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Thyroid Nodules

Thyroid nodules are lumps that form within the thyroid gland. They are very common, usually benign, and often found by accident, but some need ultrasound, biopsy, or treatment for excess hormone production.

Endocrine
Thyroid nodules are solid or fluid-filled lumps that form within the thyroid, the butterfly-shaped gland at the base of the neck that uses iodine from food to produce the hormones setting the body's metabolic pace. Nodules are extremely common — by age 60, up to half of adults have at least one — and they become more frequent with age and occur several times more often in women than in men. Many are discovered by accident on imaging done for another reason. The large majority of nodules are benign, but every new nodule deserves a systematic evaluation, because a small percentage are cancerous and some produce excess thyroid hormone. Causes: Most nodules arise from harmless overgrowth of normal thyroid tissue. Common types and causes include:
  • Colloid nodules and adenomas: Benign overgrowths of thyroid tissue; the most common kind.
  • Thyroid cysts: Fluid-filled sacs that are almost always benign.
  • Chronic thyroid inflammation: Autoimmune thyroiditis can produce nodular changes in the gland.
  • Multinodular goiter: An enlarged gland containing multiple nodules.
  • Thyroid cancer: A small minority of nodules; the risk is higher with prior neck radiation or a family history of thyroid cancer.
  • Iodine deficiency: A classic cause worldwide, though uncommon in the United States.
Symptoms: Most thyroid nodules cause no symptoms at all. When symptoms occur, they may include:
  • A visible or palpable lump: A swelling in the lower front of the neck, sometimes noticed while shaving or buttoning a collar.
  • Pressure symptoms: Large nodules can cause a sense of fullness, difficulty swallowing, or hoarseness.
  • Overactive-thyroid symptoms: A "hot" nodule that makes hormone on its own can cause hyperthyroidism — palpitations, weight loss, heat intolerance, and tremor.
  • Underactive-thyroid symptoms: When nodules occur with autoimmune thyroiditis, fatigue and weight gain from hypothyroidism may be present.
Diagnosis: Evaluation follows a well-established pathway. Your physician will ask about prior radiation exposure and family history, which influence how carefully a nodule is evaluated. A blood test for thyroid-stimulating hormone (TSH) checks whether the gland is overactive or underactive. A dedicated thyroid ultrasound measures the nodule and looks for features that suggest higher or lower risk. Based on the nodule's size and appearance, your physician may recommend a fine-needle aspiration biopsy — a quick office procedure using a thin needle to sample cells. Biopsy results are usually benign; when they are indeterminate, molecular testing or a repeat biopsy helps decide between monitoring and surgery. If the TSH is low, a thyroid scan can determine whether the nodule is a hormone-producing "hot" nodule, which is very rarely cancerous. Treatment: Treatment depends entirely on what the evaluation shows:
  • Observation: Benign nodules are typically watched with a repeat ultrasound in one to two years, then at increasing intervals; many never change, and some shrink.
  • Treating hormone excess: Hot nodules can be treated with antithyroid medication, radioactive iodine, or surgery.
  • Surgery: Recommended for nodules that are cancerous, suspicious on biopsy, or large enough to cause pressure symptoms.
  • What is not recommended: Routine thyroid hormone therapy to shrink benign nodules is no longer advised for most patients.
When to Seek Prompt Care: See a physician promptly if a neck lump grows quickly or is accompanied by persistent hoarseness or trouble swallowing or breathing. Most nodules found this way are still benign, but rapid change deserves timely evaluation. The internal-medicine team at Zimmer Medical Group evaluates thyroid nodules and coordinates ultrasound, biopsy, and specialty referral when needed.

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