Thyroid Nodules

Thyroid Nodules

Thyroid nodules are very common; more than 50% of the population has at least one nodule. The reassuring fact is that approximately 95% of them are benign.

Thyroid Ultrasound Examination

If a doctor suspects that you have a thyroid nodule or nodular goiter, an ultrasound examination should be performed. This examination is also recommended when nodules are incidentally discovered during other tests (such as carotid ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)).

Thyroid ultrasound provides information about the size and anatomy of the gland and determines which nodules require an additional fine-needle aspiration (FNA) biopsy. It is important to note that most nodules do not require a biopsy.

Fine-Needle Aspiration (FNA) Biopsy

If the TSH level is normal, but the ultrasound examination shows suspicious features, the next step is an FNA biopsy.

Biopsy results may be:
• Mostly benign
• Malignant
• Suspicious for malignancy
• Indeterminate – when results are not clearly benign or malignant.

Thyroid Scan

If a blood test shows that your TSH level is low, a thyroid scan may be needed.
• "Hot" nodules are usually benign and produce an excess amount of hormones.
• "Cold" nodules do not absorb radioactive iodine and have a 5% risk of being malignant.

Treatment of Thyroid Nodules

Benign Nodules

Benign nodules may be monitored, but if they grow, a repeat biopsy or surgical intervention may be necessary.

Malignant Nodules

Only 5% of nodules are malignant. In these cases, treatment involves surgical removal of part or all of the thyroid gland. Radioactive iodine therapy may also be required.

Suspicious for Malignancy

Surgery is often recommended for such nodules, as the risk of cancer is 67-83%.

Follicular Neoplasia

The risk of cancer in these types of nodules is 23-34%. In such cases, a thyroid scan and molecular testing may be needed to determine the necessity of surgical intervention.

Indeterminate (Atypical) Cases

This category includes nodules that are not clearly benign or malignant. Molecular tests are often used to determine whether surgery is necessary.

"Hot" Nodules

"Hot" nodules are almost always benign but may cause hyperthyroidism (excessive production of thyroid hormones). In this case, treatment may include surgery, radioactive iodine therapy, or medication.

Cystic Nodules

These nodules are fluid-filled and are usually benign. They may simply be drained, but if fluid continues to accumulate, surgical intervention may be necessary.