Thyroid nodules are very common and usually don't cause any symptoms or require any treatment. Most people with a nodule, or small lump, on their thyroid gland don’t even realize they have one.
But a small number of nodules on the thyroid gland, which is located at the base of the neck, may be cause for concern:
- Some nodules may become big enough create discomfort or difficulty when you breathe or swallow.
- Some nodules may produce too much thyroid hormone, leading to hyperthyroidism.
- About 5 percent of thyroid nodules are cancerous. Most cases of thyroid cancer, though, can be cured, and Rush has a team devoted to caring for patients with thyroid and other endocrine cancers.
Thyroid nodule causes
Possible causes of thyroid nodules include the following:
- Adenoma, or abnormal benign growth of thyroid tissue
- Multinodular goiter, in which multiple nodules are growing
- Thyroid cysts
- Low iodine intake (uncommon in the United States, where this trace mineral is commonly added to table salt and other foods)
- Thyroid cancer
In most cases, the cause of thyroid nodules is unknown.
Thyroid nodule symptoms
Most thyroid nodules have no symptoms. But some may cause 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, such as discomfort or difficulty when speaking
How can I get help for thyroid nodules?
If you have one or more of the above symptoms and they don’t go away after a few days, speak with your primary care doctor. If your doctor thinks you may have a thyroid nodule, you probably will be referred to an endocrinologist for further testing.
Care for thyroid nodules at Rush
Ruling out thyroid cancer
If you have a thyroid nodule, your endocrinologist at Rush will first want to make sure that it is not cancerous. To determine whether your nodule is 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 of TSH, it may mean your body is not producing enough thyroid hormone (hypothyroidism) because of Hashimoto’s disease or another condition. If you have low levels of TSH, it may mean your body is producing too much thyroid hormone (hyperthyroidism), and you may need to have a thyroid scan (see below).
- Ultrasound exam. If your level of TSH is normal or high, the next step will likely be an ultrasound exam, which uses sound waves to create a picture of the inside of your body. The exam will help your doctor pinpoint the precise location of the nodule and to see other characteristics — such as size, shape and whether it is filled with fluid or solid tissue — that may help with diagnosis.
- Fine-needle aspiration biopsy. Ultrasound alone cannot be used to determine whether a nodule is cancerous, so most people will also need a fine-need aspiration biopsy (FNA). During this procedure, your doctor uses a hollow needle to extract a small amount of tissue from the nodule. The procedure usually takes less than five minutes. A pathologist then examines this tissue under the microscope to determine whether it is cancerous. In the vast majority of cases, it is not.
- 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. Your doctor will give you a small dose of radioactive iodine via a pill or an injection, and will then watch to see if the nodule absorbs the substance. If it does, it is a “hot” nodule, which produces too much thyroid hormone but is not cancerous. If it does not, it is a “cold” nodule and has a 5 percent chance of being cancerous.
Treating thyroid nodules
If you are one of the majority of people whose nodule is benign, your doctor at Rush 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 at all. Your doctor may recommend periodic exams to make sure it is not growing or interfering with your thyroid function.
- Medications. If your thyroid nodule is producing too much thyroid hormone, you may need medications for hyperthyroidism, which include radioactive iodine and antithyroid medications. If your thyroid nodules are caused by hypothyroidism, you will need treatment 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 when you breathe or swallow, or if it is causing hyperthyroidism that doesn’t respond to medications.
Why choose Rush for thyroid nodule care
- Nationally recognized thyroid experts: Endocrinologists from Rush were part of the team that wrote the American Thyroid Association guidelines for the care of hypothyroidism.
- Care designed for your convenience: Endocrinologists and endocrine surgeons at Rush offer in-office diagnostic testing, minimizing the need to travel between offices during your visit.
- Surgeon-performed ultrasounds in the operating room: At Rush, surgeons perform ultrasounds during thyroid nodule surgery to help them visualize the thyroid in real time. The resulting high-resolution images help guide the procedure, which can lead to better outcomes for patients.