Thyroid Nodules And Thyroid Cancer
The biggest concern on most peoples minds is probably whether or not their thyroid nodule is actually cancer in disguise.
As I mentioned previously, most thyroid nodules are benign.
But that leaves another 5-10% which can be cancerous and should be evaluated.
There are some factors that have been evaluated that can help you understand your risk of thyroid cancer.
The risk of thyroid cancer increases with these risk factors:
Can Thyroid Nodules Be Prevented
Since researchers dont know what causes the majority of thyroid nodules, you cant prevent them in most cases.
You can, however, try to decrease your risk of developing them by managing certain risk factors. For example, if you have obesity, talk to your healthcare provider about attaining a healthy weight for you. If you smoke cigarettes, try to quit. Its also important to make sure you get enough iodine in your diet. If you use iodized table salt, youre likely consuming enough.
New Criteria Would Reduce Unnecessary Biopsies By 90%
Using a requirement that nodules have at least two of these three abnormal characteristics would reduce the number of unnecessary biopsies by 90% with a low risk of cancer in patients who do not undergo biopsy , according to the authors.
If theres a large solid nodule, or if there are any nodules with microcalcification, the likelihood of cancer increases by fivefold or tenfold, depending on the finding, and I would do a biopsy, said Dr. Smith-Bindman. On the other hand, without these characteristics, you are at very low riskless than one-half of 1%and a biopsy is not necessary. Nor is continued surveillance, she said.
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What Size Thyroid Nodule Should You Worry About
Your thyroid is critical for regulating many of your daily bodily functions, such as heart rate, libido, reproduction, and digestion. It helps your body maintain homeostasis by releasing hormones thyroxine and triiodothyronine into your bloodstream.
The thyroid gland is composed of a left and right lobe connected in the middle, which extends in a butterfly shape at the base of the neck, underneath the larynx. If your thyroid is functioning normally, you shouldnt be able to feel it externally. However, if you have developed thyroid nodules, you may be able to feel lumps on your neck, depending on the nodules size.
It is critical to monitor your thyroid health with regular visits to your physician so they can check your thyroid for the presence of nodules.
What Happens During A Thyroid Fine Needle Aspiration Biopsy
Some people, like children, might need a medicine to help them relax before the procedure. Most people will not need this, though.
In some cases, your healthcare provider might inject a local anesthetic to the area before inserting the needle. Because the needle is so small, this is often not necessary.
Your healthcare provider may perform the biopsy with the help of an ultrasound machine. This machine uses high-frequency sound waves to provide an ongoing image of the nodule. This enables your healthcare provider to guide the needle to exactly the right spot. It also prevents damage to other structures. A gel-like substance will be applied to your neck, where the ultrasound detector will be used.
After cleaning the area, your provider will insert the thin, fine needle into your thyroid gland. This may hurt a little. He or she will slowly advance the needle into the nodule itself, moving it back and forth several times.
The needle attaches to a syringe that can apply suction and remove some cells from the nodule. After the removal of the needle, these cells will be placed on a slide. Your healthcare provider might repeat this procedure a few times to obtain different samples from different parts of the nodule. Sometimes the lump will be all or mainly fluid. The fluid can be removed during the biopsy.
After the procedure, the cells will be sent to a pathology lab and analyzed for signs of cancer. A small bandage will be placed over the needle insertion site.
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How Common Are Thyroid Nodules
Thyroid nodules are very common, especially in the U.S. In fact, experts estimate that about half of Americans will have one by the time theyre 60 years old. Some are solid, and some are fluid-filled cysts. Others are mixed.
Because many thyroid nodules dont have symptoms, people may not even know theyre there. In other cases, the nodules can get big enough to cause problems. But even larger thyroid nodules are treatable, sometimes even without surgery.
How Big Is Too Big
When it comes to thyroid nodules, the size matters quite a bit.
Studies have shown time and time again that larger thyroid nodules tend to turn into thyroid cancer at a higher rate compared to smaller thyroid nodules.
The magic number in terms of size is 1 cm or 10mm.
But size isnt the only thing that matters.
It has been shown that even small thyroid nodules can be cancerous if they have certain and specific findings on thyroid ultrasound.
The number of nodules and their size are not predictive of malignancy, as a nodule smaller than 1 cm is as likely as a larger nodule to harbor neoplastic cells in the presence of suspicious US features.
For this reason, you never want to judge the risk of thyroid cancer based on the size of your nodule alone.
You will notice that while size is certainly a risk factor, you should also look at other risk factors including whether or not the nodule is causing symptoms, your age, and what the nodule looks like on ultrasound.
As a patient, though, you can use the size of your nodule as a quick and dirty way to assess whether or not you should be worried.
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Ultrasound Criteria May Allow For More Selective Thyroid Biopsies
Ultrasound criteria may help determine when a thyroid nodule should be biopsied and help reduce the number of unnecessary procedures, according to a retrospective case-control study in JAMA Internal Medicine.
Current guidelines recommend biopsy of many thyroid nodules > 5 to 15 mm in diameter. However, the new findings suggest the presence of two of three abnormal characteristics found on ultrasound may further refine the decision for biopsy.
