Otolaryngology–Head and Neck Surgery
Thyroid nodules are solid or fluid-filled lumps that form within your thyroid, a small butterfly-shaped neck gland that controls your metabolism. Although this can be pretty common, a majority of thyroid nodules are not serious and don’t cause symptoms. However, a physician evaluation is still required as approximately 5 to 10 percent of thyroid nodules are cancerous.
Thyroid nodules are very common, occurring in 15 to 65 percent of all ages. They occur in both women and men but are especially common in women (50 percent of women ages 50 or older have had a thyroid nodule).
Usually patients and their physicians first notice thyroid nodules during a routine physical exam of the neck area. Sometimes they are found incidentally during a radiographic evaluation of the neck (such as a CT scan, X-ray, MRI, or ultrasound).
There is no medical treatment for thyroid nodules. If a decision is made that the thyroid nodule needs to be removed, surgical treatment is recommended. Large nodules are often removed for a number of reasons:
- May cause pressure symptoms and can lead to the formation of goiter
- They can produce excess thyroid hormones
- Can prevent accurate assessment of the possibility of cancer
In general, a thyroid nodule is considered “significant” if it is 1 cm or larger and/or presents concerning features on ultrasound. Large nodules are often removed as they may cause pressure symptoms and can lead to the formation of goiter. Thyroid nodules that produce excess thyroid hormone also need to be removed.
Lastly, some thyroid nodules are large enough that standard diagnostic approaches prevent accurate assessment of the possibility of cancer; and therefore, they also need to be surgically removed.
- Sometimes there are no symptoms
- An enlarged thyroid gland
- Pain at the base of your neck
- Breathing difficulties
- Changes in the voice (hoarseness)
- Swallowing difficulties
Diagnosis and Treatment
The typical workup for thyroid nodules includes an initial ultrasound and a blood test to assess thyroid stimulating hormone (TSH). For nodules that are greater than 1 cm and/or appear suspicious on the initial ultrasound, a fine needle biopsy will be ordered. If the nodule cannot be felt during the office physical exam, an ultrasound-guided biopsy will be performed by a radiologist who will localize the nodule and obtain a good sample.
At the conclusion of this workup, our surgeons will determine if surgery is recommended and also the extent of surgery needed. Surgery may include removing one side of the thyroid or the entire thyroid, and it may also include removal of affected lymph nodes in the neck around the thyroid. In thyroid nodules that are either suspicious for cancer or show definite evidence of thyroid cancer, thyroid surgery is the recommended treatment.
Mass Eye and Ear has a radiofrequency ablation clinic, a joint program launched by the Thyroid and Parathyroid Endocrine Surgery Division and Department of Radiology, that shrinks small thyroid growths without surgery.
Meet Our Team
The Thyroid and Parathyroid Endocrine Surgery Divisionis staffed by surgeons, radiologists, and other medical specialists skilled in the evaluation and treatment of problems of the thyroid and parathyroid. Our combination of medical expertise allows us to treat patients of all thyroid and parathyroid conditions.
Did you know?
The workup described for thyroid nodules follows the national guidelines set by the American Thyroid Association (ATA).
Division Director Dr. Gregory Randolph plays a significant role in the leadership of the ATA and served on the 2014 American Thyroid Association guidelines taskforce writing group for thyroid nodules and differentiated thyroid cancer.