Thyroid is a butterfly shaped gland located in front of the wind pipe in the neck. It has a smooth outline. Enlargement of the thyroid gland is called goiter. This enlargement may be diffuse (smooth outline) or nodular (irregular outline). Nodules are irregular areas of growth in the thyroid gland. Big nodules may be visible. Smaller ones can be felt on palpating the thyroid gland. Even smaller ones may be seen only in ultrasound imaging. Small thyroid nodules are quite common and may be seen in up to one in three individuals if ultrasound scanning is done in all.
Thyroid nodules may be benign or malignant. Benign nodules may be left alone unless they cause symptoms. Malignant nodules grow and spread to other parts of the body. Hence, they need to be removed as early as possible. Your doctor will try to determine whether you have benign or malignant nodules
Small nodules may not cause any symptoms and are usually picked up incidentally in an ultrasound scan of the neck or during regular physical examination by the doctor. Larger ones result in cosmetic disfigurement of the neck. They may cause compression of the surrounding structures and result in breathing difficulty, difficulty in swallowing, hoarseness of voice etc. Sudden increase in size of the nodule may result in pain.
Thyroid nodules may be associated with normal, low or high thyroid hormone levels in blood. Hence patient may be euthyroid or have associated hypothyroidism or hyperthyroidism.
Your doctor will ask you to do thyroid function testing – T4 and TSH levels, to ascertain whether you have hypo or hyperthyroidism. He may ask you to do ultrasound scanning of the thyroid which gives clues as to whether the thyroid nodule is benign or malignant. Suspicious looking nodules should be biopsied. A fine needle aspiration (FNA) of the thyroid nodule gives more information regarding the nature of the nodule. In some cases, your doctor may ask for nuclear scanning of the thyroid gland.
Small benign thyroid nodules may be left alone. Malignant nodules should be surgically removed followed by radioiodine therapy. Large benign nodules that cause symptoms may also need to be removed surgically. Patients with coexisting hypothyroidism or hyperthyroidism need treatment for those conditions.
Benign nodules which are left alone may need to be followed up over time with thyroid function tests, ultrasound and FNA.
Our doctors can clinically asses the nodules, help you with tests to decide the type and extend of the nodule and decide on the best management plan. Since the guidelines for management of nodules are changing frequently, our doctors can help you decide the best way forward.
