Thyroid nodules are growths or lumps in the thyroid gland in the front of your neck. This gland controls how your body uses energy. Most thyroid nodules are not cancer and do not cause problems. Many don't even need treatment.
Sometimes a thyroid nodule can cause problems. Sometimes a nodule can make too much thyroid hormone. When a nodule makes too much hormone, the rest of the gland is suppressed and actually doesn't work as hard as usual.
Most thyroid nodules are not cancerous. But if tests show cancer, surgery will be done to remove the nodule.
It is not clear what causes thyroid nodules. But people who have been exposed to radiation have a greater chance of getting them. Also, the nodules tend to run in families. So if your parents had thyroid nodules, you are more likely to have one.
Most thyroid nodules are so small that you don't even know you have one.
If you have a big nodule, you may be able to feel it, or you may notice swelling in your neck. It's possible that you may also:
Most people don't find thyroid nodules on their own, because the nodules aren't easy to feel and don't usually cause symptoms. Your doctor may have found a nodule on your thyroid when you were having a CT scan or ultrasound for another reason. Your doctor will do a physical exam and will ask you if you have symptoms or any changes in how you've been feeling.
You may have tests to see how well your thyroid is working and to make sure the nodule is not cancer. Possible tests include:
If your nodule is not cancer (benign) and is not causing problems, your doctor will watch your nodule closely for any changes. But if the nodule is large or causing problems with swallowing or breathing, you'll need surgery to remove the nodule.
If your thyroid nodule is causing hyperthyroidism, your doctor may recommend a dose of radioactive iodine, which usually comes in a liquid that you swallow. Or your doctor may have you take medicine (antithyroid pills) to slow down the hormone production. In some cases, surgery may be done to remove an overactive thyroid nodule.
If your nodule is cancer (malignant), you'll need surgery to remove the nodule. You may also need treatment with radioactive iodine to destroy any leftover cancer cells. After surgery, you may need to take thyroid medicine for the rest of your life.
Learning about thyroid nodules:
Living with thyroid nodules:
Experts don't know the exact cause of thyroid nodules. But they do know that people who have been exposed to radiation have a greater chance of developing thyroid nodules. Exposure to environmental radiation or past radiation treatment to the head, neck, and chest (especially during childhood) raises your risk for thyroid nodules.
Experts know that thyroid nodules run in families. This means you are more likely to have a thyroid nodule if one of your parents has had a thyroid nodule.
Also, if you have another thyroid condition (such as goiter), you may have a greater chance of developing thyroid nodules.
Most thyroid nodules do not cause symptoms and are so small that you cannot feel them. They often are found during a physical exam or when another test, such as a CT scan or ultrasound, is done for a different reason.
If your thyroid nodule is big, you may be able to feel it or you may notice that your neck is swollen. In rare cases, you may also:
Most thyroid nodules do not cause problems and are not cancerous. They are often hard to notice because they are so small. Lots of people have thyroid nodules that are never found or treated.
There are three kinds of thyroid nodules: solid nodules, nodules that are filled with fluid (cystic nodules), and nodules that are partially cystic. You can have one thyroid nodule or several thyroid nodules (multinodular goiter). You can also have some nodules that are solid and some that are cystic. Solid nodules may grow slowly over time. In rare cases, cystic nodules bleed, which can cause them to grow suddenly and become painful.
Thyroid nodules usually do not prevent the thyroid gland from doing its job. But sometimes a noncancerous thyroid nodule can cause:
You are more likely to develop a thyroid nodule if:
Call your doctor if you have any of these signs of thyroid nodules:
If you have had part of your thyroid gland removed because of noncancerous thyroid nodules, you will need regular medical checkups to make sure your thyroid gland is working well.
Different types of health professionals can help treat a thyroid problem.
Your doctor may also refer you to an endocrinologist for further tests and treatment.
If you need a special exam or treatment, you may see one of these types of doctors:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
The first step in diagnosing thyroid nodules is a medical history and physical exam. Thyroid nodules often are found during a physical exam or during a CT scan or ultrasound of the neck, chest, or head done for another problem. Most people do not find thyroid nodules on their own, because they are difficult to feel and usually do not cause symptoms.
If your doctor finds a thyroid nodule, he or she may refer you to an endocrinologist for more tests and treatment.
Common tests for people with thyroid nodules are:
Other tests you may have include:
If your nodule is not cancerous, your doctor will see you regularly to monitor the size of your nodule. He or she may do other tests, such as checking your thyroid-stimulating hormone (TSH) levels or doing a thyroid ultrasound. If your nodule grows, other tests or surgery may be needed.
If your thyroid gland was removed because of cancer, your doctor may test for thyroglobulin, a protein made by both normal and cancerous cells. High levels of thyroglobulin may mean that the cancer has spread (metastasized) to other parts of your body.
Your treatment will depend on how your thyroid nodule affects you. If your thyroid nodule is not cancerous (benign) and is not causing any problems, your doctor will watch the nodule closely before doing anything else. If your thyroid nodule is causing problems, you may need to take medicine or have surgery.
Antithyroid medicine and radioactive iodine can treat benign nodules that are causing your thyroid gland to make too many hormones (hyperthyroidism). For more information on hyperthyroidism, see the topic Hyperthyroidism.
