Is It Normal To Have Nodules On Thyroid
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 they’re 60 years old. Some are solid, and some are fluid-filled cysts. Others are mixed. Because many thyroid nodules don’t have symptoms, people may not even know they’re there.
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.
Hot Vs Cold Thyroid Nodules
Thyroid nodules are classified as either cold or hot nodules. A hot thyroid nodule produces thyroid hormones that can cause hyperthyroidism. Hot nodules are also referred to as toxic nodules. When your nodule produces excess thyroid hormones, you may experience symptoms such as:
- An irregular or rapid heart rate
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What Are The Types Of Goiter
Goiter can be classified in a few different ways, including the way by which it grows and if your thyroid hormone levels are irregular or not.
Classifications for goiter based on how it enlarges include:
- Simple goiter: This type of goiter happens when your entire thyroid gland swells and feels smooth to the touch.
- Nodular goiter: This type of goiter happens when a solid or fluid-filled lump called a nodule develops within your thyroid and makes it feel lumpy.
- Multinodular goiter: This type of goiter happens when there are many lumps within your thyroid. The nodules may be visible or only discovered through examination or scans.
Classifications of goiter based on thyroid hormone levels include:
- Toxic goiter: This goiter happens when your thyroid is enlarged and produces too much thyroid hormone.
- Nontoxic goiter: If you have an enlarged thyroid but normal thyroid levels , its a nontoxic goiter. In other words, you dont have hyperthyroidism or hypothyroidism .
Healthcare providers combine these descriptors to classify certain types of goiter when diagnosing them. For example, a toxic multinodular goiter happens when theres more than one nodule on your thyroid usually several producing an extra amount of thyroid hormone.
Treatments For Thyroid Nodules
Doctors sometimes recommend a wait-and-see approach for patients with asymptomatic benign nodules. You may not need treatment unless your thyroid nodule grows or changes.
Patients with benign modules that present with symptoms may need their nodules surgically removed or ablated to alleviate their problems. Those diagnosed with thyroid cancer due to a cancerous nodule require surgery to treat their condition.
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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.
How Is A Toxic Thyroid Nodule Diagnosed
Diagnosis is very similar to that of hyperthyroidism. A blood test is carried out to measure thyroid hormone levels and a full medical history should be taken. The thyroid gland will be examined for presence of nodule. Thyroid antibodies are used to assist in diagnosis .
An ultrasound scan of the neck may be carried out to assess the thyroid nodule, and a tissue sample may be taken for analysis. This involves inserting a small thin needle into the nodule to collect a tissue sample, which can then be analysed in the laboratory. This procedure is not painful, but can feel uncomfortable.
In a small number of cases, if the swelling is large, other tests such as lung function tests may be carried out to assess whether breathing is affected. Rarely, a computerised tomography scan may also be performed to obtain a more detailed image of the gland.
A thyroid iodine uptake scan may also be performed. This is a test to measure how much iodine is taken up by the thyroid gland and gives an indication of whether the thyroid gland is under or overactive. In the case of a toxic nodule, you can see one area of increased uptake of iodine, with the rest of the gland suppressed.
All these investigations can be performed in the outpatient department.
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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.
Dr. Rx
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
What Are The Signs & Symptoms Of Goiters And Thyroid Nodules
A goiter is most often spotted because it’s in the very front of the neck and moves up and down when a person swallows. People with a goiter might have the sensation that food is stuck in the throat, especially when they lie down or sleep on their backs.
But goiters often grow very slowly over months and years before being noticed. It can be hard even for parents who pay close attention to notice the change early.
Sometimes a nodule can appear in a healthy gland. It may feel like a lump in the throat, or cause tenderness or pain in the front of the neck. A large nodule might be visible at the front of the neck. Some kids with thyroid nodules have pain in the front of the neck or feel like they have a lump in the throat.
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Chronic Inflammation Of The Thyroid
Chronic inflammation of the thyroid, also , can cause nodules to develop. Types of thyroiditis include postpartum thyroiditis, subacute thyroiditis, and Hashimotos thyroiditis. Postpartum thyroiditis occurs after giving birth and involves the body producing too much thyroid hormone, followed by a severe drop in hormone production.
Subacute thyroiditis is an immune reaction in the thyroid that develops from a viral infection. Having an upper respiratory infection puts you at risk of developing subacute thyroiditis. It can cause tenderness and pain in and around the thyroid gland and neck. Once your immune system clears the infection, thyroiditis dissipates.
Hashimotos thyroiditis is the most common form of thyroiditis. It is an inflammatory-based disease of the thyroid that causes hypothyroidism, thyroid inflammation, and enlarged thyroid nodules.
Patients who suffer from Hashimotos need to have their thyroid hormones checked regularly to maintain their health. They may also benefit from regular thyroid nodule ultrasounds, which detect smaller nodules not felt on physical exams.
