Thyroid Nodules: When to be Concerned?

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By Neena Xavier, MD, FACE, and Rachel Pessah-Pollack, MD, FACE
thyroid consultation

What are thyroid nodules?

The thyroid is a butterfly-shaped gland in the lower part of the neck below your voice box (larynx) and above your collarbones (clavicles). It produces hormones that determine how the body uses and stores energy. Thyroid nodules are lumps that are found on the thyroid gland. They are very common, and estimates are up to half of people have at least one thyroid nodule. Fortunately, most thyroid nodules (about 90-95%) are non-cancerous (benign) and most people do not know that they have one and most cause no symptoms. There are a variety of things that can cause a thyroid nodule including an overgrowth of normal thyroid cells, fluid-filled cysts, inflammation of the thyroid, and a tumor (either cancerous or benign).

For instructions on how to conduct your own “Neck Check,” visit thyroidawareness.com/neck-check

How are thyroid nodules found?

A substantial number of thyroid nodules are found by chance when a person has imaging with a scan, such as a CT, MRI, or ultrasound of the neck for another reason. However, sometimes nodules can grow big enough that some patients do notice a lump in the front of their neck when looking in the mirror or they have difficulty with clothing or jewelry circling their neck. They may also have other symptoms such as a change in their voice, difficulty swallowing, or feeling a tightness in their neck. Any lumps that you notice or symptoms of pressure in your neck should be discussed with your doctor.

(For instructions on how to conduct your own “Neck Check,” visit thyroidawareness.com/neck-check)

Other symptoms can occur if a thyroid nodule produces too much thyroid hormone on its own. These symptoms can include excess sweating, weight loss for no reason, increased heart rate or having heart palpitations, feeling anxious, or shaking. Discuss any of these new symptoms with a physician. Your doctor may recommend a special type of test called a thyroid uptake and scan if your thyroid is overactive and nodule(s) are noted.

How do doctors find out if my nodule is worrisome?

A thyroid ultrasound is very often used to get details about how the lump looks on the thyroid. Many times, the physician can look at the ultrasound images and determine which nodules need a biopsy based on its size and ultrasound features. Certain features including tiny calcium deposits in the nodule seen on ultrasound (known as microcalcifications), uneven nodule borders, very tall nodules, and/or very dark nodules can be more suspicious and may warrant a biopsy. Since ultrasounds use sound waves to make images and not radiation, physicians can repeat the test periodically to see if the nodule is changing or growing over time without large doses of radiation to the patient. If you need a biopsy of your thyroid nodule, your doctor will use a very thin needle to withdraw cells from the thyroid nodule in a safe and well-tolerated office procedure. After the procedure, the biopsy samples are used to make slides and examined under a microscope to make a diagnosis. Sometimes, tests that look at several genes within the thyroid nodule’s DNA may be used to help determine whether a thyroid nodule is benign or cancer.

Treating nodules

If the nodules are benign and not causing symptoms by pushing on your windpipe (trachea) or your esophagus, physicians will just watch your nodule(s) over time to make sure they are not growing or changing. If there are symptoms or concern for cancer, surgery will be recommended to remove the nodule and/or half or the whole thyroid gland. Patients that have thyroid nodules must remember to follow up with their doctor periodically and let them know if they are developing symptoms such as difficulty swallowing or breathing, voice hoarseness or tightness in the neck.

Be your own thyroid health advocate! If you or someone else sees or feels a lump in the area of you neck where you thyroid is, if you have trouble swallowing or breathing normally, develop hoarseness in your voice, or find there is tightness or pressure in the front of your neck, make an appointment with your health care team to get checked out.