Thyroid Nodules
Thyroid nodules are lumps that can form within your thyroid, which can be filled with either solid or liquid. They are relatively common, but only in rare cases, they might be cancerous.
Generally, most thyroid nodules are not serious and don’t cause any symptoms. More than ninety percent of thyroids are known to be benign or non-cancerous. Only a small percentage of them are cancerous.
You may never develop any noticeable symptoms unless it becomes large enough to press against your windpipe. Thyroid nodules are mostly discovered during imaging procedures such as CT scan or MRI scan, done to diagnose something else.
Symptoms
You might have a thyroid nodule and not notice any symptoms. However, if the nodule gets large enough, you might develop:
- An enlarged thyroid gland termed as a goiter
- Hoarse voice
- Swallowing difficulties
- Breathing difficulties
- Pain at the base of the neck
If your thyroid nodule is leading to excess production of thyroid hormones, you might develop symptoms of hyperthyroidism, which can include:
- Rapid, irregular heartbeat
- Unexplained weight loss
- Nervousness
- Muscle weakness
- Difficulty sleeping
Sometimes, thyroid nodules also develop in people having Hashimoto’s thyroiditis. This is an autoimmune thyroid condition that can lead to an increase in the risk of developing an underactive thyroid i.e. hypothyroidism. Symptoms of this condition include:
- Persistent fatigue
- Unexplained weight gain
- Dry skin and hair
- Constipation
- Sensitivity to cold
- Brittle nails
Causes
There are several conditions which can lead to nodules developing in your thyroid gland, such as:
Overgrowth of normal thyroid tissue- An overgrowth of normal thyroid tissue is generally termed as a thyroid adenoma. Although it is unclear why this occurs, it’s not cancerous and is not considered serious unless it can lead to some bothersome symptoms from its size. Some thyroid adenomas can lead to hyperthyroidism.
Iodine deficiency- If there is a lack of iodine in your diet, it may sometimes cause your thyroid gland to develop thyroid nodules as well.
Thyroid cyst- Fluid-filled cavities or cysts in the thyroid generally result from degenerating thyroid adenomas. Most often, solid components get mixed with fluid in thyroid cysts. Though cysts are mostly noncancerous, occasionally they may contain cancerous solid components.
Multinodular goiter- The term goiter is used to refer to an enlargement of the thyroid gland, which may be caused by a thyroid disorder or iodine deficiency. A multinodular goiter has multiple distinct nodules within the goiter, and its cause is less clear.
Chronic inflammation of the thyroid- Hashimoto’s disease, a type of thyroid disorder, can also lead to thyroid inflammation and also lead to enlarged nodules. This is often associated with hypothyroidism.
Thyroid cancer– The chances of having a cancerous nodule are small. However, a nodule that is hard and large or leads to pain or discomfort is generally more worrisome. You may want to get it checked by a doctor.
Certain factors can increase your risk of getting thyroid cancer, such as having a family history of thyroid or any other such endocrine cancers. Having a history of radiation exposure might also increase the risk.
Diagnosis
Physical exam
In most cases, a patient is not aware of a nodule until a doctor finds it during a general physical exam. They may be able to feel the nodule as well.
If they suspect a thyroid nodule, they will probably refer the patient to an endocrinologist, a doctor specializing in all aspects of the endocrine (hormone) system, including the thyroid.
Your endocrinologist will want to learn if you:
- Have a family history of thyroid nodules or any thyroid problems
- Underwent radiation treatment on your neck or head as an infant or child
Various tests
One more test might be required to diagnose the condition. Some of these tests might include:
Thyroid scan
Thyroid scan, to learn if your nodule is hot, cold, or warm
Ultrasound
Thyroid ultrasound, for examining the structure of the nodule
Blood tests
Blood tests, to check your levels of thyroid hormones as well as thyroid-stimulating hormone
Fine needle aspiration
Fine needle aspiration, to collect a sample of the nodule so that it can be tested in the lab
Treatment
Your treatment options are generally going to depend on the size and type of thyroid nodule that you may have.
If your nodule is not cancerous and is not causing any problems, then your endocrinologist might decide that treatment is not required at all. Instead, they are going to closely monitor the nodule with regular office visits and ultrasounds.
Nodules that start as benign may sometimes turn cancerous, though it is usually rare. However, your endocrinologist is likely going to perform biopsies occasionally to rule out the possibility.
Radioactive iodine or surgery
If your nodule is hot or overproducing thyroid hormones, your endocrinologist is probably going to use radioactive iodine or surgery to eliminate it. If you’ve been experiencing symptoms of hyperthyroidism, this will resolve the symptoms. However, if too much of your thyroid is destroyed or removed in the process, synthetic thyroid hormones might be required on an ongoing basis.
Medications
As an alternative to radioactive iodine or surgery, thyroid-blocking medications might also be used to treat a hot nodule.
In the past, there were doctors who used high doses of thyroid hormones in an attempt to shrink the thyroid nodules. This practice has been mostly abandoned as it was mostly ineffective.
Fine needle aspiration
However, thyroid hormones may sometimes be needed for people who are having an underactive thyroid.
Your endocrinologist can use fine needle aspiration as well, for draining your nodule if it’s filled with fluid.
Complications
Certain complications which are associated with thyroid nodules include:
Problems breathing or swallowing- Large nodules or a multinodular goiter might interfere with activities like breathing and swallowing.
Hyperthyroidism- Problems might also occur when a nodule or goiter produces thyroid hormone, which eventually leads to an excess amount of the hormone in the body. Hyperthyroidism can therefore lead you to weight loss, muscle weakness, heat intolerance, as well as anxiousness or irritability.
Potential complications of hyperthyroidism also include weak bones, an irregular heartbeat, and thyrotoxic crisis, a rare but life-threatening intensification of signs and symptoms which generally needs immediate medical attention.
Problems related to thyroid nodule surgery- If your doctor recommends surgery to remove a nodule, it is likely that you will need thyroid hormone replacement therapy for the rest of your life.