Citation Doi & Article Data
Citation:DOI:Matt A. MorganRevisions:see full revision historySystem:
- Thyroid nodules – ultrasound
Ultrasound is the first-line imaging modality for assessment of thyroid nodules found on clinical examination or incidentally on another imaging modality. This article is an overview of ultrasonographic features of thyroid nodules, which are used to determine the need for biopsy with fine needle aspiration. Specific management guidelines from various professional societies are covered in separate articles.
Is Thyroid Calcification Normal
Aim: Calcification within the thyroid gland may occur in both benign and malignant thyroid disease, and its detection on ultrasonography is frequently dismissed by many clinicians as an incidental finding of little significance.
How is thyroid calcification treated?
This may include:
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What Is A Thyroid Nodule
A thyroid nodule is a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding tissue. Nodules are common and found in 10 percent of the adult population. Luckily, most of them are benign. The clinical importance of thyroid nodules is the need to rule out thyroid cancer, which occurs in 7-15 percent of cases depending on age, sex, radiation exposure, family history and other factors. For the U.S. population, the lifetime risk of developing thyroid cancer is 1.1 percent. When a thyroid nodule is suspicious meaning that it has characteristics that suggest thyroid cancer the next step is usually a fine needle aspiration biopsy .
What Is Molecular Profiling
At UCLA, thyroid nodules with indeterminate biopsies are sent out for an additional molecular marker test. An indeterminate biopsy result is the gray zone where the risk of cancer is intermediate but cannot be ignored.
Sometimes the biopsy result is reported as indeterminate. This means the cells are not normal, but there are not definite signs of cancer. When biopsies are indeterminate, the risk of thyroid cancer is 15-30%.
In the past, to avoid missing a cancer, we recommended thyroid lobectomy to establish a definitive diagnosis. Now, we use molecular profiling. This refers to commercial DNA or RNA tests made specifically for indeterminate thyroid nodules. If the genetic profile appears benign, patients can avoid surgery and we simply watch the nodule over time with neck ultrasound.
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What Is The Treatment For Breast Nodules
Treatment
- Fine-needle aspiration. Fine-needle aspiration may be used to diagnose and treat a breast cyst if all the fluid can be removed from the cyst during the procedure, and then your
- Hormone use. Using birth control pills to regulate your menstrual cycles may help reduce the recurrence of breast cysts.
Do Lung Nodules Cause Pain
A wide range of symptoms may suggest that a patient has lung nodules or a lung mass. These include mild cough, shortness of breath, and wheezing. Other patients may experience weight loss, pain in the chest, or coughing up blood. However, many patients with a lung nodule or lung mass have no symptoms at all.
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Signs Of Thyroid Cancer
Most thyroid nodules are asymptomatic, non-palpable and only detected on ultrasound or other anatomic imaging studies. The following characteristics increase the suspicion of cancer:
- Swelling in the neck
- Trouble breathing
- A constant cough that is not due to a cold
An FNAB helps determine if a nodule is malignant or benign. But about 30 percent of the time, the results are inconclusive or indeterminate unable to determine if cancer is present. In this case, the recommended follow-up is a repeat FNAB, a core needle biopsy or a lobectomy/thyroidectomy surgery to remove part or all of the thyroid gland. Once removed, the thyroid nodule is thoroughly evaluated by a pathologist to diagnose or dismiss thyroid cancer.
In large thyroid nodules, 4 cm or bigger, the FNAB results are highly inaccurate, misclassifying half of all patients with reportedly benign lesions. Additionally, Inconclusive FNAB results display a high-risk of differentiated thyroid carcinoma. Diagnostic lobectomy is strongly considered in patients with a significant thyroid nodule regardless of FNAB results.
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What Are The Signs And Symptoms Related To Thyroid Nodules
Most thyroid nodules do not cause any symptoms. Some thyroid nodules show up as a painless lump in the neck that you can feel or see. Thyroid nodules usually move up and down with swallowing.
When thyroid nodules become large they may cause symptoms by pressing on the airway or esophagus. These are also called compressive symptoms. Compressive symptoms include:
- discomfort with swallowing
- weight loss despite normal or increased appetite
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Are Thyroid Nodules Cancer
The vast majority more than 95% of thyroid nodules are benign . If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows.
Ultrasound can help evaluate a thyroid nodule and determine the need for biopsy. A thyroid fine needle aspiration biopsy can collect samples of cells from the nodule, which, under a microscope, can provide your doctor with more information about the behavior of the nodule.
