Anytime you find an unexplained lump or bump, it can cause worry that triggers a cascade of questions — What could it be? Is it something serious? Do I need to go to the doctor?
If you have an unexplained lump on your neck, a closer examination is needed, but don’t panic. If you are over 50, chances are it is a benign thyroid nodule. These growths are very common and are rarely serious. That said, there are instances where you should see a doctor.
January is Thyroid Awareness Month, the perfect time to discuss this common medical concern. In this article, we will discuss thyroid nodules, their causes, symptoms that might indicate you have them, when you should see a doctor, treatment options, and more.
What are Thyroid Nodules?
Thyroid nodules are solid or fluid-filled abnormal growths (lumps) that form within the thyroid gland, which is located at the front of the neck, just below the adam’s apple.
The thyroid gland is a crucial organ that produces hormones regulating the body’s metabolic rate, growth, and development. It also plays a pivotal role in controlling heart, muscle, and digestive function. Additionally, the thyroid contributes to brain development and bone maintenance.
Thyroid nodules are very common, affecting 50-60% of adults. They are typically asymptomatic and often discovered by accident. You can have only one or multiple nodules, and they can vary in size and composition. Factors like age, gender, and family history contribute to their development.
While most thyroid nodules are benign, if you discover them, you should have a doctor take a closer look. Despite the majority being non-cancerous, a small percentage may warrant further attention.
What Causes Thyroid Nodules?
Thyroid nodules can stem from various factors, often with no clear, singular cause. Below is a list of the most common causes of thyroid nodules. While these factors can contribute to their development, it’s important to note that, in many cases, the exact cause remains unknown.
Additionally, certain nodules may develop spontaneously without a clear association of any of these risk factors. If you believe you have a thyroid nodule or are at high risk for one, a doctor experienced in thyroid health can determine the underlying cause and guide appropriate management strategies.
Iodine Deficiency
Although uncommon in the United States due to routine iodine supplementation in foods, a lack of iodine in the diet can contribute to developing thyroid nodules.
Genetic Predisposition
Family history may play a role, as individuals with a familial tendency may be more prone to developing thyroid nodules.
Thyroiditis
Inflammation of the thyroid, known as thyroiditis, can lead to the formation of nodules.
Radiation Exposure
Previous exposure to radiation, whether from medical treatments or environmental sources, is associated with an increased risk of thyroid nodules.
Overgrowth of Normal Thyroid Tissue (Thyroid Adenoma)
An overgrowth of normal thyroid tissue, termed a thyroid adenoma, may lead to non-cancerous nodules. While the cause remains unclear, it becomes significant if it causes bothersome symptoms due to its size.
Thyroid Cyst
Fluid-filled cavities (cysts) in the thyroid, often resulting from degenerating thyroid adenomas, can contain noncancerous or occasionally cancerous components. Solid elements mixed with fluid characterize these cysts.
Chronic Inflammation of the Thyroid (Hashimoto’s Disease)
Hashimoto’s disease, a thyroid disorder causing inflammation, can contribute to the development of enlarged nodules. This association is often linked with hypothyroidism.
Multinodular Goiter
Goiter, an enlargement of the thyroid gland, may stem from iodine deficiency or a thyroid disorder. A multinodular goiter that houses multiple distinct nodules adds complexity to its cause.
Thyroid Cancer
While the likelihood of nodules being cancerous is small, certain characteristics, such as size, hardness, or discomfort, warrant closer examination. Risk factors include a family history of thyroid or endocrine cancers, as well as a history of radiation exposure.
What are the Symptoms of Thyroid Nodules?
Thyroid nodules don’t typically have symptoms and can quietly exist for a very long time. They usually go unnoticed until they are discovered by chance during routine medical examinations or imaging conducted for unrelated reasons.
That said, there are a few red flags associated with thyroid nodules. It’s important to be aware of these potential indicators for instances when symptoms do manifest, as identifying the symptoms associated with thyroid nodules can be important for timely intervention and effective management.
Common symptoms of thyroid nodules might include:
Neck Discomfort or Pain
Some individuals may experience mild to moderate discomfort or pain in the neck, especially when swallowing or turning the head.
