Thyroid nodules are very common and the vast majority of them require no treatment or ongoing surveillance. There are some important questions about thyroid nodules that I will try to answer before recommending a particular course of action to you:
Is the nodule ‘overactive’?
This is usually quite straightforward to answer. If your thyroid blood tests are normal then the answer is ‘no’. If your thyroid blood tests indicate that your thyroid is overactive (Hyperthyroidism) then a special scan called a scintiscan will be arranged to find out if the nodule is ‘hot’ and therefore the cause of your hyperthyroidism. Hot thyroid nodules are not cancerous. The definitive treatment for hot thyroid nodules is either surgery or radioactive iodine therapy and I will discuss these options with you.
Is the nodule causing significant compressive symptoms?
Sometimes thyroid nodules can grow big enough to affect your swallowing, your breathing or even your voice. However, it is often difficult to tell if a particular nodule is responsible for symptoms. I will ask you some questions to try and work out what, if any, symptoms your nodule could be responsible for. In addition to examining your neck it may be necessary for you to have a CT scan to look more closely at your thyroid gland and the things that it might be pushing on. For larger nodules or where a nodule is clearly causing symptoms surgery to remove all or part of the thyroid gland may be recommended.
What is the chance that the nodule is a thyroid cancer?
Most thyroid nodules are not cancerous. To fully assess your nodule you will need to see a thyroid specialist who will ask about your symptoms and then examine your neck. You may require some blood tests and an ultrasound examination. Additionally a biopsy known as Fine Needle Aspiration (FNA) may be necessary, I will explain whether this is the case or not. An FNA is similar to a blood test but the sample is taken from the nodule. A very thin needle is inserted into the nodule and a small sample is taken out. The cells in the sample will then be sent to the laboratory for analysis under a microscope. The FNA procedure will either be done in the clinic or in the radiology department with the help of an ultrasound machine. I will arrange a follow up appointment to tell you the results of the biopsy.
Most people have no problems after a FNA biopsy. You may experience some mild discomfort in your neck, especially when you swallow but his will improve quickly. If you need to, I recommend using simple pain killers such as paracetamol. Occasionally patients will notice some bruising around the area where the needle was inserted. The bruising typically resolves within a week. If the thyroid lump was mainly due to fluid then it is not unusual for the fluid to collect again over a period of 1 or more weeks. This is no cause for concern unless the area becomes painful and red, in which case you should see your GP.
Most of the time the biopsy results are benign (no evidence of cancer). A benign result is highly reassuring and only rarely does it have to be repeated.
Sometimes, the biopsy result does not give us an answer, because there were not enough cells in the sample to test, or because it was not possible to decide on the significance of the cells that are seen. In such cases, I may recommend repeating the biopsy, or may advise you to have an operation to remove part of your thyroid.
In approximately one in twenty cases the biopsy shows that the thyroid nodule is cancerous. If this happens I will discuss this with you and in most cases you will need to have an operation to remove all or part of your thyroid gland. Sometimes surgery to remove lymph nodes from your neck is also necessary. As well as talking to you about your diagnosis your I will provide you with printed information about thyroid cancer and thyroid surgery.
It is much more likely that your results will be benign and that there is no cancer and then you may be discharged from the thyroid clinic. This means that the risk of you developing thyroid cancer in future is remote and no higher than anybody else.
Will I need to have any long-term surveillance for my thyroid gland?
Generally there is no requirement for surveillance of thyroid nodules once they have been fully assessed. Whatever the outcome of your tests there are some symptoms which should not be ignored if they occur, especially if they are persistent or are getting progressively worse. They include:
If you develop any new symptoms like those described above, you should let your GP know. In some cases your family doctor may be able to reassure you. In other cases you might need to come and see me again.
You should feel free to ask any questions about your thyroid at any time and might like to bring along a friend or family member to help you remember what is said.