Questions To Ask Your Doctor
- Is my thyroid nodule cancer? If it isnt now, does this mean that I am more prone to developing thyroid cancer?
- Will my children be more likely to get thyroid nodules?
- What is the best treatment for my thyroid nodules?
- If I have one thyroid nodule now and it goes away, will it come back?
- What can I do at home to prevent thyroid nodules?
- Do you have any educational materials I can read?
- Can you recommend any websites?
What Are The Risks Of Radiofrequency Ablation
Complications of RFA are similar to those of surgery but occur at a lower rate. Risks include vocal cord paralysis, bleeding, voice hoarseness, infection, and damage to the surrounding structures in the neck.
One potential drawback is that RFA may not be covered by insurance because it is so new. Radiofrequency ablation currently carries out of pocket costs, and physicians are working at the national level to encourage insurers to cover the procedure in the future. If you need or want this procedure, UT Southwestern patient services can help you navigate resource options.
What Causes Thyroid Nodules
Researchers dont know why most thyroid nodules form. Nodules can form for various reasons, and there are different types, including:
- Colloid nodules: These are one or more overgrowths of normal thyroid tissue. These growths are not cancer . They may grow large, but they dont spread beyond your thyroid gland. These are the most common type of thyroid nodules.
- Thyroid cysts: These are growths that are filled with fluid or are partly solid and partly filled with fluid. Cystic nodules pose a low risk for cancer and are either monitored or biopsied if theyre larger than 2 centimeters.
- Inflammatory nodules: These nodules develop as a result of long-term swelling of your thyroid gland. These growths may or may not cause pain.
- Multinodular goiter: Sometimes an enlarged thyroid is made up of many nodules .
- Hyperfunctioning thyroid nodules: These nodules produce extra thyroid hormone, which may lead to the development of hyperthyroidism. Hyperthyroidism requires treatment.
- Thyroid cancer: Cancer is the biggest concern when thyroid nodules form. Fortunately, thyroid cancer is very rare its found in less than 6.5% of all thyroid nodules.
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Screening For Thyroid Cancer
There is no national screening programme in the UK for thyroid cancer.
If your doctor suspects that you might have a high risk of thyroid cancer, they will refer you to a genetic clinic for advice. Some people with a significant family history of thyroid cancer may be tested to find out if they have an inherited gene fault. Depending on the results, they may be offered surgery to remove their thyroid gland.
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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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Can Nodules On Thyroid Cause Coughing
As the nodules get larger, they can irritate your throat and lead to a long-lasting cough. For most people, this cough is a dry, hacking sort of cough. In addition to cough, thyroid growth can lead to pressing on the vocal cords and a hoarse voice, or pressing on the esophagus and difficulty swallowing food.
How Does Rfa Work
RFA is a non-invasive procedure that uses friction heat to destroy tumor tissue that is very close to the electrode. Over time, the body absorbs the ablated tissue, which reduces the size of the nodule. Conduction heat results in relatively slower damage to the tumor the further away it is from the ablated area and electrode tip2.
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Treating Goiters Or Thyroid Nodules
If you have a goiter or benign thyroid nodules that are not causing symptoms, your Roswell Park physician may suggest active surveillance instead of starting active treatment right away. By monitoring the situation on a regular basis, you may be able to delay treatment and its side effects until symptoms begin.
If symptoms have already begun, your primary care physician or endocrinologist may prescribe medication, such as thyroid hormone replacement, to normalize thyroid activity. If the goiter is large or causes serious symptoms making it hard to swallow or breathe, for example surgery or radioactive iodine therapy may be recommended. Both are offered at Roswell Park.
Surgery to correct a large goiter involves removing all or part of the thyroid. Our surgeons specialize in minimally invasive thyroid surgery, using incisions as small as two centimeters to reduce scarring. If the entire thyroid gland is removed, you may need to take medication for the rest of your life to replace the thyroid hormone that will no longer be produced by your thyroid.
With the expert care provided at Roswell Park, most patients who have a goiter or benign thyroid nodules will have an excellent chance of returning to good health, free of thyroid-related symptoms.
Natural Remedies For Symptoms Of Thyroid Disease
1. Avoid Iodine Deficiency
Its well known that iodine status is a key determinant of thyroid disorders. Iodine deficiency can cause hypothyroidism and goiters because the mineral helps to convert and release thyroid hormones. Thyroid disorders that are caused by low iodine levels can cause heart complications, sluggish metabolism, weight fluctuations and mood changes.
