Nodular Thyroid Disease
Thyroid nodules are present in approximately 50 percent of the population, and incidence increases with age. Thyroid nodules are largely asymptomatic and are usually found incidentally during routine physician visits or neck ultrasounds for other purposes. Although nodules in general are more frequent in women, the incidence of cancerous nodules is higher in men. Five to fifteen percent of incidentally discovered thyroid nodules are cancerous, causing all nodules to require careful evaluation.
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Signs of a Benign Nodule
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A thyroid nodule is more likely benign if the person has symptoms of hypothyroidism or hyperthyroidism; a nodule that is painful, smooth or mobile; a multi-nodular growth; or a family history of Hashimoto's thyroiditis, benign nodule or goiter.
Signs of a Cancerous Nodule
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Signs of a cancerous nodule include a nodule that is hard or fixed to surrounding structures; a nodule that does not uptake iodine on a radioactive iodine scan; a nodule that does not decrease in size after thyroid hormone supplementation; enlarged lymph nodes; swallowing difficulties; and new onset of a hoarse voice. A single nodule appearing normal can also be cancerous. Suspicion of cancer is increased if the patient is less than 20 or over 70 years old, is male, or has had a history of thyroid cancer or childhood neck radiation.
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Diagnosis
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If a physician determines that a thyroid nodule requires investigation for potential cancer, he may order blood tests, neck ultrasound and biopsy by fine-needle aspiration (FNA). The accuracy of biopsy in detecting cancer in thyroid nodules is near 100 percent. Blood tests can determine whether the thyroid is overactive, functioning normally or underactive. A neck ultrasound can determine the size of the nodule.
Biopsy
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A thyroid biopsy may identify malignancy, be suspicious, be non-diagnostic (not enough thyroid cells for pathological determination), or be benign. A repeat thyroid biopsy is necessary after a non-diagnostic biopsy, which may be due to physician inexperience or may occur because the nodule contains blood or other fluid, or calcium.
Treatment
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If a nodule is cancerous, surgery is necessary to remove the nodule and sometimes the entire thyroid gland. Up to 60 percent of indeterminate nodules are actually cancerous, and surgical removal of the nodule is indicated. Sometimes, if a biopsy is non-diagnostic, thyroid hormone supplementation will shrink the nodule. Benign nodules generally only require follow-up. However, if a benign nodule is so large that it is not cosmetically pleasing or interferes with swallowing or breathing, surgery may be indicated.
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