What Is A Normal Size For Thyroid Nodules
Thyroid nodules range in sizeyour doctor will decide what to do depending on their size.
- Tiny nodules, which are less than 1 cm in diameter. These arent usually biopsied.
- Nodules larger than 1 cm with suspicious features are biopsied. Those that are slightly larger and have fewer suspicious features may not be biopsied until they reach a size of 1.5 to 2 cm.
- Very large nodules are surgically removed. This is necessary because of an increased risk for thyroid cancer and potential to damage nearby structures in the neck.
Nodules of any size that get bigger should also be biopsied.
A common misconception is that nodules can be shrunken by medications, such as thyroid hormone replacement. This was an approach used by doctors a long time ago, but it was found to be ineffective. In fact, it can cause harm to the heart in the form of irregular and fast heartbeats and weaken bones so it is no longer a recommended treatment. Dr. Arakawa
Sonogram Scoring System Developed For Thyroid Nodules To Reduce Biopsy Rates
Abnormalities detected by ultrasound, nodules are particularly common in the thyroid gland. An estimated two-thirds of adults have nodules in the thyroid gland, with most either benign or resulting in a slow-growing cancer that is not life-threatening.
However, a minority of these nodules can be aggressive cancers that require treatment. This in turn poses the following questions for physicians and patients which nodules need to biopsied and tested for malignancy which nodules present a small risk that merits observation without a biopsy and which require no follow-up at all?
Franklin Tessler commented: If you have a cancer that is not going to harm you, and you are not aware of it, is it useful to do a fine-needle aspiration? People are asking what are we doing? Are we using scarce resources wisely?
Read our exclusive interview with Franklin.
In the United States thyroid cancers are over-diagnosed, with approximately 75% of thyroid cancers in women and almost half of those diagnosed in men would not had the nodules not been biopsied resulted in symptoms or death.
This potentially will have a big public health effect, stated Tessler, whos 15 co-authors on the blue ribbon committee are from 13 renowned US institutions.
The groups Thyroid Imaging, Reporting and Data System is modeled after the American College of Radiologys widely accepted risk stratification system for breast lesions, BI-RADS.
How Should I Prepare
Please notify your physician if you are taking any blood thinning agents, such as aspirin, Lovenox®, Plavix® or Coumadin®.
Usually, no special preparations are required for this procedure.
For biopsies performed in children, sedation may be used. Specific instructions will be given at the time of scheduling.
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Thyroid Nodule Biopsy: Cancer Of Thyroid Nodules Is Diagnosed By Fine Needle Aspiration Biopsy
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.
What Are The Reactions Of The Thyroid
It is one of the endocrine glands that produce hormones. Thyroid hormones control the rhythm of many activities in the body. These include how quickly calories are burned and how fast the heart beats. All of these activities make up the bodys metabolism.
Thyroid Molecular Markers Allow Patients To Avoid Surgery
We want to help patients find that perfect balance between under-treatment and over-treatment. The people-gram shows how molecular testing can help patients avoid unnecessary surgery.
Left Path: Before the use of molecular markers, everyone with an indeterminate biopsy went to surgery. Of those who went to surgery, cancer was found in only 25% of those cases . 75% of the surgical patients turned out not to have needed surgery at all because their nodules were benign .
Right Path: Today, if you have an indeterminate biopsy, you also undergo molecular testing. 50% of patients were categorized as benign from the molecular test and safely avoided surgery. Of the surgical patients who received a suspicious molecular test result , cancer was found in 50% of those patients .
It is very rare that patients end up having cancer because of a false negative test. Still, it is UCLAs standard of care to have a safety net and follow every patient after molecular testing, regardless of their result. Those patients will get ultrasounds every 12 months to ensure that nodules do not grow or change in appearance.
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Fine Needle Aspiration Biopsy Of Thyroid Nodules
Procedure and interpretation of results
WHAT IS A FINE NEEDLE ASPIRATION BIOPSY OF A THYROID NODULE?
A fine needle aspiration biopsy of a thyroid nodule is a simple and safe procedure performed in the doctors office. Typically, the biopsy is performed under ultrasound guidance to ensure accurate placement of the needle within the thyroid nodule. You will be asked to lie down on your back with your head tipped backwards, so that your neck is extended. Sometimes, a pillow is placed under your shoulders to help you get in the best position for the biopsy.
