What is a thyroid nodule?
It’s common to get lumps on your neck. When your body’s fighting an infection, your lymph nodes can swell up. Those lumps appear under your jaw and typically go away when your illness does.
A lump lower down at the base of your neck is different. That’s where your thyroid gland is — just under the Adam’s apple and above the collarbone. A lump there isn’t as regular of an occurrence as a swollen lymph node, but it is the most common endocrine problem in the country. Except these lumps don’t go away on their own.
What does a lump on my thyroid mean?
Sometimes, the thyroid just grows lumps. It’s not clear why. The gland begins to grow abnormally, forming one or more nodules. Most of the time, the lumps are so small that you don’t even notice them. Instead, they’re picked up by an ultrasound or CT scan that you’re getting for a completely unrelated reason.
While most thyroid nodules are benign (non-cancerous), some may be cancerous or have the potential to become cancerous over time. A thyroid nodule may simply be swollen tissue, an overgrowth of normal thyroid tissue, or a collection of fluid called a cyst. When the enlarged thyroid gland is large enough to see easily, it's called a goiter.
What are the risk factors for a thyroid nodule?
While the exact causes of thyroid nodules, cysts, and goiter may vary, certain factors can increase the risk of developing these conditions:
- Imbalances in iodine intake can contribute to the development of thyroid nodules, cysts, or goiter.
- Thyroid nodules and goiter are more common in women and tend to increase with age.
- A family history of thyroid disorders or thyroid cancer may predispose individuals to thyroid nodules, cysts, or goiter.
- Previous radiation exposure to the head, neck, or chest area increases the risk of thyroid nodules and cancer.
What are symptoms of a thyroid nodule?
You may be able to see a large nodule or goiter when you tilt your head back. You may only be able to feel it. Often, that little lump is the only symptom. But when they’re large or abundant enough, thyroid nodules start to press up against other parts of the neck, causing these symptoms:
- Hoarseness or voice changes
- Choking or trouble swallowing
- Difficulty breathing
- Neck pain
How is a thyroid nodule diagnosed?
Whether you found the lump, or your doctor did, an evaluation is your next step. Your doctor will determine if your entire thyroid is enlarged and if the nodules are causing related issues like hypothyroidism or hyperthyroidism.
And then you’ll get tested. Thyroid nodules may cause overactive and underactive thyroid, but most of the time they’re non-functioning. So, the traditional thyroid test, a TSH blood test, will come back normal. Instead, you may get an ultrasound to identify the size, type and number of nodules.
Cancerous thyroid nodules act and look differently. With an ultrasound, your doctor can see if the nodules look suspicious and potentially order a biopsy to check for cancer.
Thyroid Biopsy
Thyroid cancer is detected through a procedure called thyroid fine needle aspiration (FNA). Sticking a sharp object in your neck might sound scary, but a thyroid FNA uses a needle so small that the procedure is painless — more like a quick pinch than a poke or prick.
A thyroid FNA is often done in conjunction with an ultrasound so a radiologist can find the nodule and precisely insert the needle into it to take a tissue sample. Then, your thyroid tissue is sent off for analysis to determine whether it’s cancerous.
Thyroid FNA Analysis
Biopsied tissue is examined under a microscope by a cytopathologist, a doctor trained to identify diseases. But they can’t always tell whether the tissue is cancerous or not. In up to 30 percent of cases, the results are “indeterminate.”
Genetic testing helps take away the uncertainty. Thyroid FNA analysis uses a genomic test that gets past the cell level seen under the microscope and down to the molecular level. Half the time, this genetic testing clears you of thyroid cancer. The other half, it finds that the nodule was cancerous, and you need treatment like surgery or chemotherapy to remove the cancer from your thyroid.
How is a thyroid nodule treated?
The treatment of thyroid nodules, cysts, and goiter depends on several factors, including the size of the growth, associated symptoms, and whether it's benign or cancerous.
Treatment options may include:
- Observation: Small, asymptomatic nodules or cysts may not require immediate treatment and can be monitored regularly for any changes.
- Medications: Thyroid hormone replacement therapy may be prescribed to manage symptoms or shrink the size of thyroid nodules or goiter.
- Radioactive iodine therapy: This treatment may be recommended for thyroid nodules or goiter associated with thyroid hormone overproduction (hyperthyroidism).
- Fine-needle aspiration (FNA) biopsy: If a thyroid nodule is suspicious for cancer, a biopsy may be performed to collect tissue samples for analysis.
- Surgery: Surgical removal of the thyroid nodule, cyst, or goiter may be necessary, especially if it's causing significant symptoms, is cancerous, or has the potential to become cancerous.
How do you know if a thyroid nodule is cancerous?
Most thyroid nodules are small and harmless. It’s estimated that half of adults will have developed a thyroid nodule by age 60 and 95 percent of them won’t have cancer. But a nodule is a symptom of thyroid cancer and you should always get it checked — even if your lump is causing no other issues.
Fortunately, thyroid cancer is one of the more curable types of cancer. The five-year survival rate is between 90 and 100 percent for the three most common types: papillary, follicular and medullary thyroid cancer.
What do I do if I find a lump near my thyroid?
Remember, it’s not like your lymph nodes. You can’t wait it out, expecting a little lump to go away. By the time thyroid nodules are large enough to create a noticeable lump, your condition has progressed. And any time cancer is in the equation, early detection and treatment are important.
Schedule an appointment with your primary care provider to talk about your thyroid troubles or any suspicious lumps on your neck. If your symptoms point to thyroid nodules, you’ll be referred for an ultrasound and possibly a thyroid FNA with Medical Imaging.
There are less than 500 thyroid cancer diagnoses every year in Iowa, so you’re likely to find that your abnormal lump is a normal thyroid nodule and get on with treatment to resolve any symptoms it’s causing.