Compared with other existing guidelines, many of which are complicated to apply, following these simple, evidence-based guidelines would substantially decrease the number of unnecessary thyroid biopsies in the United States, said lead author Rebecca Smith-Bindman, MD, Professor, Department of Radiology and Biomedical Imaging, University of California San Francisco School of Medicine. Right now, were doing far too many thyroid biopsies in patients who are really at very low risk of having thyroid cancer, she said.
Ultrasound is by far the best way to evaluate the thyroid, Dr. Alexander said. For every patient, we want to use historical data and physical examination, ultrasound and imaging data, while also recognizing that fine needle aspiration is an extremely low risk, minimally invasive procedure that can provide a lot of very useful information, he said.
Thyroid Nodules: Potential Causes
Several conditions may cause or predispose to the development of thyroid nodules including:
Diets deficient in iodine can predispose individuals for the development of thyroid nodules. Portions of the world continue to lack iodine in their diets however in the United States, the presence of iodine in our daily diets makes this an unlikely cause for thyroid nodules.
Overgrowth of normal thyroid tissue
The reason why these thyroid nodules occur is not well understood. These thyroid nodules are commonly called follicular adenomas or thyroid adenomas. . Follicular adenomas are clearly not cancerous and are not worrisome and do not require removal except if they are symptomatic due to their size. The rare follicular adenoma or thyroid adenoma will overproduce thyroid hormone and be the cause of hyperthyroidism. For some reason these excessive thyroid hormone producing adenomas lose their ability to be regulated by the pituitary glands production of Thyroid Stimulating Hormone .
Thyroid cysts are fluid filled cavities caused by degenerating thyroid adenomas, congenital cysts, or overproduction of a fluid produced by the thyroid called colloid.
Inflammatory diseases of the thyroid Multinodular disease of the thyroid Thyroid Cancer
Although the likelihood that a thyroid nodule is a cancer is quite low, the following are associated with an increased malignant risk:
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What Is The Thyroid
The thyroid is one of the glands that belongs to the endocrine system. The butterfly-shaped gland is responsible for releasing hormones into the bloodstream to control and regulate many of the bodys daily functions. It sits just below the larynx and is made up of right and left lobes that form a bridge. Without the thyroid, general regulations like digestion, sex drive and heart function would cease.
Whats The Treatment For A Thyroid Nodule
Even a benign growth on your thyroid gland can cause symptoms. If a thyroid nodule is causing voice or swallowing problems, your doctor may recommend treating it with surgery to remove all or part of the thyroid gland.
If the doctor recommends removal of your thyroid , you may not even have to worry about a scar on your neck. Some patients are good candidates for a scarless thyroid procedure, where the surgeon reaches the thyroid through an incision made on the inside of your lower lip.
A newer alternative that the doctor can use to treat benign nodules in an office setting is called radiofrequency ablation . Radiofrequency ablation uses a probe to access the benign nodule under ultrasound guidance, and then treats it with electrical current and heat that shrinks the nodule. Its simple: Most people treated with RFA are back to their normal activities the next day with no problems.
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The Diagnosis Meaning And Treatment Of Thyroid Nodules
Thyroid nodules are most commonly found when a doctor examines a patient’s neck, feeling the thyroid gland. Sometimes thyroid nodules are found when a patient gets x-rays or scans of the neck for some other reason. Sometimes it is a screening x-ray or scan for carotid arteries or neck pain that shows nodules in the thyroid. Thyroid nodules that are large, develop in women with thin necks, or are present in the middle portion of the thyroid gland may be visible and discovered as a lump in the neck.
Types Of Thyroid Nodules
There are different types of thyroid nodules that arenât cancerous:
Toxic nodules make too much thyroid hormone. This can lead to hyperthyroidism, which makes the metabolism speed up.
Multinodular goiters have several nodules. They may also make too much thyroid hormone and may press on other structures.
Thyroid cysts are full of fluid, sometimes with other debris. They may happen after an injury.
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What Causes Thyroid Nodules
Nodules can be caused by a simple overgrowth of normal thyroid tissue, fluid-filled cysts, inflammation or a tumor . Most nodules were surgically removed until the 1980s. In retrospect, this approach led to many unnecessary operations, since fewer than 10 percent of the removed nodules proved to be cancerous. Most removed nodules could have simply been observed or treated medically.
Chronic thyroiditis is an inflammation of the thyroid gland that develops slowly. It frequently leads to a decreased function of the thyroid . Thyroiditis occurs when the body’s immune system destroys the cells in the thyroid gland. Chronic thyroiditis is most common in women and people with a family history of thyroid disease.
Treatment For Thyroid Nodules
Treatments for thyroid nodules vary greatly depending on the type of nodule one has and the root cause of the nodule.
- No treatment. If the nodule is small enough, not growing at a fast rate, and isnt blocking an airway or causing pain, your endocrinologist may decide to leave it alone for the time being.