During the procedure you may feel some neck pressure from the ultrasound probe and from the needle. You will be asked to remain as still as possible and avoid coughing, talking and swallowing during the biopsy.
How Is A Thyroid Biopsy Performed
Thyroid biopsy, also called a fine needle aspiration , uses a small needle to take a little sample of the cells in the thyroid nodule. An ultrasound machine typically guides your doctor or cytopathologist during the biopsy. A topical anesthetic spray is used to make it comfortable for the patient. Once the sample is obtained, the patient usually waits one week for a pathologist to further examine the cellular characteristic of the biopsy sample.
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Clinical Implications Of The Findings
The principle of using ultrasound characteristics and guidance for helping to risk stratify is critical, and I think the principles that the authors lay out support what is the accepted standard among national and international guidelines, Dr. Alexander said.
However, the findings should be interpreted with caution as there were study limitations. For example, the incidence of thyroid cancer in patients with thyroid nodules is typically 8% to 15%, but is < 2% in this study, he said. It is also unclear if ultrasound-guidance was used for all nodule biopsies. It doesnt take away from their findings, but we want to be thoughtful and cautious in terms of how we translate those findings into a change in clinical practice, Dr. Alexander said.
Smith-Bindman R, Lebda P, Feldstein VA, et al. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study. JAMA Intern Med. 2013 173:1788-1796.
What Is Molecular Profiling
Thyroid nodules with indeterminate biopsies may be assessed for molecular mutations.
Mutational testing is designed to identify mutations within the DNA of the nodules to more accurately determine if the nodule represents a cancer or the risk of developing into a cancer. In the past, to avoid missing a cancer, we recommended thyroid lobectomy to establish a definitive diagnosis. In many cases, mutational testing will provide us with more information. If the genetic profile appears benign, patients can avoid surgery and we simply monitor the nodule with neck ultrasound.
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Genetic Testing Of Thyroid Nodules: Veracyte / Afirma Asuragen And Thyroseq
There are three commercially available genetic testing companies for thyroid nodules: Veracyte , Asuragen, and Thyroseq. They are similar, but each has some unique advantages. Typically your doctor will send your FNA biopsy specimen to just one of these three. Here are some specifics about the genetic thyroid tests:
- The Veracyte / Afirma test has the best ability to tell whether the FNA cytology is benign. This is called a ârule outâ test. It is really good at seeing if a thyroid nodule is benign. If this test tells you the needle biopsy is benign, then the possibility of it actually being a cancer is less than 4%.
- Both Asuragen and Thyroseq are ârule inâ tests. This means that they look for genetic abnormalities known to be associated with a diagnosis of thyroid cancers. Finding these particular genetic changes makes a diagnosis of thyroid cancer much more likely, and in some circumstances may also play a role in determining the best surgery for the cancer.
Large Study Of More Than 8800 Patient Records
The authors examined medical records from 8,806 patients who underwent 11,618 thyroid ultrasound examinations from January 2000 to March 2005. Of this group, 105 patients were diagnosed with thyroid cancer.
While thyroid nodules > 5 mm were found in almost all patients with thyroid cancer , they were also found in over half of patients without thyroid cancer. The authors identified three characteristics of nodules found on ultrasound that were significant predictors of thyroid cancermicrocalcifications , size > 2 cm , and an entirely solid composition .
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How Is The Procedure Performed
Image-guided, minimally invasive procedures such as fine needle aspiration of the thyroid are most often performed by a specially trained radiologist with experience in needle aspiration and ultrasound.
Doctors usually perform needle biopsies on an outpatient basis.
The neck will be cleansed with antiseptic. Medicine to numb the area may or may not be used. An ultrasound transducer with a small amount of sterile water soluble gel will be placed on your neck over the thyroid nodule. The radiologist will insert the needle through the skin under direct imaging guidance, advance it to the site of the thyroid nodule and aspirate samples of tissue. After the sampling, the needle will be removed. New needles will be reinserted if additional samples are required. Several specimens may be needed for a complete analysis.
Once the biopsy is complete, pressure will be applied to the area to decrease the risk of bleeding. A bandage may be placed if necessary. No sutures are needed.
This procedure is usually completed in less than 30 minutes.
Why Did My Thyroid Nodule Grow
The majority of thyroid nodules are caused by an overgrowth of normal thyroid tissue. The cause of this overgrowth is usually unknown, but there is a strong genetic basis. In rare cases, thyroid nodules are associated with: Hashimoto’s thyroiditis, an autoimmune disease that leads to hypothyroidism.
