Thyroid nodule

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General Illness Information

Medical Term:

THYROID NODULE

(SOLITARY THYROID NODULE, MULTINODULAR GOITER, BENIGN NODULE, MALIGNANT NODULE, COLLOID NODULE, NODULAR THYROID)

Common Name:

GOITRE

Description:

Thyroid nodule is a swelling/mass on the thyroid gland

-thyroid nodules are most often benign (fewer than 5% of detected nodules are malignant)

-a thyroid nodule may be found on palpation of the gland by your physician, or incidentally on a thyroid/neck ultrasound

-thyroid nodules are very common in the general population

Causes:

it is unknown what specifically causes thyroid nodules

- past history of head and neck irradiation (e.g. acne treatment as a child) or high levels of circulating thyroid hormone may play a role in some patient.

Prevention:

-it is unknown how to prevent thyroid nodules though they less frequently occur in the developed world because of iodization of salt.

Signs & Symptoms

	-often thyroid nodules are asymptomatic -very large thyroid nodules are more likely to be symptomatic --> hyperthyroid symptoms -HYPERTHYROID SYMPTOMS may include any or all of the following:
	feeling very warm all the time.
	sweaty moist palms
	tremor (especially of the hands)
	itchy skin
	rapid heartbeat
	fluttering sensation in the chest (palpitations)
	increased appetite
	weight loss (occasionally weight may remain stable or increase)
	anxiety, irritability, panic attacks
	fatigue
	muscle weakness
	increased looseness or frequency of bowel movements
	hair loss
	if the thyroid gland is very large, or if the nodule is large or rapidly growing one may experience compressive symptoms (pain/pressure in neck, dysphagia (trouble swallowing) and/or hoarseness)

Risk Factors

	childhood history of head and/or neck irradiation (e.g. acne irradiation as a child/teen)
	family history of thyroid cancer
	female sex
	age (the older you are the more likely you are to have a thyroid nodule)
	living in a region endemic for goiters (because of uniodinized salt

Diagnosis & Treatment

Diagnostic workup consists of a complete history and physical examination. In addition, blood tests are often performed to check the level of circulating thyroid hormones (TSH and/or free T4 )

A fine needle aspiration biopsy (a small needle is used to retrieve some fluid/cells from the nodule) is performed next, in order to obtain cells from the thyroid nodule to be analyzed in a pathology lab.

Depending on the results of the biopsy (benign, malignant or suspicious) the following tests/procedures are performed:

· Benign --> observation to ensure it does not enlarge rapidly and/or treatment with levothyroxine (see below)

-your physician may wish to reaspirate the nodule in 6-12 months time if the nodule grows or a cyst recurs ( although benign nodules usually remain benign)

· Malignant --> Surgery to remove the nodule and part/all of the thyroid gland (thyroidectomy ) followed by levothyroxine treatment to replace thyroid hormone (see below)

· Suspicious --> A thyroid scan is often performed on suspicious nodules. This will indicate the location and function (i.e. does the nodule synthesize thyroid hormone or not) of the nodule. Nonfunctioning suspicious nodules ( cold nodule) are often removed with total or near-total thyroidectomy

General Measures:

Medications:

levothyroxine (T4) or thyroid hormone can be used for one of two purposes in thyroid nodule:

· 1. in an attempt to suppress (decrease the size of) the benign thyroid nodule

· 2. in order to replace thyroid hormone in patients rendered hypothyroid by thyroidectomy

Activity:
No restrictions unless hyperthyroid (in this case restrict activity until condition returns to normal thyroid - euthyroid - state)

Diet:
	No restrictions

Possible Complications :
	cancer (in malignant nodule) may spread to nearby or distant organs
	compression of nerves around thyroid may lead to hoarseness
	compressive symptoms may include trouble swallowing (dysphagia)

Prognosis

Benign nodules usually remain benign, and approximately 40% regress (decrease in size) without any treatment

Malignant nodules differ in prognosis depending on the type of thyroid cancer present (papillary thyroid cancer (the most common type) has a very good prognosis with surgical resection)

Other

'Nothing Specified'.