General Illness Information
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 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.
- 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).
- 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.Â 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 – 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.
Levothyroxine (T4) or thyroid hormone can be used for one of two purposes in thyroid nodule:
- in an attempt to suppress (decrease the size of) the benign thyroid nodule.
- in order to replace thyroid hormone in patients rendered hypothyroid by thyroidectomy.
No restrictions unless hyperthyroid (in this case restrict activity until condition returns to normal thyroid – euthyroid – state).
- 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)
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).