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What Size Nodule Should Be Biopsied
According to the Society of Radiologists in Ultrasound, biopsy should be performed on a nodule 1 cm in diameter or larger with microcalcifications, 1.5 cm in diameter or larger that is solid or has coarse calcifications, and 2 cm in diameter or larger that has mixed solid and cystic components, and a nodule that has …
What Should You Expect After The Procedure
The procedure is usually performed using a local anesthetic and no medications are used that affect consciousness or thinking. After the procedure, you may be asked to sit up slowly to prevent you from getting lightheaded. Most patients typically leave feeling well. There are very few, if any, restrictions on what you can do after a thyroid biopsy. Because of this, it is not generally necessary to bring a companion to help or drive you home.
Some neck discomfort at the site of the biopsy is expected following the procedure. Tylenol® and ice compresses can be used to relieve discomfort.
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Who Needs A Fna Needle Biopsy Of Their Thyroid Nodule
FNA biopsy should be done on any nodule that the doctor thinks may be cancerous
- FNA needle biopsy of thyroid nodules is generally done on any thyroid nodules that is big enough to be felt. This means that they are larger than about 1 centimeter across.
- FNA biopsy is indicated on any thyroid nodule that causes symptoms. We have an entire page on symptoms caused by thyroid nodules.
- FNA biopsies should be done on any swollen or abnormal lymph nodes in the neck. This may be more accurate in diagnosing thyroid cancer than FNA of the thyroid nodule itself!
- FNA biopsy should be done on thyroid nodules that have a certain characteristic under the ultrasound.
What Genetic Tests Are Used For Thyroid Biopsies Of Nodules
Within the past few years, several molecular tests have become available to help determine whether some nodules are cancerous or benign. These tests look at many genes within the thyroid nodules genetic information. They are being used when a nodule biopsy comes back with a diagnosis of indeterminate. Sometimes, the person doing the biopsy will perform an additional pass of the needle to obtain material for such a test. This may be done on the first biopsy or at the time of a repeat biopsy.
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How Are Thyroid Nodules Diagnosed
If your doctor thinks you have thyroid nodules, you will have an ultrasound, which is the most accurate way of identifying the size, number, and other physical features of the nodules.
Based on what the ultrasound shows, your doctor will make a decision about whether the nodules should be biopsied to look for cancer cells. Nodules with irregular borders, calcifications, and lower density, and those that are taller than they are wide suggest cancer, so they should be biopsied.
A thyroid biopsy is called fine-needle aspiration . Your doctor will prick the area 3 to 4 times with a small needle to collect thyroid cells. They will be studied under a microscope. Benign nodules can be monitored with repeat ultrasounds at regular intervals, but malignant nodules must be surgically removed.
When Is A Thyroid Nodule Biopsy Needed
An imaging test can help your doctor identify a thyroid nodule, but it cant determine if the nodule is malignant . A thyroid nodule biopsy is the standard procedure for determining if nodules are cancerous.
However, not everyone with a thyroid nodule needs a biopsy. It depends on the size of the nodule and your risk of thyroid cancer.
In general, you might be a good candidate for a thyroid nodule biopsy if you have:
- a nodule bigger than 1 centimeter and a moderate to high risk
- a nodule larger than 1.5 cm and a low risk
- a nodule larger than 2 cm and a very low risk
Your doctor can determine your risk by examining your imaging test results. Theyll analyze the nodule for certain features.
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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.
What Size Of Thyroid Nodule Is A Cause For Concern
Most thyroid nodules dont cause health issues you may not know that they are there unless your doctor notices them during a routine check-up. However, once they grow beyond a certain size, they may cause adverse symptoms or conditions like hyper- or hypothyroidism.
A small nodule with a diameter of less than 1cm is often benign, but if it reaches a size greater than 2 cm, there is an increased risk of cancer. Thyroid nodules greater than 4 cm in diameter have a 15% likelihood of becoming cancerous, according to one study cited by The American Thyroid Association.
Other rarer conditions, such as papillary or follicular carcinomas, are linked with nodules of this size.
Even non-cancerous nodules can become harmful when they grow large enough to cause discomfort when swallowing or obstruct airways. If you find it difficult to eat or breathe due to discomfort or pain in your thyroid region, notify your doctor immediately.
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