Thyroid nodule(s) are abnormal growths of cells within the thyroid gland and are very common amongst middle-aged adults, especially women, though they can occur at any age. Thyroid nodules can be very small or grow very large and are sometimes a mix of fluid and solid thyroid tissue.
The majority are not worrisome, but if large enough, can cause local symptoms such as discomfort and problems swallowing. Thyroid nodules are very common. Many are detected incidentally during an unrelated imaging procedure while others are discovered by a clinician’s physical exam.
Types of Thyroid Nodules
A thyroid cyst is simply a thyroid nodule filled with fluid – it is almost always benign and can fluctuate in size.
A goiter is an enlarged thyroid that protrudes from the neck. It can be caused by a diet deficient in iodine, but in the United States it’s most often caused by a defect that causes hormones to fluctuate.
A substernal goiter is when your thyroid grows very large and extends below your breastbone where it can compress your windpipe in a non-easily accessible location.
What are the symptoms of a thyroid nodule?
Most thyroid nodules or cysts do not produce any symptoms and go undetected. However, if large enough in size (and this is different for everyone), the most common symptoms are:
Pressure in front of the neck
Difficult or uncomfortable swallowing with solid foods
Problems breathing when lying flat
Worsening snoring from growth under the breastbone (substernal goiter)
A new persistent cough
A visible protrusion in the neck
50 – 70%
of middle-aged women have thyroid nodules.
90 – 95%
of nodules are benign.
20 – 30%
of women in their 30s have thyroid Nodules.
Men get thyroid nodules too.
Thyroid Nodule Diagnosis
All thyroid nodules, cysts, and goiters should be evaluated with a dedicated neck ultrasound that includes the lymph nodes in the lateral neck.
If there are abnormal ultrasound features or the nodule reaches a certain size, a fine needle biopsy should be performed.
If the lower extent of your thyroid cannot be visualized on ultrasound, a CT scan of chest is needed to determine how far below your clavicle the thyroid extends.
Thyroid Nodule Treatment
Do all thyroid nodules need to be surgically removed?
No. There are two main reasons why your endocrinologist or endocrine surgeon will recommend thyroid surgery, or a thyroidectomy to remove thyroid nodules.
Concern for a diagnosis of cancer or an “indeterminate” biopsy
You are experiencing obstructive symptoms from a very large nodule(s) such as trouble breathing when you lie flat or trouble swallowing solid foods.
Other reasons for thyroidectomy may include
Large nodule size (larger than 4-5cm)
Worrisome ultrasound characteristics
Multiple abnormal nodules that are difficult to follow
Substernal goiter or nodules that are growing deep into the chest
Toxic “Hot” nodule
Is there another treatment besides surgery for thyroid nodules?
No. Studies have shown that medication does not shrink thyroid nodules.
If you have a pure thyroid cyst, you may be a candidate for ethanol ablation. This procedure is performed by an interventional radiologist who injects alcohol into your cyst cavity after it has been drained. Sometimes this procedure needs to be repeated more than once to be effective.
Will all of my symptoms go away if I have thyroid surgery?
This is a very difficult question to answer. If you are an otherwise very healthy person and you have a big thyroid gland, there is a good chance that removing your thyroid will relieve your symptoms. However, other medical problems such as heart disease, lung disease, asthma, and reflux can cause similar symptoms. In this situation it is difficult to predict which symptom will improve and by how much.
Follow Up of Thyroid Nodules
For patients that do not need surgery (this is most patients), discuss with your clinician the best surveillance schedule for your nodules.
This will vary depending on if you had a biopsy, how long you have had the nodules, and what they look like on ultrasound. For the most part, you should not need a repeat biopsy if you had a benign biopsy once, and you should not have to follow thyroid nodules yearly for the rest of your life.
We are a team of surgeons, medical and radiation oncologists, interventional radiologists, pathologists, translational research scientists, and multidisciplinary cancer support specialists that work together to develop the most effective plan for each patient. We have extensive endocrine knowledge, expertise and writing experience.