Thyroid Nodules, Lumps, Enlarged Thyroid, Goiter
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:
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.
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.
All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician or health practitioner before starting a new treatment program. Please see our full disclaimer.