Who Do Thyroid Nodules Affect
Anyone can have a thyroid nodule, including children and adults. However, theyre about four times more common in people assigned female at birth than people assigned male at birth.
They also occur more often in people who live in countries in which food isnt fortified with iodine.
Other factors that lead to an increased risk of thyroid nodules include:
- History of thyroid radiation.
- Uterine fibroids.
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Is Breast Cancer More Common In Women
Breast cancer is a condition that has been known since ancient times, and exhibits itself as one of the most prevalent conditions of the modern world. This is one of the most common types of cancer, and is often one of the main causes of death for women worldwide. Cancers of the mammary gland usually affect females, and is 100 times more likely to occur in women rather than men.
When Should I Worry About Thyroid Nodules
In most cases, thyroid nodules arent a cause for concern. But even though the vast majority of thyroid nodules are benign, some thyroid nodules do contain thyroid cancer.
For this reason, you should see your healthcare provider so they can evaluate the nodule to be sure its benign. As with all cases of cancer, the earlier it can be diagnosed and treated, the better.
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Benign Vs Malignant Thyroid Nodules
There are some signs that doctors look for to help figure out whether a thyroid nodule is benign or malignant . Benign nodules feel soft to the touch, like a rubber ball, and move easily when being pushed.
Some benign thyroid nodules can start producing large amounts of thyroid hormone, which are called hot nodules. They can cause symptoms like:
- A sensation that something is stuck in your throat
What Foods Are Bad For Thyroid Nodules
Foods that are bad for the thyroid gland include foods from the cabbage family, soy, fried foods, wheat, foods high in caffeine, sugar, fluoride and iodine. The thyroid gland is a shield-shaped gland located in your neck. It secretes the hormones T3 and T4 that control the metabolism of every cell in the body.
What causes calcification of the thyroid?
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Ultrasound Imaging And Fna
The criteria for considering a nodule as suspicious for malignancy was based on the following sonographic features: hypoechogenicity, calcification, irregular/lobulated margins, and/or a taller-than wide shape. Microcalcification was also defined as small punctate echogenic foci without acoustic shadowing or a comet tail. The FNA procedure was conducted by a senior radiologist with an experience of more than 15 years. The thyroid nodules underwent ultrasound-guided FNA using a Samsung H60 ultrasound machine and a 23-gauge needle connected to a 5-cc syringe with the freehand procedure. The aspiration was performed from the solid area of the sample nodule for solid-cystic nodules.
Is There A Cancer Risk
Most thyroid nodules are benign. According to the American Thyroid Association , about 5% of thyroid nodules develop into thyroid cancer.
The ATA also note that solid hypoechoic thyroid nodules have a higher chance of becoming cancerous compared to cystic or fluid-filled lesions. However, other characteristics, such as size, may also indicate the potential risk of a nodule developing into thyroid cancer. Doctors will recommend further testing if necessary.
If a doctor suspects that a nodule is cancerous, they may perform a fine-needle biopsy to take a small sample of cells for further analysis.
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How Is A Thyroid Biopsy Performed
A thyroid biopsy, also called a fine needle aspiration , uses a small needle to take a little sample of the cells in the thyroid nodule. The possible outcomes from a biopsy are:
Non-diagnostic: Non-diagnostic is a technically failed biopsy. There were not enough cells taken during the biopsy so the cytologist was not able to determine anything. These usually need to be repeated.
Benign: Most thyroid nodule biopsies come back benign, meaning your doctor is highly re-assured that it’s not cancerous. Patients can almost always avoid surgery unless the nodule is large and pushing on adjacent structures like the airway.
Indeterminate: Indeterminate means there was enough cells taken during the biopsy, but the cytopathologist was not sure if it is benign or malignant. Indeterminate results occur in about 20% of thyroid biopsies. This is a gray zone and means that the risk of cancer is about 10-30%. These nodules require additional work-up such as a repeat biopsy, molecular marker test, or surgical removal.
Suspicious for Malignancy or Malignant: Results categorized in these two categories are a strong indicator that there is cancer present and usually require surgical removal.
Patients usually wait one week for the cytopathologist to examine the cellular characteristic of the biopsy sample. If your doctor is reassured that it’s benign based on the biopsy result, further work-up is stopped and serial ultrasound surveillance is recommended usually once a year.
The Link Between Hoarseness And Thyroid Cancer
Thyroid cancer may not be as well known as some other types of cancer, like lung cancer, breast cancer, or colorectal cancer, but its just as serious. More than 43,000 Americans are diagnosed with thyroid cancer yearly, and about 2,200 people will die from the disease.
