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Call
(630) 938-6161
to Schedule a Consultation

25 N Winfield Rd Ste 505
Winfield IL 60190-1295

Thyroid Nodules

Overview

Central Neck Dissection

What are thyroid nodules?

Thyroid nodules are a collection of thyroid cells that form a discrete growth within the thyroid gland, distinct from normal surrounding thyroid tissue.

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Thyroid nodules are present in ~60-70% of the population.

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They are more common in women.

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They are more common as we age

This may be due to more imaging studies (CT Neck, CT Chest, Carotid Ultrasound, etc.) being ordered as we age, and subsequent increased incidental discovery.
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Thyroid nodules often do run in families

There may be a genetic component to why nodules form.
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Thyroid nodules are most commonly discovered on physical exam or incidentally on imaging of the neck or chest (e.g., Carotid Ultrasound, CT or MRI cervical spine, CT Neck, CT Chest, PET Scan, etc.). 

When present, thyroid nodules can be felt on exam in 5% of women and 1% of men – most cannot be felt.
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Roughly ~5% of thyroid nodules are cancer.

Whenever thyroid nodules are discovered, the main goal is to rule out cancer. The more nodules that are present in a thyroid, the risk for cancer becomes lower.
Thyroid Anatomy

What is the difference between a thyroid nodule and thyroid goiter?

A goiter is a general term to describe an enlarged thyroid gland.

Sometimes a goiter is the entire thyroid that has enlarged without any distinct nodules, other times a goiter is the result of one nodule that has substantially enlarged or multiple nodules causing its enlargement (aka multinodular goiter).

The presence of a thyroid nodule or nodules do not automatically result in the formation of a goiter.

To learn about thyroid goiters read more here.

Why do thyroid nodules form?

We do not know why most thyroid nodules form, or why some nodules grow
and others do not. Exceptions to this include:

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Iodine Deficiency

There is an increased incidence of thyroid nodules in iodine deficient regions

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Pregnancy

During pregnancy or just after delivery, thyroid nodules can potentially grow, likely due to large fluctuations in reproductive hormone levels in the body

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Heredity

Thyroid nodules can be hereditary
(run in families)

Is there a way to shrink or prevent further growth of thyroid nodules medically?

  • American Thyroid Association (ATA) guidelines recommend against the use of thyroid hormone medication (e.g., levothyroxine or Synthroid) to suppress TSH (Thyroid Stimulating Hormone) levels with the goal of shrinking or preventing further growth of a thyroid nodule.
  • No peer reviewed literature exists to suggest diet (other than to treat objectively identified iodine deficiency) has shown to shrink or prevent the growth of thyroid nodules.
  • No other supplements or prescription medications have been shown to shrink or prevent the growth of thyroid nodules.
  • ATA guidelines also recommend against the use of iodine supplements with the goal of shrinking or preventing further growth of a thyroid nodule unless iodine deficiency has been objectively discovered.
    • In cases of documented iodine deficiency, a daily iodine 150 mcg supplement is recommended.
    • The ATA recommends against higher doses being used.

Are thyroid nodules functional?

The vast majority (> 95%) of thyroid nodules are non-functional (do not produce thyroid hormone)

  • The presence of thyroid nodules does not cause hypothyroidism (low thyroid hormone levels).
    • A diagnosis of hypothyroidism is not a reason to obtain a thyroid ultrasound.
  • When thyroid nodules are discovered, thyroid function labs should be drawn to rule out a hyperfunctioning (‘hot’) thyroid nodule causing hyperthyroidism.
    • These include TSH, possibly free T4 and total T3 if the TSH is abnormal (low).
  • If a diagnosis of hyperthyroidism is made, a radioiodine scan (‘thyroid uptake scan’) is obtained to determine the cause: Graves’ disease vs hot thyroid nodule(s) vs other.
    • A hot thyroid nodule produces excess thyroid hormone independent of the normal feedback loop with the brain.
    • A hot thyroid nodule will absorb the iodine tracer in a thyroid uptake scan more strongly compared to the remainder of the thyroid gland and therefore distinctly be seen.
    • It is extraordinarily rare for hot thyroid nodules to be cancerous. Hot nodules therefore do not need to be biopsied (aka FNA) unless there are high risk features present on ultrasound.
    • A ‘cold’ nodule is a nonfunctioning thyroid nodule. It will not absorb the iodine tracer in a thyroid scan compared to the rest of the functioning thyroid gland and will not be seen on an uptake scan.

Radioactive Iodine Uptake Test

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Image Source: Medizzy

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How do you feel (palpate) for a thyroid nodule?

  1. Use the pads of the fingers on both hands to find your collar bones.
  2. Follow the collar bones to the midline of your neck where they meet in a small valley called the sternal notch.
  3. Staying in the midline, work your fingers up along the windpipe 1-3 fingerbreadths, then 1-3 fingerbreadths to the side.
  4. You should be feeling for a small ball-shaped mass, anywhere from the size of a marble all the way up to a tennis ball.
  5. The location of your thyroid may vary:
    • If you are young or have a long neck, the thyroid may be even higher, 4-5 fingerbreadths above the collar bones.
    • If you have a large neck or a large nodule, the thyroid nodule may be farther away from the midline (4-5 fingerbreadths).
Central Neck Dissection

Do thyroid nodules cause symptoms?

Understanding the signs and potential effects of thyroid nodules is crucial for managing your health and addressing any concerns.

Depending on the size and location of a thyroid nodule, it can push on important structures in the neck causing compressive symptoms:

Trachea / Windpipe

This can result in symptoms of feeling choked, pressure low in the neck (which can be position dependent – looking down, turning your head sided to side, laying down in bed), shortness of breath at rest or with activity, stridor (loud / audible breathing, particularly on the inhale).

Pharynx / Esophagus

Difficulty swallowing, particularly solid foods like meat and dry foods like bread.

Nodules are slow growing

Typically, nodules are slow growing, and the body accommodates well to small changes over time, therefore usually nodules are quite large before they become symptomatic (~ 5 cm or larger).

This can be dependent on the relative size of the patient (smaller people may become symptomatic earlier) and location of the nodule (deeper nodules may become symptomatic earlier).

Nodule Size

Since thyroid nodules are solid structures and do not fluctuate in size on a day-to-day basis, true compressive symptoms are typically experienced daily, as opposed to occasionally.

Small Nodules

Usually, nodules ~ 3 cm and smaller do not cause compressive symptoms.

  • If the thyroid nodule is ‘hot’, it can cause symptoms of hyperthyroidism:
    • Unexplained weight loss, rapid/irregular heartbeat, tremor, sweating, irritability, heat intolerance, insomnia, diarrhea, nervousness, anxiety.
  • If the thyroid nodule is ‘cold’ (>95% of thyroid nodules), it will NOT cause symptoms of hypothyroidism, unless there is hypothyroidism for another reason independent of the nodule’s presence (e.g., Hashimoto’s thyroiditis).

To learn more about thyroid nodules visit

 

To learn more about the Thyroid, head back to the Thyroid main page here.

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