There are a few ways to avoid iodine deficiency, with the most important step being eating iodine-rich foods like seaweed, wild-caught cod, organic yogurt, raw milk and eggs. Iodine supplements are also available and when taken in low doses, can help to normalize the production of thyroid hormones. But only use iodine supplements under the care of your doctor and make sure you are being monitored for side effects. High doses of iodine can actually aggravate thyroid disorder symptoms.
2. Eat Foods High in Selenium, Zinc and B Vitamins
To improve symptoms of thyroid disease, make sure you are getting enough selenium, zinc and B vitamins in your diet. These nutrients are needed for proper thyroid function and will help to balance your thyroid hormone levels.
Did you know that the thyroid is the organ with the largest content of selenium? The mineral is needed for the conversion of hormones T4 and T3. Some of the best selenium foods that can be added to your diet to improve thyroid function include Brazil nuts, sunflower seeds, pinto beans, halibut, grass-fed beef, wild-caught salmon and organic oats.
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Radiofrequency Ablation Is An Outpatient Surgery
Benign thyroid nodules are very common. Many may not know that thyroid nodules can be found in 2-10 percent of patients during a physical examination, meanwhile 20-70 percent of patients reveal nodules using ultrasound.
Historically, surgery has been the only modality available to treat symptomatic and enlarging thyroid nodules, or any size of cancer. Since Radiofrequency Ablation for thyroid nodules was introduced in 2006, it has been reported to be both safe and effective for treating benign thyroid nodules and recurrent thyroid cancer1.
With symptomatic benign thyroid nodules, not all patients will need surgery. Now there is another option
What Is A Thyroid Nodule
The thyroid is a small gland located at the base of your throat that regulates body functions such as heart rate, metabolism, and the rate at which your body burns calories. A thyroid nodule is a lump in the thyroid gland in your neck. More than 90% of all thyroid nodules are benign . Some are actually cysts filled with fluid.
Thyroid nodules are more common in women than in men. They also tend to run in families.
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Genetic Testing For Thyroid Cancer
Several genetic testing techniques can be applied depending on the type of tumor and suspected mutation. Some of these tests are:
Sanger Dideoxy Sequencing
This is the most widely used method to detect single nucleotide variants. Through this next generation sequencing technique, technicians copy target DNA sequences many times to create DNA fragments that are later separated.
Polymerase Chain Reaction
This method is used to amplify a DNA sequence. This sequence is then used to identify markers at specific positions to confirm the presence of a mutation.
Fluorescence In Situ Hybridization
This technique uses a tag with a fluorescent probe on DNA sequences of interest. These are then viewed under fluorescent microscopy.
Multiplex Ligation-Dependent Probe Amplification
This is a specialized form of PCR that identifies point mutations.
Afirma Gene Expression Classifier
This new technology uses microarray technology to analyze messenger RNA expression of over 150 genes and was designed as a rule out test to more accurately diagnose patients and allow more patients to avoid surgery.
Eat Foods High In B Vitamins Zinc And Selenium
To eliminate thyroid nodules symptoms, ensure that you are receiving enough B vitamins, zinc, and selenium in your diet. These nutrients are good for proper thyroid function and help balance your thyroid hormone levels. The thyroid is the body organ with the largest content of selenium. In addition, selenium will help convert hormones T4 and T3. Some of the best selenium foods you can add to your diet to improve thyroid function include organic oats, wild-caught salmon, grass-fed beef, halibut, pinto beans, sunflower seeds, and Brazil buts.Foods that contain high B vitamins and zinc are also important for thyroid health these foods include the following:
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What Tests Will Be Done To Diagnose And Evaluate Thyroid Nodules
Your healthcare provider may order any of the following tests to help diagnose and evaluate a thyroid nodule:
- Thyroid blood test: This test checks the levels of thyroid hormone in your blood. The hormone levels are usually normal even if you have nodules, but they can be abnormal in some cases and point to thyroid disease.
- Thyroid ultrasound: This is an imaging test that uses sound waves to create pictures of your thyroid gland. It can determine if a nodule is solid or a fluid-filled cyst. This test also checks on the growth of nodules and helps find nodules that are difficult to feel. In addition, providers sometimes use ultrasound to help guide the placement of the needle during a fine-needle biopsy.
- Fine-needle biopsy: With this test, your provider uses a very thin needle to take a sample of cells from one or more thyroid nodules. They then send the samples to a laboratory for evaluation. Most nodules are noncancerous. However, if the test results are inconclusive, your provider may repeat this test. They may also suggest you have surgery to remove the nodules to make an accurate diagnosis.
- Thyroid scan: In this test, you take a small amount of radioactive iodine orally. Your provider will check to see how much of the radioactive iodine the thyroid nodules absorb and how much is absorbed by normal thyroid tissue. This will provide further information about the thyroid nodules, helping your provider determine the likelihood of cancer.
