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Thyroid nodules? 50% of us have them
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Dr. David Laird examines Barbara Powers' neck to check for any thyroid nodules. |
Thyroid nodules, or lumps, are so common that more than 50% of the world's population will have them. Most people, however, won't realize that until their doctor detects a nodule during a routine physical exam.
"You often won't know you have a thyroid nodule until your doctor discovers it," said Dr. David Laird, a board-certified general surgeon with Jackson Surgical Associates.
Thyroid nodules are solid or fluid-filled lumps that form within your thyroid, a small gland located at the base of your neck, just above your breastbone. The great majority of thyroid nodules aren't serious and don't cause symptoms. Occasionally, however, some nodules become so large that they can be felt or be seen, often as a swelling at the base of the neck. They can make it hard to swallow or can cause shortness of breath.
Most thyroid nodules do not cause any symptoms like neck pain or fever, which is why most remain unnoticed until a physician finds them. Although most nodules are small, some can be seen just by looking at the front of your throat.
The likelihood of developing a thyroid nodule increases with age and in part represents the aging process of the thyroid gland. Although most nodules are harmless and do not require any treatment at all, about five percent are cancerous.
"Although most thyroid nodules are noncancerous (benign) and don't cause problems, it is important to have a doctor evaluate any unusual swelling in your neck, especially if you have trouble breathing or swallowing," said Dr. Laird. "It's difficult to tell which nodules are malignant by symptoms alone. Though size isn't a predictor of malignancy, cancerous thyroid tumors are more likely to be large fixed masses that grow quickly."
The cause of most thyroid nodules is unknown, but some risk factors for developing nodules include a lack of iodine in the diet, which can cause thyroid enlargement; family history of benign thyroid nodules; and pre-existing thyroid disease.
"Although the chances that a nodule is malignant are small, you're at higher risk if you have a family history of thyroid or other endocrine cancers, are younger than 30 or older than 60, are a man, or have a history of radiation exposure, particularly to the head and neck," said Dr. Laird. "A nodule that is large and hard or causes pain or discomfort is more worrisome in terms of malignancy."
Besides a patient's medical history and the physical examination, blood tests also may help to diagnose a nodule.
Your doctor may order a biopsy if he finds the thyroid nodule suspicious. A biopsy is the removal of a small amount of fluid or tissue from the thyroid by needle insertion for further microscopic examination. There are two types of biopsies, a fine needle aspiration, which removes a few clusters of individual cells with a small needle, and a coarse (large) needle biopsy, which uses a large needle to remove a core of thyroid tissue.
Usually, thyroid biopsies provide the most definitive conclusions about the nature of thyroid nodules.
Treatment options are based on the results of the biopsy. The nodule is diagnosed as benign, malignant, indeterminate or non-diagnostic.
A non-diagnostic fine needle aspiration biopsy results when there are not enough thyroid cells to make a definite diagnosis. A repeat biopsy is usually recommended in order to make a diagnosis.
"The accuracy of a cancer diagnosis by needle biopsy is close to 100 percent," said Dr. Laird. "Most nodules are found to be benign, but if a nodule is cancerous, surgery is recommended to remove it. Generally, most or all of your thyroid gland is removed, after which you'll need to take thyroid hormone replacement therapy for the rest of your life."