- What are thyroid nodules?
- What are the symptoms of thyroid nodules?
- How are thyroid nodules diagnosed?
- Treatment of thyroid nodules
- Your first appointment with Dr Lancashire
What are thyroid nodules?
Thyroid nodules are solid or fluid-filled (or mixed) cell growths that develop in the thyroid gland. They can range in size from a few millimetres to several centimetres. Thyroid nodules are extremely common, and incidence increases with age. About 50% of people will have at least one thyroid nodule by the age of 50, and 90% of us by age 80. Most thyroid nodules are benign (non-cancerous); however, a small proportion (approximately 7-15%) are malignant, meaning they are cancerous thyroid nodules.
Many different thyroid conditions can present with thyroid nodules:
- Thyroid cysts
- Thyroiditis
- Thyroid adenomas (follicular adenomas, papillary adenomas or Hürthle cell adenomas)
- Hyperplastic nodules
- Congenital nodules
- Thyroid cancer
The key questions we seek to answer regarding thyroid nodules are:
- Is it cancerous?
- Is it causing symptoms by pressing on structures in the neck, like the trachea (windpipe) or oesophagus (food pipe)?
- Is it producing too much thyroid hormone?
What are the symptoms of thyroid nodules?
Often, thyroid nodules don’t cause any symptoms. They are frequently an incidental finding (i.e., discovered by accident) during investigations for other medical conditions.
Enlarged thyroid nodules may cause a lump or pain in the neck, difficulty breathing or swallowing or voice changes. If the nodule contains active glandular tissue, it may interfere with your normal thyroid tissue and gland function, causing symptoms of thyroid hormone imbalance (e.g., rapid heartbeat or palpitations, anxiety, weight loss, difficulty sleeping).
How are thyroid nodules diagnosed?
Initial investigations are usually arranged by a GP or an Endocrinologist. This will generally involve a combination of medical history, physical examination, blood tests, and medical imaging (neck ultrasound), as well as a biopsy of some thyroid tissue (Fine Needle Aspiration Biopsy or FNA). Sometimes additional scans are needed to help determine the size and activity of the developing thyroid nodules, and Dr Lancashire can arrange these if necessary.
Thyroid nodule biopsies are usually done by a radiologist under the guidance of an ultrasound, with local anaesthetic. Because the thyroid has such a rich blood supply and is surrounded by many very important other structures (like the trachea, blood vessels and nerves), a relatively small sample is taken. This means that the pathologist analysing the biopsy sample may not always be able to give a definitive result. A complex international scoring system (called the Bethesda System) is used to guide doctors and patients about the risk of the nodule being malignant (cancerous).
How are thyroid nodules treated?
The most appropriate management plan will depend on the type of thyroid nodule(s) diagnosed. Dr Lancashire will be able to explain what your biopsy result means and consider it together with your blood tests and scan results to help determine the best plan of action, and whether thyroid surgery is the right option for you.
In many cases (e.g., small benign nodules), no upfront treatment is necessary, and the nodules can be monitored over time. If a nodule grows over time, a repeat biopsy or a procedure to remove the nodule (via surgical excision or ablation) may be recommended. For larger benign thyroid nodules, suspicious nodules, or malignant nodules, upfront thyroid nodule surgery will usually be recommended.
Your first appointment with Dr Lancashire
Dr Lancashire will discuss your diagnosis and let you know if further appointments, surgery, or medications are recommended. If so, any questions you may have will be answered, and Dr Lancashire will liaise with your referring doctor.