Like other types of cancer, thyroid cancer benefits from early diagnosis and early treatment. The best way to get treatment: learn to recognize the symptoms of thyroid cancer, including one of the most common signs changes in your voice.
At Desert West Surgery, our team has extensive experience in state-of-the-art treatment for thyroid cancer, helping patients at our three Las Vegas, Nevada, locations receive the most appropriate treatment as early as possible. Heres how thyroid cancer and other thyroid problems can affect your voice.
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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.
Studies have shown that people who take oral birth control and/or statins may have a reduced risk of developing thyroid nodules.
Where Thyroid Cancer Starts
The thyroid gland is in the front part of the neck, below the thyroid cartilage . In most people, the thyroid cannot be seen or felt. It is shaped like a butterfly, with 2 lobes the right lobe and the left lobe joined by a narrow piece of gland called the isthmus.
The thyroid gland has 2 main types of cells:
- Follicular cells use iodine from the blood to make thyroid hormones, which help regulate a persons metabolism. Having too much thyroid hormone can cause a fast or irregular heartbeat, trouble sleeping, nervousness, hunger, weight loss, and a feeling of being too warm. Having too little hormone causes a person to slow down, feel tired, and gain weight. The amount of thyroid hormone released by the thyroid is regulated by the pituitary gland at the base of the brain, which makes a substance called thyroid-stimulating hormone .
- C cells make calcitonin, a hormone that helps control how the body uses calcium.
Other, less common cells in the thyroid gland include immune system cells and supportive cells.
Different cancers develop from each kind of cell. The differences are important because they affect how serious the cancer is and what type of treatment is needed.
Many types of growths and tumors can develop in the thyroid gland. Most of these are benign but others are malignant , which means they can spread into nearby tissues and to other parts of the body.
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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.
What Are Thyroid Nodules
Thyroid nodules are abnormal lumps on the thyroid gland, located in the front of your neck. In many cases, you cant feel them and wont have any other symptoms. Thyroid nodules are often discovered when your doctor orders imaging tests for another reason.
Its not unusual to develop thyroid nodules. Up to two-thirds of adults in the U.S. have them, according to a study in JAMA Internal Medicine. Thyroid nodules can affect anyone, but theyre more common in women, older people, and smokers.
Pro Tip
An ultrasound can help determine if a nodule is worrisome. Worrisome nodules appear dark and solid on the ultrasound scan. They tend to have irregular borders and contain calcifications. A larger sized nodule, measured by greatest diameter, can also be concerning. Dr. Rachel Arakawa
Nodules range in size from 1 cm to 4 cm or larger. You may also develop a goiter, which is an enlargement of the thyroid.
Most nodules arent cancerous. But according to a study in the New England Journal of Medicine, thyroid cancer occurs in 5% to 15% of nodules, so its important that any lumps in your neck are examined by your doctor.
To check for cancer, your doctor will order ultrasound scanning. Depending on the size of the nodules, you may need a needle biopsy, which is when a needle is used to remove tissue from the nodule for testing.
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How Are Thyroid Nodules Treated
Treatment depends on the type of thyroid nodule. Treatment options include:
- No treatment/watch and wait: If the nodules arent cancerous, you and your healthcare provider may decide that you dont need to be treated at this time. Youll see your provider regularly so they can check for any changes in the nodules.
- Radioactive iodine: Your provider may use radioactive iodine to treat hyperfunctioning thyroid nodules and goiters with several nodules. Your thyroid gland absorbs the radioactive iodine, causing the nodules to shrink.
- Surgery: Surgery to take out the nodules is the best treatment for nodules that are cancerous, cause obstructive symptoms like breathing or swallowing issues and are suspicious (they cant be diagnosed without being surgically removed and examined.
Thyroid Cancer And Your Voice
The thyroid gland is a two-lobed gland that wraps around your voicebox . The thyroid cartilage makes up the front part of your larynx, protecting your vocal cords from damage. It also forms the Adams apple that tends to be more prominent in males.
Studies show that the larynx tissue has special receptors that bind with or react to hormones produced by the thyroid, explaining why even mild changes in gland activity can change the way your voice sounds. Because of their proximity and involvement with each other, its not surprising that changes in the thyroid can have a direct effect on your larynx and your voice.
In thyroid cancer, nodules or growths form in and around the thyroid gland changing its shape and putting pressure on your larynx and vocal cords. Thats why changes in your voice including hoarseness, changes in the loudness of your voice, or changes in how high or low your voice sounds can be a sign of thyroid cancer.
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