- Radioactive Iodine. Taking radioactive iodine may help improve the function of the thyroid, allowing it to heal itself and stopping other nodules from forming.
- Surgery. If the thyroid bump grows large enough to pose a risk, your doctor may order its surgical removal. If the nodule is cancerous, surgery is typically one of the first steps of treatment.
- Radiation and/or Chemotherapy. If cancer is the cause of the thyroid nodule, a host of cancer treatments may be implemented to combat both the thyroid cancer and the nodule itself.
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What Symptoms Can Thyroid Nodules Cause
Most thyroid nodules dont cause symptoms. However, if you have several nodules or large nodules, you may be able to see them.
In rare cases, nodules can grow big enough to cause the following symptoms:
- Trouble with swallowing or breathing.
- Hoarseness or voice changes.
- Pain in the front of your neck.
- Enlargement of your thyroid gland .
Hyperfunctioning thyroid nodules can lead to overproduction of thyroid hormones, also known as hyperthyroidism. Symptoms of hyperthyroidism include:
- Frequent, heavy menstrual periods.
Most Thyroid Nodules Are Benign But Some Thyroid Nodules Are Thyroid Cancer
A small percentage of thyroid nodules are malignant . You can not tell if a thyroid nodule is malignant due to symptoms or lack of symptoms. Those thyroid nodules that are cancer, tend to be very slow growing. The very rare thyroid nodule that is an aggressive thyroid cancer may present with a large thyroid mass, firm or non-mobile mass or even change in vocal quality. Only in these very rare circumstances, when the thyroid nodule is an aggressive thyroid cancer, is there an urgent need for prompt evaluation and thyroid cancer surgery by the most highly experienced thyroid cancer surgeon. Otherwise, thoughtful evaluation and consultation by an expert thyroid cancer surgeon is required for thyroid nodules. In other words, the vast majority of thyroid nodules can be worked up without a sense of urgency. Don’t make rash, quick decisions–thyroid nodules in almost all cases provide plenty of time to get figured out. So chill if you are here because you just found out you have a thyroid nodule. Read and understand what this means. And realize that in almost all cases, you have time to figure this out! We have created a Thyroid Nodule and Cancer Guide app to help, you can to better understand your thyroid nodule, determine what you “next steps” are, and examine your risk of thyroid cancer.
Watch a video at https://www.youtube.com/embed/92gv34o-46A
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What Is A Thyroid Fine Needle Aspiration Biopsy
A thyroid fine needle aspiration biopsy is a procedure that removes a small sample of tissue from your thyroid gland. Cells are removed through a small, hollow needle. The sample is sent to the lab for analysis.
The thyroid gland is in the front of your neck. It is butterfly shaped, with 2 lobes connected by a narrow band of tissue. It is an endocrine gland that makes thyroid hormone. This hormone has many functions in your body.
In some cases, hard nodules form inside the gland. You might notice a small bump in your gland area. Most times, the nodules are not dangerous. But in some cases they can be thyroid cancer. A thyroid fine needle aspiration biopsy can take a sample from the nodule to test for cancer.
Thyroid Nodules: When To Worry
Suppose you go to your doctor for a check-up, and, as shes feeling your neck, she notices a bump. Then, suppose she tells you theres a nodule on your thyroid. Is it time to panic?
No, say experts at Johns Hopkins Department of Otolaryngology and Head and Neck Surgery. Thyroid nodules even the occasional cancerous ones are treatable.
Heres what you need to know about thyroid nodules and how concerned you should be if you develop one.
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Patients Inclusion And Exclusion
Patients with all documented thyroid US, US-guided FNA records and surgical histopathology were collected. Such nodules were excluded: nodules with incomplete information or without formal US report patients records without a clear correlation in nodular location, cytology, and histopathology patients with an incidental thyroid cancer .
Fna Technique And Categorization
Thyroid FNA at our hospital was performed under US guidance and by the same surgical team. All FNA performers received certification and support from the cytology and ultrasound technician. The final FNA results were verified by at least one experienced cytopathologist . Nodules smaller than 10 mm in size would receive US-guided FNA when at least one of the following requirements was met: Nodular location was close to thyroid capsule, trachea, or nerve Patients had a family history of thyroid cancer or a history of radiotherapy Enlargement of neck LN was observed by US or neck LN was suspicious of cancer metastasis. Patients had a heavy psychological burden and strongly demanded US-guided FNA to evaluate nodular pathological type. US-guided FNA would be recommended to nodules equal to or larger than 10 mm in size when at least one of the following requirements was met: TI-RADS 4c-6, TI-RADS 4b and nodule size 15 mm, TI-RADS 4a and nodule size 25 mm, TI-RADS 3 and nodule size 40 mm, or any nodule that needed thyroidectomy. If a patient had more than one biopsy on the same nodule, the FNA record immediately before surgery was adopted in the following analysis. Cytology results were recorded as nondiagnostic or unsatisfactory , benign , atypical , follicular neoplasm/suspicious for follicular neoplasm , suspicious for malignancy , or malignancy according to the 2009 Bethesda System for Reporting Thyroid Cytopathology .
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