Surgery is usually only necessary if your thyroid nodule is so large that it causes problems with breathing or swallowing or if your nodule is cancerous. After a cancerous nodule is surgically removed, you may need radioactive iodine to destroy any thyroid tissue or cancer cells that are still causing problems. If you need to have your entire thyroid gland removed, you will need to take thyroid hormone medicine for the rest of your life.
For information about thyroid cancer and its treatment, see the topic Thyroid Cancer.
When you know you have a thyroid nodule, your treatment options include:
If part or all of your thyroid gland needs to be surgically removed because of cancer, radioactive iodine may be used to destroy any thyroid tissue or cancer cells that remain after surgery.
If you have a thyroid nodule:
If your thyroid nodule gets bigger, your doctor may recommend another fine-needle aspiration to see whether the nodule has become cancerous. If your nodule has become cancerous or appears to be cancerous, your doctor will probably recommend surgery (thyroidectomy) to remove some or all of your thyroid gland. You may also need radioactive iodine.
Thyroid nodules cannot be prevented.
The American Thyroid Association recommends that all adults be tested beginning at age 35 and continuing every 5 years.2 But after reviewing all of the research, the U.S. Preventive Services Task Force (USPSTF) has not recommended for or against routine thyroid testing.3 Some other groups suggest that people who are high-risk—women older than 60 and anyone who has a family history of thyroid disease or who has other autoimmune diseases—may want to be screened.4 Talk to your doctor about whether you need to be tested for thyroid problems.
Most thyroid nodules aren't cancerous. Many thyroid nodules don't need medical treatment. If you have a thyroid nodule that is being watched, schedule regular medical checkups to see whether there are any changes.
If you have had surgery to remove your thyroid gland, it is important to:
If you have had radioactive iodine treatment for thyroid nodules, call your doctor if:
Radioactive iodine is sometimes used to treat hyperthyroidism in people who have noncancerous thyroid nodules.
If a nodule is noncancerous but is producing too much thyroid hormone, causing hyperthyroidism, antithyroid medicines may be used before radioactive iodine treatment. For more information on treating hyperthyroidism, see the topic Hyperthyroidism.
Surgery (thyroidectomy) is the best treatment for thyroid nodules that are:
People who develop thyroid nodules after receiving radiation treatment to the head, neck, or chest are more likely to need surgery because their risk for developing thyroid cancer is greater. But most nodules in people who have had radiation therapy are not cancerous.
For information about thyroid cancer and its treatment, see the topic Thyroid Cancer.
Thyroid-stimulating hormone (TSH) suppression therapy may be given to shrink noncancerous thyroid nodules. This uses medicines such as levothyroxine (for example, Synthroid, Levoxyl, or Levothroid), liothyronine (for example, Cytomel), liotrix (Thyrolar), or desiccated thyroid (for example, Armour Thyroid).
It is not clear how well thyroid-stimulating hormone suppression therapy works to shrink noncancerous thyroid nodules. If you have a noncancerous nodule, talk to your doctor about whether TSH suppression therapy is right for you.
TSH suppression therapy can raise your risk of heart and bone problems, especially if you have heart disease or osteoporosis. If you have heart disease, this kind of medicine can make chest pain or problems with your heart rhythm worse. It can also raise your chances of heart attack. If you have osteoporosis, TSH suppression therapy can further weaken your bones.
Hypothyroidism (too little thyroid hormone) occurs in some people after being treated with radioactive iodine for thyroid nodules. For this reason, your doctor will check your thyroid hormone levels regularly after you have this treatment.
If a thyroid nodule is not cancerous but is making too much thyroid hormone, causing hyperthyroidism, antithyroid medicines may be used before radioactive iodine treatment. For more information on treating hyperthyroidism, see the topic Hyperthyroidism.
|American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)|
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The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) is the world's largest organization of physicians dedicated to the care of ear, nose, and throat (ENT) disorders. Its Web site includes information for the general public on ENT disorders.
|American Thyroid Association|
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|Falls Church, VA 22041|
The American Thyroid Association promotes scientific and public understanding of thyroid disorders. It publishes a monthly journal and manages a Web site.
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The Hormone Foundation is a nonprofit organization started by the Endocrine Society. The organization promotes the prevention, treatment, and cure of hormone-related conditions through public outreach and education.
- Ladenson PW (2010). Thyroid. In EG Nabel, ed., ACP Medicine, section 3, chap. 1. Hamilton, ON: BC Decker.
- Ladenson PW, et al. (2000). American Thyroid Association guidelines for detection of thyroid dysfunction. Archives of Internal Medicine, 160: 1573–1575.
- U.S. Preventive Services Task Force (2004). Screening for thyroid disease: Recommendation statement. Annals of Internal Medicine, 140: 125–141.
- Surks MI, et al. (2004). Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA, 291(2): 228–238.
Other Works Consulted
- American Thyroid Association Guidelines Taskforce (2009). Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 19(11): 1167–1214. Also available online: http://thyroidguidelines.net/revised/taskforce.
- Carling T, Udelsman R (2008). Thyroid tumors. In VT Devita Jr et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 1663–1682. Philadelphia: Lippincott Williams and Wilkins.
- Gharib H, et al. (2010). American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocrine Practice, 16(Suppl 1): 3–43.
- Jameson JL, Weetman AP (2012). Disorders of the thyroid gland. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 2911–2939. New York: McGraw–Hill.
- Nygaard B (2010). Hyperthyroidism (primary), search date February 2010. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Matthew I. Kim, MD - Endocrinology|
|Last Revised||March 28, 2011|
Last Revised: March 28, 2011
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