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Thyroid (goiter)
Thyroid nodules and nodular goiter
Short answer
Thyroid nodules are the most common change in the gland, and about 90–95% of them are benign. Finding a nodule is not always an indication for surgery. First, the nodule is examined carefully with ultrasound. If there are suspicious signs, a fine-needle aspiration biopsy is done. Depending on the result, either monitoring or surgery is chosen (video).
Schematic — not a real scan image
General information
- How nodules are detected. Some nodules can be felt by hand, but most are found with special tests, mainly ultrasound.
- Malignancy. Among the endocrine organs, cancer is found most often in the thyroid. Even so, the vast majority of thyroid nodules are benign. So when you find out about a nodule, the right response is not fear but a detailed examination by the doctor to learn whether the nodule is benign or malignant.
- Hot and cold nodules. On scintigraphy, nodules that secrete hormones (active ones) are called “hot,” and those that do not are called “cold.”
- Suspicious ultrasound signs (the doctor's list):
- large size or rapid growth;
- microcalcifications;
- irregular (uneven, jagged) margins;
- central blood flow;
- thickness greater than width;
- marked hypoechogenicity.
- When surgery is needed (video):
- the nodule presses on the patient heavily and causes a choking sensation;
- for some patients, the cosmetic appearance of the nodule is bothersome;
- a medical indication — an unfavorable biopsy result, meaning a pathology report of malignancy.
That is why diagnosis is carried out under the supervision of an endocrinologist, in person and, if necessary, with ultrasound and biopsy.
- Prognosis. According to the doctor's explanation, in most patients who are diagnosed with cancer by biopsy and have surgery, the outcome is encouraging, because most thyroid cancers progress slowly. Only a small share, especially in some patients who did not keep the nodule under monitoring, are aggressive and require additional treatment after surgery.
In the doctor's practice
- “We don't recommend a biopsy for every nodule!” A biopsy is done on nodules with a specific appearance. In an 8 mm nodule, a biopsy done on suspicion came back as papillary carcinoma.
- Size does not indicate malignancy. A patient with a large nodule who did not return after a biopsy was recommended 5–6 years ago turned out to have a benign biopsy result. Neither surgery nor serious treatment was needed.
- A more careful approach in men and children. A 39-year-old male patient lived for about 10 years with a diagnosis of an “insignificant nodule.” The nodule was assessed as TIRADS-5, the biopsy result was FN (follicular neoplasm), and the next steps were decided on.
- Large nodules. A patient with nodules of 60, 65 and 70 mm in the right lobe was examined, and the treatment approach was explained. For a huge nodule occupying almost the entire left lobe (complaints: choking, coughing, throat irritation), the doctor calls a biopsy “the ideal option for fully assessing the next steps.”
- An observation during biopsy. “Thyroid nodules can sometimes show their character during a biopsy. If the nodule tugs at the needle (as if it won't let go of it), the chance that it is suspicious is higher. But this is not a 100% bad sign.”
- The doctor's advice. “Even the smallest nodule in your thyroid gland should definitely be discussed with an endocrinologist and kept under control with a suitable treatment or monitoring plan.” If you have a known nodule, it is recommended to be examined at the intervals the doctor sets.
Q&A
A nodule has been found in my thyroid. Do I need surgery?
Not always. First the nodule is examined carefully with ultrasound, and if there are suspicious signs, a biopsy is done. A biopsy may not show a serious pathological finding; when there is no need, the nodule is monitored (video).
My nodule is large. Does that mean cancer?
No. “The large size of a nodule does not show whether it is malignant or benign.” The decision is made based on the character of the nodule.
Can a small nodule need a biopsy too?
Yes. If there are suspicious signs, even a 7–8 mm nodule can be an indication for a biopsy. If there is a suspicious sign, it does not matter whether the size is 7 mm, 5 mm or larger (video).
The doctor’s videos
The videos are in Azerbaijani.
41 sec
When a thyroid nodule needs surgery
54 sec