Last year alone, over 64,000 men and women were diagnosed with thyroid cancer in the U.S. Women are two to three times more likely to develop cancerous nodules than men. In recent years, the advancement of new, highly sensitive diagnostic testing is leading to increased early detection and saving thousands of lives.
The thyroid is an endocrine gland in the neck that produces the thyroid hormone, a crucial hormone in your body, and helps regulate your metabolism. The gland can develop nodules and can grow into a thyroid goiter as well. When to operate on these nodules and how to evaluate them all depends on your situation, so it is important to have a doctor familiar with management to guide the workup and determine your next step.
- About 30-40% of all adults have at least one thyroid nodule. Typically, nodules are found after an ultrasound.
- Roughly 90-95% of thyroid nodules are benign.
- Most thyroid cancers occur between 20 and 50 years of age.
- A history of radiation exposure is a risk factor for thyroid cancer.
- A solitary nodule is more likely to be cancer than a thyroid full of nodules.
- A nodule in a normal thyroid gland is more likely cancer than a nodule in a hyperfunctioning gland, or hyperthyroid.
When Should I Be Concerned?
Every thyroid nodule needs to be evaluated with imaging – usually a neck ultrasound. An evaluation of a thyroid nodule by a doctor will determine if a biopsy needs to be done.
Benign thyroid nodules can be monitored over time to assess the size and growth. If a nodule is easily felt on the physical exam, then a thyroid surgeon can biopsy the nodule with a very fine needle in the office setting. Following thyroid nodules is done with serial ultrasound exams of the thyroid to assess the nodule. Ultrasound is the most common X-ray modality to evaluate nodules. All nodules found on physical exam and all goiters in the neck should be evaluated with ultrasound.
Surgery is only necessary for thyroid nodules for the following reasons:
- Cancer – If there is cancer in the nodule then surgical removal is needed. The good thing is that most thyroid nodules are benign. A biopsy is done with a very fine needle which is used to extract cells from the nodule and then examined under a microscope. Removal of the thyroid may involve a lobectomy (partial removal) or require total thyroidectomy (complete removal).
- Obstruction – Thyroid nodules or thyroid goiters can cause obstruction or blockage in the neck of the esophagus or trachea. The gland may compress the trachea (breathing tube) or esophagus where it can cause difficulty breathing, swallowing or a choking feeling in the neck. If there is hoarseness associated with a thyroid nodule that could mean a higher risk for malignancy.
- Hyperthyroid Nodule – If a nodule is producing high amounts of thyroid hormone and causing hyperthyroidism, medical or surgical treatment may be necessary. This may involve RAI (Radio active Iodine) treatment or surgical excision of the nodule.
- Pain – Pain or discomfort from a nodule may require surgery, but this case is rare. If the biopsy (FNA) is not normal, then surgery would be considered.
Most nodules are benign, so a simple checkup with your board-certified general surgeon should help you determine your next steps.
Dr. Rajesh Padmanabhan is board certified by the American Board of Surgery and a Fellow of the American College of Surgeons. Dr. Padmanabhan has practices in both the Dallas-Fort Worth and Arlington areas. He is named Top10MD – 1-in- 3 doctors succeeds with this recognition in the United States. To schedule a consultation with Dr. Padmanabhan link to his profile or call his office today at 817-466- 7400.