Thyroid Nodule Symptoms: Uncommon But Can Happen
Thyroid nodule patients usually have no symptoms, but when they do have symptoms they are most commonly:
- A lump in the neck
- Uncomfortable pressure sensation on the breathing tube
- A sense of feeling like they need to swallow something or difficulty swallowing
- Discomfort in the neck
Thyroid nodules may also rarely produce the thyroid hormone, thyroxine, in excess. This is uncommon but the reason why all patients with thyroid nodules should have a blood test for thyroid stimulating hormone . Thyroid nodules that produce extra thyroid hormone can cause symptoms of hyperthyroidism which include:
- Unexplained weight loss
- Rapid or irregular heart rate
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Optimize Iodine Levels To Improve Thyroid Nodules
Thyroid hormone is made up in large part by iodine, which has led some clinicians to recommend iodine supplementation to support thyroid health. However, we need to get just the right amount of iodine. The American Thyroid Association states, Iodine deficiency, which is very uncommon in the United States, isknown to cause thyroid nodules. However, too much dietary iodine can increase the risk of goiter, multinodular goiter, nodules, and thyroid autoimmunity, especially in Hashimotos thyroiditis.
To learn more about how to assess your iodine levels, check out our blog.
What Causes Thyroid Nodules To 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: Hashimotos thyroiditis, an autoimmune disease that leads to hypothyroidism.
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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.
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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How Thyroid Nodules Are Diagnosed
Thyroid nodules are diagnosed through physical examination and imaging. Doctors routinely perform physical exams of your thyroid to check for enlargement and the formation of nodules. Your thyroid nodule may be large enough for your doctor to feel by hand.
Your doctor might suspect thyroid nodules if you have abnormal blood work. Routine thyroid blood tests can detect hormone abnormalities that suggest thyroid nodules, even if your doctor cant feel any through examination. You may need additional imaging for diagnosis, such as a thyroid ultrasound.
Do They Go Away On Their Own
According to an ATA study, thyroid nodules that occur due to iodine deficiency may resolve on their own over time if people increase their iodine intake. In 618 participants with thyroid nodules, roughly one-third of single nodules were no longer present at the 11-year follow-up.
The researchers concluded that increasing iodine intake through iodized salt might be the reason for the disappearance of the nodules.
In other cases, benign thyroid nodules may grow larger over time, and people may need treatment to remove them.
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How Big Does A Thyroid Nodule Have To Be To Cause Symptoms
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.
Can benign thyroid nodules cause problems?
Although most thyroid nodules are noncancerous and dont cause problems, ask your doctor to evaluate any unusual swelling in your neck, especially if you have trouble breathing or swallowing. Its important to evaluate the possibility of cancer.
Can a thyroid nodule make you feel sick?
Most thyroid nodules dont cause any symptoms. However, if they grow large enough, they can cause swelling in your neck and lead to breathing and swallowing difficulties, pain, and goiter.
Associated Endocrinologists Treat Thyroid Nodules
Thyroid nodules can impact your thyroid function and cause unpleasant side effects. While most nodules are benign, its important to get the proper diagnosis and treatment of your thyroid nodule for your overall health.
The doctors at Associated Endocrinologists understand the diagnostic process and offer services to help. Our skilled practitioners provide thyroid ultrasounds and fine needle aspiration biopsies in our office for your convenience. Contact us today to schedule treatment or examination of your thyroid nodule.
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What Size Thyroid 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 …
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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Thyroid Nodule Treatment Options
Most nodules, benign or cancerous, are not an immediate health risk. However, as with most conditions, treating the issue early is less intensive and less invasive than waiting until it becomes serious.
The treatment your endocrinologist recommends will depend upon the nodule characteristics:
If you are diagnosed with a thyroid nodule, dont panic. The majority of thyroid nodules are benign, and most do not require surgery. See an endocrinologist to find the most effective treatment option for you and to get your questions answered.
To find out whether you or a loved one might benefit from a thyroid exam or a second opinion, call or request an appointment online.
What Are The Longer
The long-term implications of a toxic thyroid nodule or adenoma depend on the treatment option used. Patients taking carbimazole tablets will likely need to take them daily for life. Blood tests should be carried out regularly to monitor thyroid hormone levels and to adjust the dose of carbimazole accordingly. The majority of patients are able to find a medication regime that works for them and go on to live full, active lives.
If untreated, besides feeling poorly and unwell, the patient is also at risk of heart dysfunction or failure due to the increased heart rate and raised metabolic state. This irregular heart rate can result in strokes and dizziness. Long-standing toxic nodules can also affect the patients bones and cause osteoporosis, which results in weak bones that are more likely to fracture.
The patient may also develop symptoms due to the enlarged thyroid gland such as difficulty with breathing or swallowing . If patients have any concerns about this condition, they should discuss them with their doctor.
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