Thyroid Nodule

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 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 – 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.

Medications:

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.

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’.

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