According to the Hormone Health Network, more than 90 percent of all thyroid nodules are benign (noncancerous). Most thyroid nodules aren’t serious and cause few symptoms and it’s possible for you to have a thyroid nodule without even knowing it. Unless it becomes large enough to press against your windpipe, you may never develop noticeable symptoms.
Small thyroid nodules typically do not cause symptoms. However, larger nodules can press on the structures in the neck to cause:
Breathing troubles
Swallowing troubles
Voice changes
Discomfort due to a fullness feeling in the neck
All of these symptoms “compressive symptoms” because they are putting pressure on the neck; when there are compressive symptoms, which are usually a reason to have that part of the thyroid removed. Overactive “toxic” thyroid nodules can be associated with symptoms of hyperthyroidism as well as the neck symptoms described.
2. Know if your thyroid function is normal from lab testing (i.e., T3, T4, TSH) and your doctor’s evaluation. Your doctor may take a blood sample to measure levels of T3 and T4—the thyroid hormones (sometimes the tissue in a nodule makes too much of the thyroid hormones), and thyroid-stimulating hormone (TSH). TSH is a hormone made by the pituitary gland to regulate the thyroid's production of T3 and T4. These blood tests cannot detect if a thyroid nodule is cancerous, but will help rule out other thyroid conditions.
3. Thyroid nodules are commonly associate with goiter. A goiter is an abnormally large thyroid gland. A goiter develops either because the whole gland is swollen or the gland has multiple growths or nodules on it. Some people with a goiter have no symptoms; others may have symptoms of an overactive or underactive thyroid.
4. A note on iodine intake – you may have read about iodine deficiency is associated with thyroid disorders. Iodine may be tricky, as too little and too much may both cause problems. People with thyroid disease may be particularly susceptible to ill effects of iodine. Iodine regulation should be under medical guidance; do not take iodine supplement or reduce iodine intake on your own.
Thyroid nodule classification and biopsy criteria
A TIRADS scoring system was developed to provide more decision levels than standard scoring through the selection of the ultrasound features which include the calcification shape, margins, taller-than-wide, internal echo, blood flow quantization of features, setting of the weight, and calculation of the score.
A practical TIRADS classification to categorize thyroid nodules and stratify their malignancy risk is expressed with scores ranging from 1 to 5:
TIRADS 1 corresponds to a normal gland
TIRADS 2 to a benign nodule (both with 0% malignancy)
TIRADS 3 to a highly probable benign nodule (<5% malignancy)
TIRADS 4 (5 to 80% malignancy) - TIRADS 4A, 4B and 4C corresponding to low, intermediate and moderate suspicion for malignancy, respectively.
Treatment plan will depend on the size and type of thyroid nodule. If your nodule isn’t cancerous and isn’t causing problems, your doctor may decide no need for treatment at all, just watch with regular office visits, lab work, and ultrasound follow-up. The best thing to do may just be continued observation, if you do not have any symptoms and clinical impression of the nodule is benign. Follow up is important – thyroid ultrasound repeat at regular intervals will provide meaningful clinical picture. Your doctor will notice the changes from comparison with previous results and advice for medical interventions when necessary.
Treatment options for larger or cancerous nodules, or nodules that produce additional thyroid hormones, may include:
Radioactive Iodine: This treatment is mainly used to shrink a goiter or nodule that causes the thyroid to produce too much thyroid hormone. The iodine is given as a capsule or liquid. Once swallowed, it concentrates in the thyroid and destroys some or all of the thyroid tissue, without harming other tissues.
Thyroid hormone medication (L-thyroxine): This synthetic form of thyroid hormone can help to shrink an enlarged thyroid and treat an underactive thyroid. Hypothyroid symptoms usually start to improve within the first week of starting the medication, and disappear within a few months.
Surgery: Total thyroidectomy (removes the entire thyroid) or lobectomy (removes only the lobe that contains the nodules) are popular surgical options. All surgery brings risks for complications like bleeding and infection. Thyroid surgery can also involve risks for impairment to vocal cord nerves, which could cause hoarseness, and impairment to your parathyroid glands, which are located behind and very close to your thyroid and regulate your body's calcium levels. Also note that recurrent thyroid nodules may develop up to 19.5 percent, as reported from a follow up study.
Radiofrequency ablation is a new procedure that shrinks thyroid nodules without surgery. Radiofrequency ablation is a treatment that uses heat to shrink nodules from the inside. RFA for thyroid nodules is performed by inserting a needle-like probe into the thyroid nodule. The tip of the needle heats up, destroying the nodule from the inside, causing it to shrink. This treatment requires no surgery, scarring, or lifelong hormone therapy. Various complications of radiofrequency ablation have been reported, including pain, voice change, hematoma, skin burn at the puncture site, thyrotoxicosis, hypothyroidism, edema, and fever, but most patients recovered spontaneously without sequelae. Several studies reported a regrowth rate of 20% to 30% after RFA and LA, and regrowth appears to occur after 2 or 3 years, depending on the degree of complete treatment of the nodule margin. Since thyroid RFA is still a new treatment, insurance covers the cost of your thyroid nodule evaluation, and you may be able to apply for approval for the RFA from your insurance company. Depending on your plan, you may be covered or may have to pay for the procedure out-of-pocket.
The good news is many people can live a normal life with asymptomatic thyroid nodules without treatment, even the nodules may not go away or being “cured”. For patients who have papillary or follicular type of thyroid cancer may expect a normal life expectancy with treatment.
Disclaimer: This information is for educational and informational purposes only. It is not medical advice. Consult your healthcare professional for personal conditions.
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