Thyroid nodules — small lumps on the thyroid gland at the base of the neck — are very common and usually don’t cause symptoms or require treatment.
Symptoms of Thyroid Nodules
Most thyroid nodules cause no symptoms, but a small percentage may be cause for concern. Some nodules may become big enough to create discomfort or difficulty when you breathe or swallow. Some may produce too much thyroid hormone, leading to hyperthyroidism. About 5% are cancerous; fortunately, most cases of thyroid cancer can be cured.
Symptoms include the following:
- A lump you can feel under the skin of your neck, just above your collar bones
- Dysphagia (difficulty swallowing)
- Pain or swelling in your neck
- Voice changes, including discomfort or difficulty when speaking
Diagnosis and Treatment of Thyroid Nodules at Rush
If you have any of these symptoms that don’t go away after a few days, see your primary care provider. If your provider thinks you may have a thyroid nodule, you may be referred to an endocrinologist for further testing.
If you have a thyroid nodule, your endocrinologist will want to make sure it’s not cancerous. To determine whether it's benign (noncancerous) or malignant (cancerous), you may need one or more of the following tests:
- Test of thyroid-stimulating hormone: This blood test measures the level of thyroid-stimulating hormone (TSH) in your blood. If you have a high level, your body may not be producing enough thyroid hormone (hypothyroidism) because of Hashimoto’s disease or another condition. If you have low levels of TSH, your body may be producing too much thyroid hormone (hyperthyroidism) and you may need a thyroid scan.
- Thyroid scan: If you have a low level of TSH, your doctor will likely perform a thyroid scan before performing a fine-needle aspiration biopsy. You will be given a small dose of radioactive iodine via a pill or injection. If the nodule absorbs the substance, it is a “hot” nodule that is not cancerous but produces too much thyroid hormone. If it does not absorb the substance, it is a “cold” nodule and has a 5% chance of being cancerous.
- Fine-needle aspiration biopsy: In this procedure, which typically takes less than five minutes, your doctor uses a hollow needle to extract a small amount of tissue from the nodule. A pathologist then examines the tissue under a microscope to determine whether it is cancerous. In the vast majority of cases, it is not cancerous.
- Ultrasound exam: If your level of TSH is normal or high, your provider may recommend an ultrasound to create a picture of the inside of your body. This helps pinpoint the precise location of the nodule and allows the doctor to see other characteristics – such as size, shape and whether it is filled with fluid or solid tissue – that may help with a diagnosis.
If your nodule is benign, your doctor may recommend one or more of the following options:
- Watchful waiting: If your benign nodule is not causing pain or discomfort, you may not need any treatment. Your doctor may recommend periodic exams to make sure it is not growing or interfering with your thyroid function.
- Medications: If your nodule is producing too much thyroid hormone, you may need medication for hyperthyroidism, such as radioactive iodine and antithyroid medication. If your nodule is caused by hypothyroidism, you will be treated for this condition.
- Surgery: Most people do not need surgery for benign thyroid nodules, but your doctor may recommend this option if your nodule is large enough to cause discomfort or difficulty in breathing or swallowing or if it causes hyperthyroidism that does not respond to medication.
If thyroid cancer is diagnosed, you can receive treatment from our dedicated thyroid cancer team at Rush.
Rush Excellence in Thyroid Nodule Care
- Nationally recognized thyroid experts: Rush endocrinologists helped write the American Thyroid Association guidelines for the care of hypothyroidism. Also, U.S. News & World Report ranked Rush University Medical Center among the best in the nation for endocrinology.
- In-office diagnostics: Rush endocrinologists and endocrine surgeons offer in-office diagnostic testing, minimizing the need to travel between offices during your visit.
- Ultrasounds during surgery: Rush surgeons perform ultrasounds during thyroid nodule surgery to visualize the thyroid. The high-resolution images help guide the procedure, which can lead to better outcomes for patients.