Thyroid Nodules

Thyroid nodules are exceedingly common, being clinically detectable by palpation alone in between 4-7% of the general population. Advances in, and increasing use of medical diagnostic imaging has unearthed a much larger reservoir of subclinical nodules (nodules smaller that 1 cm that escape being detected by the patient or the physician). Recent estimates are that about 30% of women under the age of 50, and 50% of women over the age of 60 may have thyroid nodules detectable by ultrasound.

* The main concern with a thyroid nodule is that 1 in 20 harbors a thyroid cancer

Most thyroid nodules present as a painless central neck lump that moves well with swallowing. Nodules are otherwise completely asymptomatic. This applies for both benign and malignant nodules. A lack of symptoms therefore does not assure one is dealing with a benign process. Symptoms of difficulty in swallowing or breathing are sometimes seen in very large nodules. A nodule associated with voice hoarseness, rapid growth, and with other neck lumps should raise the suspicion of cancer.

The challenge in evaluating a patient with a thyroid nodule is in accurately and consistently identifying the malignant or suspicious nodules from the vast majority of benign ones. This is done by careful clinical assessment and by performing two very important diagnostic investigations, a thyroid ultrasound and a fine needle aspiration biopsy (FNAB). Performed and read accurately, these investigations collectively provide an accuracy of 90 – 95%.  (see CLINIC SERVICES)

Thyroid nodules that are small and appear benign on the ultrasound and needle biopsy can be safely observed and followed.

INDICATIONS FOR THYROID SURGERY for a thyroid nodule include:

          A nodule that is confirmed to be cancerous on FNAB
          A nodule that is indeterminate or suspicious of cancer either on the thyroid ultrasound or FNAB
          A benign nodule that continues to grow over a period of time
          A large nodule or goiter that compresses onto the windpipe (trachea) or gullet (oesophagus)
          A nodule or goiter that is descending into the chest cavity (called a retrosternal goiter)

The Thyroid Head & Neck Surgery Centre