A Thyroid Nodule Primer: Benign, Malignant and Suspicious.
Karen Fitzpatrick-Dame, ChhC, AADP
Thyroid nodules feel round or oval-shaped, and differ from the surrounding normal thyroid tissue.
In some cases a person notices a nodule in their own neck, while in other cases a healthcare provider will feel a nodule during a routine examination of the neck. Nodules can also be discovered during tests for an unrelated condition.
Thyroid nodules are very common; up to half of all people have at least one thyroid nodule, although most do not know about it. Thyroid nodules can be caused many different conditions. Reassuringly, about 95 percent of all thyroid nodules are caused by benign (non-cancerous) conditions.
Benign nodules: These nodules usually develop as a result of overgrowth of normal components of the thyroid gland. Surgery is not usually recommended, and the nodule can usually be monitored over time. If the nodule grows, a repeat biopsy or surgery may be recommended.
Malignant nodules (thyroid cancer): Only about 5 percent of all thyroid nodules are malignant. The majority of thyroid cancers are papillary thyroid cancer. Most patients with thyroid cancer have an excellent chance for cure or long-term survival. The treatment of thyroid cancer will depend on the type of cancer. Thyroid cancers require surgical removal of the thyroid gland and one or more treatments with radioiodine, followed by thyroid hormone (T4) suppressive therapy.
Indeterminate or suspicious nodules: These nodules are not officially classified as malignant nodules, but they share many features with thyroid cancer. With time, they may invade surrounding tissues, at which point they are classified as cancer. Surgical removal of these nodules is generally recommended. At the time of surgery, about 10 to 20 percent of suspicious nodules have become invasive and are classified as cancers. Occasionally, synthetic thyroid hormone (T4) treatment may be recommended to slow the growth of a microfollicular nodule. Close monitoring is also recommended.
Autonomous nodules: Some nodules produce thyroid hormone, similar to the thyroid gland, but fail to respond to the body's hormonal controls. These nodules are called autonomous nodules. They are almost always benign, but they can lead to excess thyroid hormone production and hyperthyroidism. Patients with an autonomous nodule and marked hyperthyroidism usually undergo surgery to remove the nodule, or undergo radioactive iodine treatment to destroy the nodule.
If there is an autonomous nodule and normal thyroid function or minimal hyperthyroidism, the appropriate treatment will depend on the patient's age and other health factors. This type of nodule may be monitored in young adults. However, high thyroid hormone levels pose a risk of an abnormal heart rhythm (atrial fibrillation) and bone loss (osteoporosis) with advancing age, and radioactive iodine treatment may be recommended for older adults.
Cystic nodules: Cystic nodules are usually benign nodules that have filled with fluid. These nodules may simply collapse when the fluid is removed. Cystic nodules are usually monitored for changes; some symptoms, such as recurrent bleeding or cyst reformation require that the nodules are surgically removed.
Where to begin for Thyroid Health and suspected Thyroid Nodules?
Start by seeing your health care professional.
Then testing, begin treatment, then re-test again annually. Learn more.
Step #1: Comprehensive Thyroid Panel Test available without a prescription.
