What are thyroid nodules?

Thyroid nodules are growths in the thyroid gland, a small organ in your neck located in front of your windpipe (trachea). The thyroid gland produces thyroid hormone, which regulates many of your body’s functions, including metabolism.

Kaitlyn Frazier, M.D., a head and neck endocrine surgeon in the Department of Otolaryngology–Head and Neck Surgery, reports that “thyroid nodules are quite common in adults and may be found in up to two-thirds of Americans over the course of their lifetime. Most nodules (about 90%) are noncancerous (benign), but some can be cancerous (malignant). Thyroid nodules are less common in children and teens, but if a child or a teen has a nodule, it is more likely to be malignant.”

There are several types of thyroid nodules:

• Colloid nodules are benign buildups of thyroid cells.
• Follicular adenomas are also benign.
• Thyroid cysts are fluid-filled sacs inside of your thyroid gland that are almost never cancerous.
• Thyroid cancers can appear similar to any of the other types of thyroid nodules. An ultrasound and sometimes a biopsy are needed to determine if a nodule is malignant.

Thyroid Nodule Symptoms

Many nodules do not cause symptoms until they are large enough to compress the surrounding tissues and organs or to be visible on the neck. A very large thyroid gland is also called a goiter. Other nodules may affect the hormones produced by the thyroid gland, causing symptoms of under-active (hypothyroidism) or overactive thyroid gland (hyperthyroidism). Nodules can sometimes exist alongside autoimmune diseases that attack the thyroid gland.

Depending on the type and cause of the nodule, symptoms may include:

• A lump or swelling in the neck that you can see or feel

• Difficulty swallowing

• Hoarseness or other voice changes

• Neck pressure or fullness

• Pain in the front of the neck
• Sudden, rapid weight loss
• Fast or irregular pulse
• Nervousness or anxiety
• Cold intolerance
• Fatigue
• Dry skin
• Weight gain
• Facial swelling (edema)

Thyroid Nodule Diagnosis

• Palpation of the thyroid by your health-care provider during a physical examination

• Ultrasound of the thyroid and neck is almost always performed to determine the size and features of thyroid nodules. The size and appearance of the nodule on ultrasound can help determine the need for additional studies (such as a biopsy) and treatment options.

• A CT scan is sometimes ordered if very large nodules are present or there is concern for cancer.

• Blood tests to measure the level of thyroid hormones in the blood

• Biopsy of the nodule, which involves taking a small sample of the nodule with a needle and examining the cells under a microscope (cytopathology). This is the best way to determine whether a nodule is benign or cancerous, but is not always necessary. Rarely, the biopsy is inconclusive (indeterminate) and genetic testing or a repeat biopsy may be recommended.

When to See a Doctor for a Thyroid Nodule

If you or your child has any of the symptoms listed above, consult your health-care provider. You may see your primary care provider, or you may be referred to an endocrinologist, a medical doctor who treats thyroid diseases. Sometimes, consultation with a thyroid surgeon is also recommended.

Treatment Options for Thyroid Nodules

Treatment will depend on the type and cause of the nodule. Sometimes, observation (watchful waiting with regular follow-up) is all that is needed. Certain thyroid conditions are treated with medications to restore normal thyroid function. Surgery to remove part or all of the thyroid gland is sometimes necessary if nodules grow very large, if medications don’t work, or if cancer is suspected. Most surgeries in the United States are performed as an open surgery with a scar, but endoscopic “scarless” surgery is sometimes possible for small thyroids or small masses. In certain cases, nonsurgical, minimally invasive procedures can treat nodules. Ethanol ablation (EA) can be used to reduce recurrence of fluid buildup in a thyroid cyst. Radiofrequency ablation (RFA) and microwave ablation (MWA) use energy to reduce the size of a solid or mostly solid thyroid nodule over time. 

Frazier emphasizes that the thyroid is an important gland for your overall health with effects on many other parts of your body, and treatment of thyroid nodules is not a “one size fits all” practice. You may have other medical conditions that impact your treatment options. A large nodule can sometimes affect your quality of life, while other nodules have no symptoms. Some patients are anxious about long-term observation, and others prefer to minimize surgery or reduce their odds of needing medication. According to Frazier, “it is important for you to discuss your health-care priorities with your doctor to find the treatment plan for your thyroid nodules that is best for your health and your life.”

Radiofrequency Ablation: A Treatment Option for Thyroid Nodules

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Endocrine surgeon and laryngologist Vaninder Dhillon describes radiofrequency ablation (RFA), a minimally invasive treatment option for thyroid nodules. Dhillon demonstrates how it is performed and explains what patients can expect.