Thyroid Enlargement (Goiter)
Nodules can contribute to the enlargement of the thyroid gland, leading to a noticeable swelling in the neck.
Voice Changes
Nodules pressing on the surrounding structures may cause hoarseness or other alterations in voice quality.
Difficulty Swallowing
Larger nodules may impede the normal swallowing process, resulting in difficulty or discomfort while swallowing.
Hyperthyroidism and Hypothyroidism
While not as common, certain thyroid nodules can lead to either an overproduction of thyroid hormones (hyperthyroidism) or an underproduction of thyroid hormones (hypothyroidism.)
Hyperthyroidism causes symptoms like increased heart rate, weight loss, and nervousness. In contrast, hypothyroidism typically exhibits symptoms such as fatigue, weight gain, and sensitivity to cold.
Breathing Difficulties
While rare, large nodules may exert pressure on the windpipe (trachea), causing breathing difficulties.
Are All Thyroid Nodules Cancer?
The good news is that even when symptomatic, the probability of a thyroid nodule being cancerous is relatively low, ranging from 5% to 15% of all thyroid nodules.
Various factors influence the likelihood of a nodule being cancerous, including age below 30 or above 50, male gender, a positive family history of thyroid or other endocrine cancers, a history of significant radiation exposure, larger nodule size, and the presence of symptoms such as hoarseness due to vocal cord paralysis.
In the rare instances where thyroid nodules are found to be cancerous, the most common form is papillary thyroid carcinoma, a slow-growing cancer that typically carries a favorable prognosis. Another less common type is follicular thyroid carcinoma, which also tends to have a good prognosis, especially when diagnosed early.
If a thyroid nodule is cancerous, it is generally treatable, and the prognosis is often very favorable, especially with early detection and intervention.
Are Non-Cancerous Thyroid Nodules Dangerous?
Most of the time, thyroid nodules are not dangerous, particularly when they are small and exhibit no concerning features. However, certain factors may elevate the risk of complications and require closer attention.
The size of the nodules, their growth patterns, and the presence of symptoms play a vital role in determining the level of risk associated with thyroid nodules. For example, larger nodules, especially those causing compression on nearby structures, may lead to difficulty swallowing or breathing.
In cases where nodules exhibit suspicious characteristics or cause troublesome symptoms, your doctor can address the specific concerns and typically mitigate any potential dangers associated with these thyroid growths.
When to See a Doctor for Thyroid Nodules
If you detect a lump in your neck, don’t panic. Chances are it’s nothing serious. The first thing you need to do is evaluate any accompanying conditions that may raise concern.
If you have a lump in your neck, here are some indicators that may warrant closer attention by a doctor:
Nodule Size and Growth
While nodules under 1 cm are typically benign, rapid growth or larger-than-average nodules may signal a more serious condition. Nodules exceeding 1 cm, especially those growing swiftly, could be indicative of malignancy or thyroid cancer.
Discomfort
Pain associated with the thyroid, such as discomfort while swallowing, sensitivity in the thyroid area when pressure is applied, or discomfort when turning the head, may be a sign of thyroid cancer.
Difficulty Swallowing or Breathing
While the nodule itself may be benign, if it grows large enough to obstruct the esophagus, immediate medical attention is necessary. Difficulty swallowing or breathing should not be ignored, as it can be indicative of a potentially serious issue.
Symptoms of Hyperthyroidism or Hypothyroidism
Experiencing symptoms of either hyperthyroidism or hypothyroidism in conjunction with thyroid nodules should raise awareness.
Hyperthyroidism, characterized by an overactive thyroid, may manifest as increased metabolic rate, weight loss, irritability, and insomnia. In contrast, hypothyroidism, where the thyroid underproduces hormones, may result in a slowed metabolism, lethargy, and decreased libido.
Family History of Cancer
A family history of cancer, particularly thyroid cancer or other cancers associated with it, can elevate the risk of cancerous thyroid nodules.
How are Thyroid Nodules Diagnosed?
