get advice, contact us through the listed numbers.
Alcohol ablation:
Another option for controlling some small cancerous nodules is alcohol ablation. This technique involves injecting a small amount of alcohol into the cancerous thyroid nodule to destroy it. This procedure often requires multiple treatment sessions.
Radioactive iodine:
A doctor may use radioactive iodine to treat hyperactive thyroid nodules and goiters with multiple nodules. Your thyroid gland absorbs the radioactive iodine, which causes the nodules to shrink.
Antithyroid drugs:
In some cases, the doctor may recommend an anti-thyroid drug such as methimazole (Tapazole) to reduce the symptoms of hyperthyroidism. This treatment is generally long-term and can have serious side effects on your liver, so it’s important to discuss the risks and benefits of treatment with your doctor.
What are the complications of thyroid nodule?
Although thyroid nodules are not life-threatening in most cases, they may cause complications if they grow too large or do not receive proper treatment. The most important complications of thyroid nodule include the following:
Swallowing or breathing problems:
Large nodules or multinodular goiters can interfere with swallowing or breathing.
Hyperthyroidism:
When a nodule or goiter produces thyroid hormone, problems arise that lead to an increase in the amount of hormone in the body. Hyperthyroidism can lead to weight loss, muscle weakness, heat intolerance, and anxiety or irritability. Potential complications of hyperthyroidism include an irregular heartbeat, weak bones, and thyroid storm (a rare and potentially fatal complication of hyperthyroidism).
Problems related to thyroid nodule surgery:
If your doctor recommends surgery to remove the nodule, you may need to use thyroid hormone replacement therapy (levothyroxine) for the rest of your life.
Prevention of thyroid nodule
Since the cause of most thyroid nodules is unknown, you often cannot prevent them. However, you can try to reduce the risk of thyroid nodule by managing some risk factors.
For example, if you are overweight, consult your doctor about the most appropriate way to reach your ideal weight. If you smoke, try to quit. Also, make sure you’re getting enough iodine through your diet. If you use iodized table salt, you’re probably getting enough iodine.
Also, some studies have shown that the use of oral contraceptives or statins may reduce the risk of developing thyroid nodules.
FAQ
Small thyroid nodules usually do not cause any pain and the patient will not notice their existence; except during a clinical examination by a doctor. However, large and multiple thyroid nodules can create a state of tightness and pressure and cause heaviness and discomfort in the front of the neck.
More than 95% of thyroid nodules are benign and non-cancerous and do not cause any danger. However, malignant and cancerous thyroid nodules can be dangerous and even life-threatening if not treated on time and properly.
Yes. Thyroid ultrasound can determine the exact location of nodules, the number of nodules and the nature of the material inside them (solid or liquid).
Thyroid nodules are relatively common. Usually, a doctor can detect thyroid nodules in 5-7% of adults through physical examination. Ultrasound also shows that 20-76% of adults have thyroid nodules. Thyroid nodules are less common in children.
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