Thyroid Nodules

Background

  • The thyroid is a butterfly shaped gland that sits in front of the windpipe in the lower neck
  • The thyroid makes thyroid hormone, which helps to regulate your body’s metabolism
  • Thyroid hormone can also effect heart rate, bone loss, and how blood sugar is used

What is a Thyroid Nodule?

  • A thyroid nodule is an abnormal growth within the thyroid gland
  • Nodules are very common, especially with increasing age
  • Most thyroid nodules are not cancerous
  • There is a 5-15% risk of thyroid cancer in patients without other risk factors (see risk factors)

Signs and Symptoms

  • Most thyroid nodules do not cause any symptoms
  • Most patients with nodules have normal thyroid hormone levels
  • Symptoms that can occur include:
    • Rapid increase in nodule size
    • Enlarged neck lymph nodes
    • Voice changes that do not go away

Risk Factors

  • Factors that increase a thyroid nodule being cancerous include:
    • A family history of thyroid cancer or thyroid cancer syndromes
    • Age <20 years, or >70 years
    • Male gender
    • Personal history of radiation to the head, neck, or upper chest

Diagnosis

  • A complete medical history and physical
  • A thyroid neck ultrasound
  • Blood work
  • Certain thyroid nodules based on size and the way they look on ultrasound will require biopsy

What is Thyroid Biopsy?

  • Biopsy of the thyroid is called a fine needle aspiration (FNA)
  • The biopsy is an accurate way to determine if your thyroid nodule is cancerous or not
  • A small sample of thyroid cells are collected with a needle and examined

Bethesda Criteria

  • Thyroid FNA results are put into categories based on Bethesda Criteria
  • This gives the probability of the thyroid nodule being cancerous
  • Bethesda Criteria has six categories ranging from low, 0-3% to high 95-97% risk of thyroid cancer

Results of FNA Biopsy

  • Bethesda II, or benign biopsy is the most common result
  • If benign, most thyroid nodules require continued monitoring
  • If suspicious for cancer or cancer is seen, you may need surgery to remove part or all of your thyroid gland
  • Indeterminate results may occur. If this happens there are several options including molecular genetic testing, continued monitoring, or repeating FNA biopsy

Summary

  • Thyroid nodules are very common, and most are benign
  • Your doctor should evaluate any thyroid nodules to exclude cancer
  • Evaluation includes a comprehensive history, physical exam, thyroid ultrasound, and thyroid biopsy
  • Treatment options include surveillance, additional molecular marker testing, and/or surgery