What Happens if I Have a Thyroid Nodule?

January 31, 2019
thyroid photo

You might be looking in the mirror while shaving or fastening a necklace when you first see it. Or your doctor might feel it during a routine physical exam. Other times it will show up during unrelated scans of the neck.  

That lump at the base of your neck could be a thyroid nodule, an abnormal growth of thyroid cells within the thyroid gland. The thyroid gland helps regulate many body functions by releasing a steady flow of hormones into the bloodstream.

Rarely, thyroid nodules can produce an excess amount of thyroid hormone, causing hyperthyroidism or hyperactive thyroid gland. If thyroid nodules are large enough, they can cause neck pain, voice changes or difficulty swallowing.

Most nodules are not cancerous and don’t cause any symptoms. Testing is important as treating thyroid cancer at the earliest stages improves chances for cure and decreases effects of the disease.

The initial laboratory test might include measurement of thyroid hormone (Free T4 or thyroxine) and thyroid-stimulating hormone (TSH) in the patient’s blood. Since it’s usually not possible to determine whether a thyroid nodule is benign or malignant from a blood test alone, the evaluation of thyroid nodules commonly includes thyroid ultrasound and fine-needle biopsy. A nuclear thyroid scan may be indicated for further evaluation of thyroid nodules associated with hyperthyroidism

New tests that examine the gene mutations in the DNA of thyroid nodules are very helpful in providing information about the presence of cancer. Molecular testing is particularly helpful when a fine-needle biopsy result is indeterminate.

If the biopsy is suspicious for a cancerous nodule, the patient is referred to our surgical team right away. Surgery, called thyroidectomy, is the primary therapy for all thyroid cancers. The extent of the surgery depends entirely on the size of the tumor and whether it has spread to lymph nodes in the neck. For very small nodules, less than 1 centimeter, partial thyroidectomy (removal of only the affected lobe) can be considered. After surgery, most patients require thyroid hormone replacement for the rest of their lives.

Thyroid cancer can be cured by surgery alone, especially if the cancer is small. If the cancer has spread to lymph nodes or the patient is at high risk for recurrent or persistent disease, radioactive iodine therapy is needed following thyroid surgery.

In some cases, thyroid cancer spreads outside of the neck area and can cause serious complications. Thyroid surgery and radioactive iodine treatments are still the best way to treat these types of cancers. However, for more advanced cancers, external beam radiation or chemotherapy can slow or partially reverse the growth of the cancer.

It must be noted that thyroid cancer is one malignancy where multidisciplinary team approach is very important due to complexity of treatment. Close interaction between the endocrinology team, pathologist, nuclear medicine physician and surgeon helps our patients achieve optimal management.

Maya Peltsverger, MD, is a board-certified endocrinologist with NHRMC Physician Specialists - Internal Medicine Specialists.

Types of thyroid cancer

• Papillary Thyroid Cancer: The most common type, making up 70 to 80 percent of all thyroid cancers. May occur at any age and often spreads to lymph nodes in the neck. However, unlike many other cancers, it tends to grow slowly. Patients diagnosed with papillary thyroid cancer usually have an excellent prognosis, even if it has spread to the lymph nodes.

• Follicular thyroid cancer: Represents about 10 percent to 15 percent of all thyroid cancers. Can spread to lymph nodes in the neck, but it is less common compared with papillary thyroid cancer. Can potentially spread to distant organs, particularly the lungs and bones.

• Medullary thyroid cancer: Makes up only 2 percent of thyroid cancers. Commonly runs in families and is associated with other endocrine tumors. In family members of the affected patient, a genetic mutation in the RET proto-oncogene can lead to an early diagnosis of medullary thyroid cancer and curative treatment.

• Anaplastic thyroid cancer: The most aggressive thyroid cancer and the least likely to respond to treatment. Luckily, this type of thyroid cancer is rare and found in less than 2 percent of patients with thyroid cancer.

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