Detecting thyroid cancers within nodules is challenging as they often do not exhibit symptoms. Furthermore, routine blood tests and labs typically do not identify thyroid cancers. In fact, approximately 50% of cancerous thyroid nodules remain undiagnosed until after surgical removal.
There are many signs that your thyroid isn’t working right. If you are concerned that you might have thyroid nodules or are at high risk for developing them, you should make an appointment with a doctor who specializes in thyroid function.
First, they will ask you some questions about any symptoms and family history. Next, they will perform a painless physical exam to assess the lump (if one is present.) Your doctor will also look for signs and symptoms of hyperthyroidism or hypothyroidism.
Next, they might order thyroid function tests. These tests measure blood levels of thyroid-stimulating hormone (TSH) and hormones produced by your thyroid gland and can indicate whether you have hyperthyroidism or hypothyroidism.
Imaging tests, such as a thyroid ultrasound, might also be ordered. A thyroid ultrasound provides the best information about the shape and structure of nodules, can help distinguish cysts from solid nodules, or help determine if multiple nodules are present.
Your doctor may also perform a thyroid scan to further evaluate the nodules or perform a fine-needle aspiration biopsy to make sure no cancer is present.
Treatment Options for Thyroid Nodules
If it is confirmed that you have thyroid nodules, the course of action your doctor will take to treat them depends on their characteristics, symptoms, and if they are cancerous or benign.
Benign Nodules
A watchful waiting strategy may be recommended for benign nodules if a biopsy confirms a non-cancerous nature. Regular physical exams, thyroid function tests, and occasional ultrasounds become part of routine monitoring.
Treatment may not be necessary if the nodule remains unchanged over time. In cases where thyroid hormone production is insufficient, thyroid hormone therapy may be recommended to maintain optimal thyroid function.
Surgical removal might be considered for large benign nodules causing difficulty in breathing or swallowing. Surgical removal allows for further examination in multinodular goiters or when a biopsy indicates indeterminate or suspicious results.
Nodules Causing Hyperthyroidism
For nodules causing hyperthyroidism, treatment options include radioactive iodine administration, causing nodules to shrink and alleviating symptoms over a few months.
Anti-thyroid medications like methimazole may be prescribed for long-term management. However, potential liver side effects necessitate a thorough discussion with your doctor.
Surgical removal of the overactive thyroid nodule becomes an option when radioactive iodine or anti-thyroid medications are not suitable.
Cancerous Thyroid Nodules
In cases of cancerous nodules, observation may be suitable for small cancers with low growth risk, involving close monitoring through regular ultrasound checks and blood tests.
Surgical removal is a common approach for cancerous nodules, with more limited surgery, removing only a portion, now considered suitable depending on the extent of the disease.
You have many surgery options if you have thyroid cancer. Thyroid radiofrequency ablation (RFA) is a common technique used, as well as various other scarless transoral endocrine surgeries. Your oncology surgeon will discuss the best option for you and your unique circumstances.
If you want to learn more about thyroid cancer, we encourage you to read “Everything You Need to Know About Thyroid Cancer.”
Thyroid Awareness Month in January
January is Thyroid Awareness Month, a time dedicated to emphasizing the importance of thyroid health and raising awareness about thyroid-related conditions.
The goal of this yearly awareness month is to educate individuals about the role of the thyroid gland in maintaining overall well-being and to encourage proactive steps for early detection and management of thyroid disorders.
Thyroid Awareness Month is an excellent time to prioritize thyroid health through regular check-ups, discussions with your healthcare providers, and staying informed about the latest developments in thyroid care.
Awareness and understanding of the thyroid can contribute to a healthier future for people managing thyroid conditions and those yet to be diagnosed.
Where to Diagnose and Treat Thyroid Nodules in Middle Tennessee
If you detect a lump in your throat, encounter neck pain, or observe any typical indications of thyroid nodules that might be thyroid cancer, we encourage you to reach out to our team of general and oncology surgeons at The Surgical Clinic.
Our surgeons specialize in thyroid and endocrine surgery, offering expertise in addressing these concerns with precision and care.