Malignant Thyroid Nodules Treatment
We have written a very informative section on Thyroid Cancer Surgery. Almost all thyroid nodules which are malignant are treated by surgery. The options of extent of surgery including total removal of the thyroid gland versus removal of half of the thyroid gland are discussed in detail. Only expert thyroid cancer surgeons should be performing thyroid surgery because the risk to the patients including the nerves to the voice box and glands that control calcium are significantly higher in those that do not do these types of surgery routinely and frequently.
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Thyroid Nodule Removal Fact: Removal Provides The Definitive Diagnosis Of The Nodule
Most of the time, a needle biopsy is performed prior to thyroid nodule removal to obtain a diagnosis and guide treatment. Patients should realize that thyroid nodule biopsies are only as good and reliable as the people performing them and the pathologists who are evaluating the cells. The results of a thyroid needle biopsy are categorized according to the Bethesda System for Reporting Thyroid Cytopathology for Thyroid Nodules.
The diagnostic categories are as follows:
Many thyroid nodules cannot be diagnosed as cancerous until the entire nodule has been taken out during thyroid nodule removal where half or the whole thyroid is resected. Frequently, a needle biopsy before surgery does not yield a definitive diagnosis as to whether a thyroid nodule is cancerous or benign . Even special molecular/genetic testing of thyroid cells from a biopsy often does not reveal whether a nodule is cancer or benign. In some large studies, up to 50% of thyroid cancers are not diagnosed until after thyroid nodule removal.
Efficacy Of Rfa Treatment:
- Greater than 50 percent reduction in nodule size 3
- Significant improvement in symptoms or cosmesis 3
- Normalizes the thyroid function 3
RFA is an outpatient procedure, and depending on the size and shape of the lesion, may last between 30 minutes to an hour. Saint Johns Health Center is one of the only facility offering this novel technique on the west coast.
Though RFA has been proven to be highly effective for thyroid nodules, it is not a definitive option like surgery. While surgery physically removes tissues, RFA reduces nodules over time, focusing mainly on larger nodules that cause local symptoms. This is not a procedure for small noduleseveryone has those, says Dr. Melanie Goldfarb, Director, Center for endocrine Tumors and Disorders, and Professor of Surgery at SJHC and SJCI.
This procedure has been successfully performed in Europe and Asia for the past 10 years.
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Symptoms Of Thyroid Nodules
Most thyroid nodules dont cause symptoms. For people who do have symptoms, they may have trouble swallowing or breathing or have a feeling of fullness, pain, or pressure in the throat or neck. Some people might notice a lump in their neck when they look in the mirror, but this is uncommon. Some people experience rapid unintended weight loss, feelings of nervousness, or an irregular heartbeat.
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.
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Your Guide To The Genetics Of Thyroid Function
Knowing your risk for thyroid disease can help you stay in front of complications. Learn in this guide how genes impact your risk for hypothyroidism.
There are several reasons why a person may develop a thyroid nodule:
- Normal tissue overgrowth – For reasons unknown, you can experience non-cancerous tissue overgrowth in specific organs . Usually, it only becomes problematic if it bothers you because it is large or noticeable or compresses surrounding tissues.
- Chronic inflammation of the thyroid – Nodules can appear in people with Hashimoto’s, an autoimmune condition that causes chronic inflammation of the thyroid gland.
- Thyroid cyst – Cysts are fluid-filled cavities that often show up after a thyroid adenoma begins to break down. These are usually non-cancerous.
- Goiter – Any enlargement in the thyroid gland is referred to as a goiter and may be due to a thyroid disorder or iodine deficiency. Sometimes, people develop a multi-nodal goiter with multiple distinct nodules, and the cause remains unclear.
- Iodine deficiency – Iodine deficiency is now rare in most developed countries because of iodized salt. Still, some people who do not get enough iodine through their diet can develop nodules.
- Thyroid cancer – Nodules that are large and hard or painful are a more worrisome sign of thyroid cancer.
Cytological And Pathological Data
From a cytological point of view, 37 patients had a nodule scored class III, 84 class IV and 10 class V . Central review confirmed the IC status in all 131 nodules.
Molecular alterations in patients with malignant or benign nodules for each cytological subgroup . WT wild-type, PTC papillary thyroid cancer, FVPTC papillary thyroid cancer with follicular variant, FTC follicular thyroid carcinoma, HCC HÃ¼rthle-cell carcinoma, PDTC poorly differentiated thyroid carcinoma
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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.