First off, what are thyroid nodules?
A thyroid nodule refers to an abnormal growth of thyroid cells that forms a lump within the thyroid gland. Although the vast majority of thyroid nodules are benign (non-cancerous), a small proportion of thyroid nodules do contain thyroid cancer. In order to diagnose and treat thyroid cancer at the earliest stage, most thyroid nodules need some form of evaluation.
Are thyroid nodules a cause for concern?
Thyroid nodules are actually very common!
In fact, it's been estimated that about 1 in 2 adults above the age of 60 will have such thyroid issues. However, most people are not aware that they have a thyroid nodule as most are too small to cause any problems.
Many patients with thyroid nodules have no symptoms and are found by chance to have a lump in the thyroid gland during a routine physical exam or an imaging study done for unrelated reasons. A minority of patients may become aware of a gradually enlarging lump in the front portion of the neck or may experience a vague pressure sensation or discomfort when swallowing.
Before we continue, where exactly is the thyroid gland?
The thyroid gland is a butterfly shaped organ located in the lower front of the neck, below the voicebox (larynx) and above the collarbones. It is called a gland because it secretes hormones called thyroxine which controls the metabolism of the whole body. There are many glands and hormones in the body. The hormones levels are tightly regulated in the body and hence any excess (hyperthyroidism) or deficit (hypothyroidism) can manifest in symptoms such as heat/cold intolerance, weight loss/gain, irritability/depression etc.
However, most thyroid nodules do not cause change in thyroid hormone levels and hence do not cause any symptoms. Nodules can be caused by a simple overgrowth of normal thyroid tissue, fluid-filled cysts, inflammation (thyroiditis) or a tumor (either benign or cancerous). More than 95 percent of thyroid nodules are benign (noncancerous), but tests are needed to determine if a nodule is cancerous.
How are thyroid nodules diagnosed?
Ultrasound
In thyroid ultrasonography, high-frequency sound waves pass through the skin and are reflected back to the machine to create detailed images of the thyroid. It can visualize nodules as small as 2-3 millimeters. Ultrasound distinguishes thyroid cysts (fluid-filled nodules) from solid nodules. At the same time, characteristics of the nodules are defined to determine how suspicious they look. Depending on the size and level of suspicion, the doctor will decide if further tests such as fine needle aspiration cytology are required.
Fine Needle Biopsy (FNB) or Fine needle aspiration cytology (FNAC) A thyroid fine needle biopsy is a simple procedure that can be performed in the outpatient setting and patients can usually return to work or home afterward with no ill effects. The FNAC is usually performed under the guidance of the ultrasound. Ultrasound guidance enables the doctor to biopsy the nodule to obtain an adequate amount of material for interpretation. This test provides information that no other test can offer short of surgery. A thyroid needle biopsy will provide sufficient information on which to base a treatment decision more than 85 percent of the time if an ultrasound is used.
However, about 10-20 percent of biopsy specimens are interpreted as inconclusive or inadequate, that is, the pathologist cannot be certain whether the nodule is cancerous or benign. In such cases, the doctor will decide either to repeat the test or offer surgery to remove the affected lobe of further evaluation.
Even when a thyroid biopsy sample is reported as benign, the size of the nodule should be monitored. A thyroid ultrasound examination provides an objective and precise method for detection of a change in the size of the nodule. A nodule with a benign biopsy that is stable or decreasing in size is unlikely to be malignant or require surgical treatment.
Hence, in short, there is no need to worry when one has a thyroid nodule(s) as most are benign and do not require surgery. However, it is best to see a doctor to determine what is the best course of action.
Reach out to us for more information and to understand what the best course of action is if you have or suspect that you have thyroid nodule(s).
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