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What is the workup for a thyroid nodule?
A thyroid nodule workup starts with physical examination and blood work to see your thyroid functional status. If you meet the American Thyroid Association criteria for Fine needle aspiration or biopsy, you may be offered then.
How is the thyroid biopsy done?
The procedure is straightforward and done in the office. A very thin needle is used to aspirate a cell sample from the thyroid nodule utilizing an ultrasound machine. You will be given numbing medication to make you feel comfortable. Please inform your physician about any allergies to lidocaine. The procedure is relatively straightforward and does not require any advance preparation. You lie on your back with a small pillow under your shoulders to achieve the best possible positioning. While the sample is being taken using the fine needle, you may feel pressure but no pain due to numbing medication. A real-time ultrasound helps your physician to localize the nodule and watch the needle. The sample collected is then sent to a lab for microscopic evaluation. It can take from 1-4 weeks to get back the results.
What are the possible outcomes of a thyroid biopsy?
Your biopsy results can be benign, meaning that there is no concern for thyroid cancer. A minimal chance that a biopsy can miss cancer.
The biopsy may also result as “indeterminate”, which means that the pathologist viewed your biopsy sample and couldn’t rule in or rule out cancer. At this point, your endocrinologist may offer you a repeat biopsy, genetic testing, or surgery.
What are thyroid nodules?
The thyroid gland is a butterfly-like small gland located at the base of your neck. It may have nodules which could be either solid or fluid-filled lumps that you may or may not be able to feel with your fingers. Generally, these nodules are primarily asymptomatic and are found during a doctor check-up visit or undergo radiographic imaging. Some thyroid nodules may be large enough to be visible are and may also affect swallowing or breathing because of pressure in the neighboring structures in the area.
Do thyroid nodules cause symptoms?
Most thyroid nodules are asymptomatic, however; occasionally, they may cause symptoms which may be:
· Pressing your windpipe which may cause shortness of breath
· Compressing your esophagus or feeding tube, which may result in difficulty swallowing.
· Lump could have cosmetic issues.
· patient may have a feeling of having a mass in the neck.
Most of the time, thyroid nodules do not produce an excessive amount of thyroid hormone, and hence they are asymptomatic. However, there are times when these nodules may produce thyroid hormones, which can result in several symptoms of the overactive thyroid gland:
· Unintentional weight loss
· Nervousness
· Rapid or irregular heartbeat
· Increased sweating
· Anxiety or nervousness
· Tremor or shakiness
A small number of thyroid nodules up to 7 to 15% can be cancerous. Your doctor may have to do a detailed physical examination of the neck, learn about your personal medical history, and then offer a fine needle thyroid biopsy.
Thyroid nodules are usually slow-growing; however, there are certain times when aggressive thyroid cancer may have rapid growth.
When to see a doctor
Up to 15% of the thyroid nodule can be cancerous, so it is crucial that if you feel a thyroid nodule or are found incidentally on imaging, it is essential to talk to your doctor and possibly visit an endocrinologist.
Based on the nodule, your doctor may offer you a thyroid fine-needle thyroid biopsy (FNA).
When the thyroid is not making enough thyroid hormone, there can be several reasons the thyroid hormone thyroid gland can be enlarged when patients have iodine deficiency for an extended period. Production or hypothyroid may present with the following symptoms
· Feeling cold – Fatigue – Depression – Constipation – Dry skin – Memory problems.
In case if you have symptoms of overactive thyroid with a nodule, you should get evaluated.
What workup is done for thyroid nodules?
Following tests/procedures may be offered to you to help make a diagnosis.
· Physical exam.
· Thyroid function tests.
· Ultrasound.
· Fine-needle aspiration biopsy.
· Thyroid scan.
How are the thyroid nodules treated?
Treatment depends on the kind of thyroid nodule you have.
A: Treating benign nodules
If a thyroid nodule isn’t cancerous, treatment options include:
· Watchful waiting: If your thyroid nodules are non-cancerous, your physician may recommend you do clinical monitoring, which usually comprises thyroid ultrasound at particular intervals. If there is a change in the size of these nodules over some time, you may be required to undergo a thyroid fine needle biopsy·
Medical therapy: If your doctor finds that your thyroid gland is either overactive or underactive, you may be offered medications. If the nodules are not affecting the thyroid’s functional status, you may not need any treatment.
· Surgery: A non-cancerous thyroid nodule is large enough to cause breathing problems or swallowing food or fluids; your doctor may recommend you the surgical option.
B: Treating nodules that cause hyperthyroidism
Options for an excessive amount of thyroid hormone production by the thyroid nodules include
· Radioactive iodine. Patients are given a capsule of radioactive iodine, which then shrinks the thyroid nodules. It can result in the underproduction of thyroid hormone, which then requires levothyroxine or thyroid replacement supplements.
· Anti-thyroid medications. If you have an overactive thyroid gland, you may need an anti-thyroid prescription such as methimazole or PTU.
· Surgery. If radioactive iodine or anti-thyroid medication fails, you may be offered surgical removal of the thyroid gland.
C: Treating cancerous nodules
· Observation: Very rarely, if the thyroid cancer is extremely small, you may be asked to do observation which includes serial thyroid ultrasound.
· Surgery: Most commonly, the first treatment option is to do surgical removal of the thyroid, which is based on the ENT surgeon’s decision whether to do either half of the thyroid or complete thyroid removal. The decision depends on the extent of thyroid cancer and thyroid cancer features seen on the thyroid ultrasound and fine-needle biopsy results.
Thyroid surgery poses a risk of complications such as vocal cord damage and the risk of damage to the parathyroid glands; these glands control calcium, leading to several problems if not treated. Depending on the extent of thyroid removal after surgery, most patients will require thyroid hormone replacement such as levothyroxine treatment. Your thyroid specialist will determine how much thyroid hormone replacement is necessary to manage thyroid cancer risk reduction.
· Alcohol ablation: Another option to manage thyroid cancer nodules is alcohol ablation. This is done in minimal circumstances and is mostly not preferred here in the US.
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