Check Your Neck

What you Should Know About Thyroid Nodules

Questions & Answers with Tammy Holm, MD, PhD, UC Health surgical endocrinologist at West Chester Hospital and assistant professor of surgery, University of Cincinnati College of Medicine

What are thyroid nodules, and how common are they?
The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body’s functions. Nodules are lumps of tissue in the thyroid gland, or clusters of normal cells in the thyroid that are multiplying. While nodules are common, the vast majority are benign. In fact, 50% of people over age 60 have at least one thyroid nodule and may not know it.

What causes nodules?
It is not clear why nodules form. We do not know how the body sends a signal to trigger a growth. We tend to see them more when the body is low in iodine, an element needed for the production of thyroid hormone. The body does not produce its own iodine, so it is an essential part of our diet. We also know that women and older adults are more susceptible to thyroid nodules. Nodules are also more likely to be cancerous in patients under 30 years of age, and in those above age 60.

How to Fuel Your Thyroid
It is important to eat foods that contain iodine, an element necessary for production of thyroid hormone. Fish, such as cod and tuna, seaweed, shrimp and other seafood, are generally rich in iodine. Dairy products, including milk, yogurt and cheese, as well as products made from grains, like breads and cereals, are major sources of iodine.

How are thyroid nodules detected?
When a nodule grows to about two inches, it is often prominently visible. When touching your neck, you may be able to feel a nodule. You may also feel something pushing on your windpipe, making it more difficult to get a full breath, or an uncomfortable feeling when swallowing. Most nodules don’t cause symptoms and may not be diagnosed unless found during a thyroid exam by a doctor. Nodules are most commonly discovered during an imaging scan being performed for a different medical reason for a problem occurring in the neck or chest area.

Can nodules occur even when all tests are normal?
Yes. Thyroid dysfunction isn’t related to cancerous nodules most of the time. If a nodule is “warm,” that means it is producing an excess amount of thyroid hormone, which would show up in bloodwork. However, cancerous thyroid nodules are “cold” and are not found in bloodwork. This can cause confusion, thinking that since their thyroid has been functioning normally—no symptoms, thyroid levels are normal—they do not have cancerous nodules. However, those two things are completely different—cancerous nodules do not produce extra hormone in the thyroid.

How do you determine if nodules are cancerous or benign?
First, we perform an ultrasound. We look at the size of the nodule, and whether it has calcification, or a growth of calcium. We look at the border of the nodule and whether it seems to be invading and affecting surrounding tissue. Based on the ultrasound results, we will have a better understanding about whether the nodule is malignant, or cancerous. Using ultrasound guidance, we use small needles to sample cells within the nodules. Those cells are sent to the laboratory to be studied, so we know the specific type of nodule that we are dealing with.

Is it true that thyroid cancer is one of the most curable cancers?
Thyroid cancer is generally more easily curable than some other cancers. Around 95 percent of patients diagnosed with cancerous nodules have what is called differentiated thyroid cancer, or DTC. There are two types of DTC—papillary carcinoma and follicular carcinoma—and both have high survival rates.

What are treatment options?
The treatment is generally a combination of surgery, radioactive iodine and hormone replacement medication. Surgery provides a great deal of information about the specific type of cancer. We then have a better understanding that helps us figure out next steps in treatment.

What do you hope to see in the future of endocrine surgery?
We strive for a precise balance between giving the patient the right amount of treatment. For example, removing the entire thyroid can cause uncomfortable side effects. A treatment strategy of “less is more” has shown to be a positive approach for most patients with smaller nodules. In addition, clinical research is ongoing. Our goal is to measure outcomes ahead of time in order to better address patients’ needs.

To connect with an endocrinologist, please call 513-298-DOCS (3627). For more information, visit uchealth.com/services/diabetes-endocrinology.

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