What Is A Thyroid Nodule? Are All Thyroid Nodules Serious And Must Be Treated?
Have you ever heard of thyroid nodules? Do you know the thyroid gland? Thyroid is a small butterfly-shaped gland that is placed in front of your lower cervical spine and just above the first thoracic vertebra. This gland secretes certain hormones into the body, including thyroxine (T4), triiodothyronine (T3) and calcitonin. These hormones regulate certain functions in the body, including regulating metabolism and that is why hypothyroidism and hyperthyroidism affect the growth in children. In some people, the gland develops abnormal spherical or ellipsoid mass(es), called the thyroid nodule
What is a thyroid nodule?
Nodule formation in the thyroid gland results from abnormal growth in a segment of thyroid tissue. Many thyroid nodules are benign, but thyroid nodule treatment is not limited to malignant nodules and although some nodules are considered benign and harmless, in some cases they start to grow unrelentingly and cause complications including pain in the neck area, shortness of breath, and pressure on other organs, mostly airway in the throat, so these types of nodules must be treated.
With regard to high prevalence of thyroid nodules in the population, in this section we try to explain more about the thyroid nodule conditions demand medical attention to answer the most frequently asked questions of this group of patients.
Thyroid nodules can be solid, fluid-filled (cystic) or combination of both. Most thyroid nodules (about 95%) are benign and only less than 5% of these nodules progress to malignancy.
Why the thyroid nodules must be evaluated and examined?
Given that some thyroid nodules are more likely to be malignant and cancerous, and in some cases thyroid nodules can produce mass effect and put pressure on other organs in the neck area which results in patient discomfort, the examination of these conditions is recommended. It is important to note that small malignant nodules are curable with minimally invasive therapies such as RF and Microwave ablation, and early diagnosis of the condition makes the successful treatment of these thyroid nodules and other thyroid conditions highly possible.In addition to improving the patient’s health and well-being, this avoids future financial and emotional costs and stresses.
What are the symptoms of a thyroid syndrome?
It may come as a surprise to you if you know that in many cases the thyroid nodules or thyroid syndrome are asymptomatic and incidental findings in the diagnosis or treatment process of other conditions; for example, they may be diagnosed in ultrasonography or CT scan of the neck, through thyroid biopsy, or other examinations, so the patient is unaware of his/her disease in the organ. In some cases, perception of the mass in the neck area or observing it in the mirror leads the patient to seek medical assistance.
Many thyroid nodules are non-functional or “inactive”, but in some cases, the nodules begin to secrete thyroid hormones, which can lead to hyperthyroidism, however, malignant nodules are inactive in some patients, i.e. TSH test results are normal in these people.
Is the thyroid nodule painful?
In some cases, a patient with thyroid nodule may experience pain in the neck, ear, or pharynx area.In rare cases the nodule is extended and it has produced respiratory and swallowing disorders due to mass effect on airways and pharynx, these conditions are often indications of thyroid cancer. However, diagnosis and treatment of thyroid nodules in the early stages is much easier and the probability of successful treatment is significantly higher. So, people with thyroid problems and symptoms of thyroid syndrome should undergo periodic examinations, including thyroid ultrasonography, imaging studies and physical and clinical examinations.
What are the signs of thyroid nodules?
Most thyroid nodules are asymptomatic, and laboratory tests indicate normal results, but sometimes there are some symptoms and signs:
- The presence of a mass in the neck
- Swelling in the neck
- A painful thyroid (rarely)
- Change voice and hoarse voice
- Swallowing and respiratory disturbances in case of multiple and very large nodules
Important points in thyroid nodules and conditions treatment
- It is very important to know that in many cases the nodules are asymptomatic
- Thyroid laboratory tests may indicate normal results even in case of thyroid cancer
- And finally, the best way to diagnose thyroid cancer is to refer to a specialist and perform examinations and tests that he/she orders for you.
Types of Thyroid Nodules
- Nodules caused by thyroiditis or thyroid inflammation.
- thyroid nodules due to long term iodine deficiency
- Thyroid adenomas that have no definite cause and can be asymptomatic. (These types of nodes can lead to hyperthyroidism by excess hormone secretion)
- Thyroid cysts due to spontaneous destruction of adenomas.
- Thyroid cancer: Most thyroid nodules are non-cancerous, but thyroid cancer develops in the form of nodule.
- Multinodular goiter, where the entire thyroid contains multiple nodes.
For more information about Thyroid nodules and conditions that lead to nodule development click here.
