What are thyroid nodules?

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

Thyroid cyst

A thyroid cyst is simply a thyroid nodule filled with fluid – it is almost always benign and can fluctuate in size.

Goiter

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.

Substernal Goiter

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.

Symptoms

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.

Diagnosis

Thyroid Nodule Diagnosis

Neck Ultrasound

All thyroid nodules, cysts, and goiters should be evaluated with a dedicated neck ultrasound that includes the lymph nodes in the lateral neck.

Biopsy

If there are abnormal ultrasound features or the nodule reaches a certain size, a fine needle biopsy should be performed.

CT Scan

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.

Treatments

Thyroid Nodule Treatment

Follow Up

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.