Thyroid Nodules

Thyroid Nodules Endocrine Conditions Sydney Endocrine Surgeon

What is the thyroid gland?

The thyroid gland is a butterfly-shaped gland that sits in the front of your neck just below your voice box (or larynx). It wraps around the windpipe (trachea). The thyroid is responsible for converting iodine from your diet into thyroxine, the thyroid hormone. Thyroid hormone controls most of your body’s metabolic functions including growth, temperature and heart rate.

What are thyroid nodules?

Thyroid nodules are solid or fluid-filled lumps that develop within your thyroid. Most thyroid nodules are not serious and do not cause symptoms. Only a small percentage of thyroid nodules are cancerous.

Thyroid nodules are often discovered incidentally when you have a scan (for example an ultrasound or CT) done for another health reason. Sometimes, thyroid nodules become large enough to be visible or to cause symptoms like swallowing or breathing difficulties.

What symptoms do thyroid nodules cause?

Most thyroid nodules don’t cause symptoms. Occasionally they can become large enough that they cause symptoms and can:

  • Be seen as a swelling in the neck

  • Be felt as a lump in the neck

  • Cause pressure on your trachea (windpipe) or oesophagus (food pipe) and cause shortness of breath, choking or difficulty swallowing

In some cases, thyroid nodules produce an excess amount of thyroxine (thyroid hormone). The excess thyroid hormone can result in symptoms of hyperthyroidism (overactive thyroid). These include:

  • Rapid or irregular heart rate

  • Tremor

  • Nervousness and anxiety

  • Unexplained weight loss

  • Increased sweating

Rarely, thyroid nodules are cancerous. In most cases, it is not possible to tell which nodules are cancerous based on symptoms alone. A biopsy (and sometimes surgery) is required to tell the difference between benign (non-cancerous) and cancerous nodules.

What conditions cause nodules in the thyroid gland?

Many conditions can cause thyroid nodules to develop. These include:

  • Thyroid adenoma – a benign (non-cancerous) overgrowth of thyroid tissue.

  • Thyroid cyst – a fluid-filled sac or cavity in the thyroid.`

  • Hashimoto’s disease – a thyroid condition that causes thyroid inflammation and can result in enlarged thyroid nodules. It is often associated with hypothyroidism (underactive thyroid).

  • Multinodular goitre – a goitre is a swelling or enlargement of the thyroid gland. “Multinodular goitre” is an enlarged thyroid gland containing thyroid nodules. Some people with multinodular goitre feel or see a lump in their neck or have symptoms due to pressure on their trachea or oesophagus. Sometimes, they can have symptoms of hyperthyrodism (overactive thyroid).

  • Thyroid cancer – there are a number of different types of thyroid cancer. Some types are more serious than others.

During your consultation, depending on your condition and symptoms, Dr Graham will discuss in detail the appropriate investigation and management options for you.

What tests will I need?

There are a number of tests that are used to make sure the nodule is not a threat to your health. These include:

  • Blood tests - used to assess thyroid function and hormone levels

  • Ultrasound – imaging test to look at thyroid gland and any nodules that may be present as well as lymph nodes in the neck

  • Fine needle aspiration biopsy – depending on the size and characteristics of the thyroid nodule, a biopsy may be required to diagnose the cause of the nodule and whether further treatment is required. A small needle is inserted into the thyroid nodule and a sample of cells is taken for a pathologist to look at under the microscope.

  • Thyroid scan – you will need this scan if you have hyperthyroidism (overactive thyroid). A radioactive substance is injected and a special camera takes a picture of the thyroid gland. 

How are thyroid nodules treated?

Thyroid nodules are treated in a number of different ways. Depending on the cause of the nodule and how much thyroid hormone is in the body, different treatments will be recommended. During your consultation, Dr Graham will discuss the different treatments appropriate in your situation and help you decide on the best treatment for you.

The different treatment options include:

  • Watching and waiting – surgery is not always required for thyroid nodules. If the nodule is small and does not look worrying, Dr Graham may recommend close monitoring with imaging and clinical examination.

  • Surgery – removal of half of the thyroid (hemithyroidectomy) or all of thyroid (total thyroidectomy) may be required.

  • Medication – if you have hyperthyroidism (overactive thyroid), Dr Graham will work in conjunction with an endocrinologist to determine the best treatment plan for you. Medication can be used to lower thyroid hormone levels.

  • Radioactive iodine – radioactive iodine can be used to destroy the thyroid gland so it does not make so much thyroid hormone. It comes in a pill or liquid that you swallow.