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Thyroid Nodules, Lumps, Enlarged Thyroid, Goiter
Key Information

by Mary Shomon

If your doctor has diagnosed you as having a thyroid nodule, a thyroid lump or an enlargement of the thyroid known as goiter, you'll want to know more about the diagnosis and treatment process, the relationship between nodules to thyroid cancer, and followup.

What is a Thyroid Nodule?

Thyroid nodules are very common. A nodule is a swelling or lump, which can be a solid or liquid filled cyst or mass. Most are benign, but a small percentage can be cancerous. So you should always have a nodule evaluated by your physician as soon as you notice it.

Symptoms of a nodule can be varied. Some people have hyperthyroidism symptoms -- such as palpitations, insomnia, weight loss, anxiety, and tremors -- and others have hypothyroidism symptoms -- weight gain, fatigue, depression. Some will cycle back and forth between hyperthyroid and hypothyroid symptoms. Some people mainly have difficulty swallowing, a feeling of fullness, pain or pressure in the neck, a hoarse voice, or neck tenderness. And finally, many people have nodules wiht no obvious symptoms related to thyroid dysfunction at all.

If you have a thyroid nodule, don't be very worried that it is cancerous. Only 5% of nodules are cancerous, and most forms of thyroid cancers are highly treatable and curable.

Thyroid Nodule Statistics

An estimated one in 12 to 15 women and one in 50 men has a thyroid nodule
More than 90 percent of all thyroid nodules are not cancerous

Evaluating a Nodule By Blood Test

Typically, the first step when a nodule is discovered is for the doctor to conduct a blood test to evaluate your thyroid hormone levels. The results are usually normal, because thyroid nodules do not typically produce thyroid hormone.

Occasionally, nodules will produce thyroid hormone, and cause hyperthyroidism. Nodules can also develop in patients who have an existing thyroid condition. This frequently occurs with people who have Hashimoto's Disease, the autoimmune thyroid condition that can cause hypothyroidism.

A rare form of thyroid cancer is medullary cancer, which can sometimes be detected by a blood test to measure calcitonin levels. Medullary thyroid is known to have hereditary factors, so calcitonin tests are recommended for those who have family members with medullary cancer.

Evaluating a Nodule By Thyroid Scans

Commonly, in addition to a blood test, a thyroid scan will also be conducted to evaluate the nodule. In a thyroid scan, you'll receive a small amount of radioactive iodine that is absorbed by your thyroid. An image of the thyroid taken is then taken, and can show a picture of the distribution of the radioactive material in your thyroid gland. Thyroid nodules may some iodine ("warm nodules"), show more activity ("hot" nodules), or take up little iodine and show decreased acitvity ("cold" nodules). Warm and hot nodules are rarely cancerous. Even among cold nodules, only a small percentage are cancerous, but these types of nodules typically require further evaluation.

Evaluating a Nodule By Ultrasound Test

A next step can be an ultrasound of the thyroid. This test can determine the nature of the cold nodule -- solid versus fluid-filled. Ultrasounds are being used less frequently, however, because most doctors evaluating a cold nodule prefer to evaluate both the type of nodule, and test the cells for cancer at the same time, a process than can be accomplished by a test known as "Fine Needle Aspiration," (FNA) or a needle biopsy.

Evaluating a Nodule By Needle Aspiration / Needle Biopsy.

In needle aspiration or needle biopsy a local anesthetic is usually used to help minimize any pain. You'll mainly feel just pressure or a pinching feeling as a needle is inserted into the thyroid in order to withdraw cells for testing. Typically, in what's known as a fine needle aspiration (FNA), several samples will be taken from the nodule in order to make sure various parts are evaluated. The sample taken from the thyroid will be evaluated by a pathologist. Typically, the findings will indicate that your nodule is:

Benign. This means your nodule is not cancerous. Approximately 70% of nodules will come back benign.
Malignant. This means your nodule is cancerous. Approximately 5 % of suspicious nodules will be malignant.
Suspicious. This means diagnosis wasn't conclusive, but there was possible cancer.
Inconclusive. If the sampling wasn't sufficient, a diagnosis might be difficult. In this case, an additional biopsy might be recommended.

For an in-depth discussion of the fine needle aspiration process, see my article, Fine Needle Aspiration Biopsy of the Thyroid -- Questions & Answers.

Thyroid Nodule Treatments

Typically, for a benign nodule, the treatment is to prescribe thyroid hormone, which can usually shrink the nodule, or prevent it from growing. If the nodule continues to grow, your doctor may biopsy it again, or recommend surgical removal.

Most doctors will recommend surgical removal of a malignant nodule. While in surgery, the thyroid cells can be evaluated, and a decision to remove the lobe of the thyroid -- or the entire gland -- can be made based on the results. Based on the diagnosis, thyroid cancer treatment can then be pursued.

In the case of an inconclusive nodule, if a repeat biopsy is not possible, or if the doctor is suspicious of the nodule, some doctors will recommend surgical removal and evaluation. The majority of these nodules are also benign.

Goiters

What is a Goiter?

A goiter is an enlargement of the thyroid, and is sometimes used as a term to refer to an enlarged thyroid. The thyroid becomes large enough so that it can be seen as enlarged on ultrasounds or x- rays, and may be enlarged enough to enlarge the neck area visibly.

What are the Symptoms of a Goiter?

Some goiters can be tender to the touch. An enlarged thyroid can also press on your windpipe or your esophagus, which may make you cough, have a hoarse voice, feel shortness of breath, feel like you don't want to wear turtlenecks or neckties, feel fullness in your neck, experience choking or shortness of breath at night, or feel like food is getting stuck in your throat.

Causes of Goiter

In areas outside the U.S., particularly parts of Asia and Africa, iodine deficiency is a key cause of goiter. But in the U.S. and many other industrialized nations, the use of iodized salt and processed foods has eliminated that problem for all but about 10-20% of the population.

In the U.S., goiter is more commonly caused by autoimmune thyroid problems that cause an inflammatory reaction in the thyroid.

Doctors will typically treat a smaller goiter with thyroid hormone replacement drugs. This can slow down or stop the growth of the goiter, but doesn't typically shrink the goiter.

If the goiter continues to grow while on thyroid hormone, or symptoms continue, or the goiter is cosmetically unsightly, most doctors will recommend surgery. If the goiter contains any suspicious nodules, that may also be reason for surgery.

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