Determinant factors in thyroid nodule development
- Family history
- Age; the probability of having nodules increases with age
- Gender; women are more likely to have thyroid nodules than men
- X-rays exposure increases the risk of developing nodules, although this is not related to perform radiography or CT scans, some modalities including radiotherapy increases the risk.
Thyroid cancer risk factors
- Family history and thyroid cancer in relatives
- Rigid and stiff nodules
- Female gender
- Age under 20 and over 60 years
- Radiation exposure
Is Thyroid Nodule Dangerous?
Thyroid nodules are actually present in many people and in most cases they do not cause any harm or discomfort to the people. Ultrasonography of thyroid in adults show thyroid nodules in most cases and some of them become symptomatic and cause pain in the neck, show overgrowth or multiple over a given period of time; in such conditions the doctor may examine and evaluate nodules by different methods and modalities to make sure about thyroid malignant nodules.
In answer to the question of whether nodules are dangerous specialists may say that sometimes they can be dangerous, but in the majority of cases they are benign masses that can be treated by simple methods and occasionally they do not require any treatment.
Diagnosis of malignant thyroid nodules
One of the primary goals of a radiologist is to check the thyroid nodule for cancer potentials and also to know if the thyroid gland has a proper function. Followings are examinations and assessments of your condition by radiology specialist:
Clinical examinations:
When you visit a specialist for thyroid problems, he/she will perform a series of clinical examinations, including a thyroid physical examination in swallowing (thyroid gland moves up and down when you perform swallowing)
Other clinical evaluations are for assessment of hyperthyroidism symptoms such as tremors, excessive reflexes, and irregular or fast heart rate (arrhythmias and tachycardia) and hypothyroidism symptoms including dry skin, facial swelling and a slow heart rate (Bradycardia)
Thyroid function and blood tests:
T3/T4/TSH is a thyroid blood test that examines the serum levels of thyroxine (T4), triiodothyronine (T3) and pituitary gland-secreted testosterone (TSH). This test indicates hyperthyroidism or hyperthyroidism.
Thyroid ultrasound:
In ultrasonography an image is produced by a probe (ultrasound transmitter) and high-frequency sonic waves, rather than radiation, to determine the number and size of nodules as well as differentiation of cancerous masses from thyroid nodules. It also has applications as a guide in biopsy by Fine Needle Aspiration.
Fine Needle Aspiration (FNA)
A biopsy is performed to check whether the thyroid nodule is cancerous or not; the biopsy is performed by an experienced specialist.
In this procedure a fine needle is inserted into the thyroid gland to sample a specimen for pathological examinations. Called FNA, this type of outpatient thyroid biopsy does not require general anesthesia and is performed with local anesthesia.
The risks of failed biopsy and the complications are minimal. The procedure for biopsy required general anesthesia and surgery in the past, but today due to technological innovations in medical equipment and devices including thyroid Doppler ultrasound, traditional procedures have become obsolete and are limited to special cases.
Core Needle Biopsy is another similar innovation in the field, except that it is performed with a special needle and it provides a larger specimen for accurate assessment of thyroid tissue. Core needle biopsy is very similar to FNA with regard to complications and pain.
Thyroid scan
In some cases, the specialist orders a thyroid scan. In this diagnostic test, performed to evaluate the thyroid nodule(s), first a low risk radioactive tracer is injected into the patient’s vein and after a while the patient is positioned on the imaging device table and the imaging is performed.
The nodules with hormone secretion capability are called hot nodules; because they uptake more radiotracer than normal thyroid tissue.
Cold nodules are actually “inactive” nodes that look like holes in the scan. It can be said that between 20% to 25% of cold thyroid nodules are cancerous so this differentiation is highly important for specialists. However, one of the drawbacks of thyroid scan is its inability to differentiate benign and malignant cold nodules which calls for more complementary tests.
Thyroid nodule treatment
Is it possible to treat hyperthyroidism?
In past decades surgical treatment was selected method for thyroid nodules, but advances and innovations in thyroid diseases treatment introduced modern and less invasive procedures including radiofrequency and microwave ablations as standard therapies. These procedures started in Iran at the same time as other countries, including China and South Korea and also American Thyroid Association in 2013. Since then, many patients have recovered their health without having their thyroid glands surgically removed.
In this procedure, which in Iran is performed only in our subspecialty institute, the patient is treated briefly without anesthesia and hospitalization. The implementation of the procedure is explained in video clips contained in Gallery section of the website and if you have any further questions, please contact us.
