The main information:
Thyroid nodules are growths of cells in the thyroid gland. These growths can be noncancerous (benign) or cancerous (malignant). Some nodules are fluid-filled (cysts), while others are made of thyroid gland cells. Sometimes, what feels like one nodule will actually be a collection of small nodules.
Thyroid nodules are more common in women than in men. A person's chance of a thyroid nodule increases with age.Only a few thyroid nodules are cancerous.
Most thyroid nodules don't cause signs or symptoms. Occasionally, however, some nodules become so large that you can:
- Feel them
- See the swelling at the base of your neck
They may become apparent when you're shaving or putting on makeup. Men sometimes become aware of a nodule when their shirt collars suddenly feel too tight.
In some cases, thyroid nodules produce too much thyroxine, a hormone normally secreted by your thyroid gland. The extra thyroxine can cause problems such as:
- Sudden, unexplained weight loss
- Rapid or irregular heartbeat
Although thyroid nodules are seldom cancerous (malignant), a nodule is more likely to be cancerous if it:
- Grows quickly or feels hard
- Causes you to become hoarse or to have trouble swallowing or breathing
- Causes enlarged lymph nodes under your jaw or in your neck
Exams and Tests
Very often, nodules produce no symptoms. Doctors will find thyroid nodules only during a routine physical exam or imaging tests that are done for another reason. However, thyroid nodules that are big enough to feel during a physical exam occur in a few people.
If the doctor finds a nodule or you have symptoms of a nodule, the following tests may be done:
Treatments and drugs
Depending on the type of thyroid nodule you have, your treatment options may include:
- Watchful waiting. If a biopsy shows that you have a benign thyroid nodule, your doctor may suggest simply watching your condition, which usually means having a physical exam and thyroid function tests at regular intervals. You're also likely to have another biopsy if the nodule grows larger. If a benign thyroid nodule remains unchanged, you may never need treatment beyond careful monitoring. Talk to your doctor if you're not comfortable with this approach or want more information on other options.
- Thyroid hormone suppression therapy. This involves treating a benign nodule with levothyroxine (Levoxyl, Synthroid), a synthetic form of thyroxine that you take in pill form. The idea is that supplying additional thyroid hormone will signal the pituitary to produce less TSH, the hormone that stimulates the growth of thyroid tissue. Although this sounds good in theory, levothyroxine therapy is a matter of some debate. There's no clear evidence that the treatment consistently shrinks nodules or even that shrinking small, benign nodules is necessary.
- Radioactive iodine. Doctors often use radioactive iodine to treat hyperfunctioning adenomas or multinodular goiters. Taken as a capsule or in liquid form, radioactive iodine is absorbed by your thyroid gland, causing the nodules to shrink and signs and symptoms of hyperthyroidism to subside, usually within two to three months.Because thyroid hormone is released into your bloodstream as the nodules are destroyed, in rare cases your symptoms may worsen for a few days or weeks after therapy. You also might experience neck tenderness or a sore throat. And because this treatment eventually causes thyroid activity to slow considerably, you may develop hypothyroidism.
- Surgery. The usual treatment for malignant nodules is surgical removal, often along with the majority of thyroid tissue — a procedure called near-total thyroidectomy. Occasionally, a nodule that's clearly benign may require surgery, especially if it's so large that it makes it hard to breathe or swallow. Surgery is also considered the best option for people with large multinodular goiters, particularly when the goiters constrict airways, the esophagus or blood vessels. Nodules diagnosed as indeterminate or suspicious by a biopsy also need surgical removal so they can be examined more thoroughly for signs of cancer.Risks of thyroid surgery include damage to the nerve that controls your vocal cords and damage to your parathyroid glands — four tiny glands located on the back of your thyroid gland that help control the level of calcium in your blood. After thyroidectomy, you'll need lifelong treatment with levothyroxine to supply your body with normal amounts of thyroid hormone.
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