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Thyroid nodule

A thyroid nodule is a growth (lump) in the thyroid gland. The thyroid gland is located in the neck, just above where your collarbones meet in the middle.

Alternative Names

Thyroid tumor; Thyroid adenoma; Thyroid carcinoma; Thyroid incidentaloma

Causes

Thyroid nodules are growths of cells in the thyroid gland. These growths can be:

  • Not cancer (benign) or thyroid cancer
  • Fluid-filled (cysts)
  • One nodule or a group of small nodules
  • Producing thyroid hormones (hot) or not making thyroid hormones (cold)

Thyroid nodules are more common in women than in men. A person's chance of getting a thyroid nodule increases with age.

Only a few thyroid nodules are due to thyroid cancer . A thyroid nodule is more likely to be cancer if you:

  • Have a hard nodule
  • Have a nodule that is stuck to nearby structures
  • Have a family history of thyroid cancer
  • Have noticed a change in your voice
  • Are younger than 20 or older than 70
  • Have a history of radiation exposure to the head or neck
  • Are male

Causes of thyroid nodules are not always found, but can include:

Symptoms

Most thyroid nodules do not cause symptoms.

Large nodules can press against other structures in the neck, causing symptoms such as:

Nodules that produce thyroid hormones will likely cause symptoms of overactive thyroid gland , including:

Thyroid nodules are sometimes found in people who have Hashimoto's disease, which may cause symptoms of an underactive thyroid gland, such as:

Exams and tests

Very often, nodules produce no symptoms. Doctors find thyroid nodules only during a routine physical exam or imaging tests that are done for another reason. A few people have thyroid nodules that are big enough that they notice the nodule on their own, causing them to have a doctor examine their neck.

If the doctor finds a nodule or you have symptoms of a nodule, the following tests may be done:

 

Treatment

Your health care provider may recommend surgery to remove all or part of your thyroid gland if the nodule is:

  • Due to thyroid cancer
  • Causing symptoms such as swallowing or breathing problems
  • Not able to be diagnosed as cancer or not cancer
  • Believe to be making too much thyroid hormone

Patients with nodules that are making too much thyroid hormone may be treated with radioactive iodine. This treatment reduces the size and activity of the nodule. Pregnant women are not given this treatment.

Both surgery to remove thyroid gland tissue and radioactive iodine treatment can cause lifelong hypothyroidism (underactive thyroid), which needs to be treated with thyroid hormone replacement.

For noncancerous nodules that do not cause symptoms and are not growing, the best treatment may be:

  • Careful follow-up with a physical exam and ultrasound
  • A thyroid biopsy repeated 6 to 12 months after diagnosis, especially if the nodule has grown

Another possible treatment is ethanol (alcohol) injection into the nodule to shrink it.

Outlook (Prognosis)

Noncancerous thyroid nodules are not life-threatening. Many do not require treatment. Follow-up exams are enough.

The outlook for thyroid cancer depends on the type of cancer. With most common kinds of thyroid cancer, the outlook is very good after treatment.

When to Contact a Medical Professional

Call your health care provider if you feel or see a lump in your neck, or if you experience any symptoms of a thyroid nodule.

If you have been exposed to radiation in the face or neck area, call your health care provider. A neck ultrasound can be done to look for thyroid nodules.

References

Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2010;16(suppl 1):1-43.

Kim M, Ladenson P. Thyroid. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 233.

Schlumberger MJ, Filetti S, Hay ID. Nontoxic diffuse and nodular goiter and thyroid neoplasia. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 14.

Updated: 5/23/2013

Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.


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