Ultimately the type of your thyroid nodule(s) determines its treatment plan
Treatment of benign thyroid nodules
There are several options for treating non-cancerous thyroid nodules
Watchful waiting treatment:
In some cases, the thyroid nodule does not need treatment, if your specialist diagnose your thyroid nodule as a benign one, he/she may give you a schedule for regular office visit to check the condition of the nodule and its progression. Sometimes in this period specialist may ask you to perform a thyroid biopsy. If thyroid nodule does not change in size and number over the time, there is no need for treatment.
Hormone therapy with Levothyroxine
Levothyroxine is a synthetic form of thyroxine that is marketed as a tablet, the idea behind the hormone therapy is that the use of excess thyroxine causes the pituitary gland to produce lower amount of TSH hormone (TSH is a thyroid-stimulating hormone).
Thyroid nodule surgery
Despite being benign, some thyroid nodules require surgery due to overgrowth and related complications including mass effect on airways, esophagus, or neck blood vessels. Those thyroid nodules that have been diagnosed as suspicious or complicated in biopsies require the surgery, too.
Nodules that cause hyperthyroidism
Some types of thyroid nodule secrete excess thyroid hormones and increases their concentrations in the patient’s body. Following treatment options may be used by a specialist for you:
Radioactive iodine therapy:
This modality is often used by specialists for treatment of hyperthyroidism, thyroid adenomas and multinodular goiter. in this treatment plan radioactive iodine is administered orally in the form of capsule or liquid to uptake in thyroid and shrinks the nodules.
Antithyroid drugs
This is often a long-term treatment plan. Methimazole (topazol) which is used to reduce the symptoms of hyperthyroidism, generally leads to liver complications. It is highly recommended to consult your specialist before using these drugs and its advantages and disadvantages must be considered before prescription.
Surgery
If the above mentioned treatments are not suitable for you, specialist may decide to remove your active thyroid nodules.This treatment also has its own side effects and complications, so you should consult your doctor before undergoing surgery.
Treatment of malignant (cancerous) thyroid nodules
Surgery
Thyroidectomy is the most common procedure for the treatment of thyroid malignant nodules in which the thyroid gland is removed almost entirely with complications including injury to vocal cords and parathyroid glands -small glands behind the thyroid responsible for control of calcium level in the bloodstream. After thyroidectomy, the patient must use Levothyroxine indefinitely to control the level of thyroid hormones in the body.
Ablation with alcohol injection
Another way to destroy a malignant thyroid nodules is injection of a small amount of alcohol into the thyroid cancerous nodule. This procedure is performed in several sessions to remove inaccessible nodules for surgery.
Radiofrequency ablation of nodules
One of innovative and minimally invasive treatments for thyroid nodules is radiofrequency ablation of nodules using sound weave which is performed without anesthesia and skin incision and it does not lead to hormonal disturbance.
The following applications have been mentioned for this modern therapy:
- Treatment of benign thyroid masses (cystic or solid)
- Treatment of malignant thyroid masses with lower than 1cm diameter, confined to the thyroid gland without parathyroid involvement
- Treatment of malignant cervical lymph nodes in patients who are not candidates for reoperation due to previous surgeries or radiotherapy in the area.
- Treatment of hyperactive thyroid adenoma with less post-treatment hypothyroidism compared to radioiodine therapy. It can also be used in pregnant and lactating women who are not candidates for radioiodine therapy.
- Treatment of parathyroid adenomas in people who cannot undergo surgery for any reason.
The last word
It is important to note that not all types of nodules or thyroid cancers can be treated in this way, and if during RF counseling sessions and based on tests results it is determined that they are responsive to treatment, these therapies and be prescribed. In these cases best initial measures are ultrasonography or thyroid biopsy by experienced radiologist in subspecialty and equipped centers and also performing laboratory tests. The results of these examinations and test is invaluable in determining next necessary treatments.
Therefore, the presence of patient for examinations and assessments is very important and all the ambiguities must be clarified for him/her. It should be emphasised that the surgery is still in the forefront of thyroid cancer treatment unless the above-mentioned qualifications and conditions for radiofrequency ablation are met.
Thyroid nodule treatment at Tirad Imaging Institute
At the Triad Imaging and Ultrasound Institute, we have been able to treat benign and malignant thyroid nodules and cysts. Using the latest advancements and innovations in minimally invasive procedures, the top and experienced specialists of Tirad Institute providing most up-to-date treatments for patients and realize new hopes in the treatment of these cysts and nodules.
Tirad Sono is the first and the only subspecialized center for treatment of thyroid diseases in Iran, which has been able to achieve tremendous success in the treatment of thyroid conditions and nodules.
Please contact us for more information.