Definition

     A thyroid nodule is a growth (lump) in the thyroid gland. The thyroid gland is located at the base of the neck.

Causes

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

• Iodine deficiency

• Suppression of thyroid hormone

• Hashimoto's disease

Risk Factors

     The following characteristics increase the risk for a cancerous nodule:

• Family history of medullary thyroid carcinoma

• Family history of multiple endocrine neoplasia Type II

• A hard nodule

• A nodule that is stuck to nearby structures

• Vocal cord paralysis

     Other risk factors for a cancerous nodule include:

• Male gender

• Age -- younger than 20 years or older than 70

• History of radiation exposure to the head or neck

Symptoms 

     Most thyroid nodules produce no symptoms.

     Large nodules can press against other structures in the neck. Symptoms may include:

• Difficulty breathing  

• Difficulty swallowing  

• Hoarseness or changing voice   

• Pain in the neck

• Goiter

     Nodules that produce thyroid hormones will cause symptoms of hyperthyroidism, including:

• Weight loss 

• Increased appetite 

• Nervousness

• Restlessness 

• Clammy skin

• Skin blushing or flushing

• Bounding pulse

     Thyroid nodules resulting from Hashimoto's disease may cause symptoms of hypothyroidism, including:

• Intolerance to cold

• Fatigue

• Dry skin

• Hair loss

• Unintentional weight gain

• Facial swelling

Screening and Diagnostics

     Very often, doctors will find thyroid nodules only during a routine physical exam, because the nodules produce no symptoms. When a doctor finds a nodule, or when there are symptoms that suggest a nodule, your doctor may order the following tests:

• TSH level

• Fine needle aspiration biopsy

• Thyroid ultrasound

• Thyroid Scan -- a nodule that works apart from the thyroid gland is said to be "warm" or "hot," and will appear darker on the scan. Only 1% of working nodules are cancerous. Approximately 20% of cold (non-working) nodules are cancerous. 

• T3  and T4  levels

Treatment 

     Some thyroid nodules disappear without treatment. Surgery is recommended for nodules that:

• Are cancerous

• Cause symptoms

• Cannot be diagnosed as cancer or non-cancer

     Patients with working nodules sometimes receive treatment with radioactive iodine, which reduces the size of the nodule. However, the treatment can cause hypothyroidism and radiation-induced thyroiditis (inflammation of the thyroid gland). Pregnant women should not be given this treatment. Women being treated with radioactive iodine should not get pregnant.

     Levothyroxine (Synthroid, Levoxyl, Levothroid, Unithroid) is a drug that suppress the production of the thyroid hormone T4. A doctor may prescribe levothyroxine to treat benign nodules only in special cases, including:

• A growing nodule

• A nodule causing pressure on other structures in the neck

• When many nodules are growing in the thyroid gland

     Levothyroxine does not seem to benefit most people with thyroid nodules, and can cause serious complications. Complications include heart problems and loss of bone density.

     Careful follow-up is the only recommended treatment for benign nodules that do not cause symptoms and are not growing. A thyroid biopsy may need to be repeated 6-12 months after diagnosis. An ultrasound may be repeated as well.

     Newer treatments include ethanol (alcohol) injection into the nodule and laser therapy.

Prognosis

     Non-cancerous thyroid nodules are not life threatening. Many do not require treatment, only follow-up. Non-cancerous nodules that do require treatment have an excellent outlook.

     The outlook for cancerous nodules depends on the type of cancer. See Thyroid Cancer for more information.

Complications 

     Hyperthyroidism is a common complication of non-cancerous thyroid nodules. Complications of treatment can include:

• Nodule regrowth

• Scarring from surgery

• Hoarseness or  voice changes as a result of vocal cord damage during surgery -- this happens especially if the nodule is close to the voice box

• Heart-related problems as a result of side effects from medication

• Weak bones resulting from medication treatment

• Hypothyroidism

Prevention 

     The reason for most thyroid nodules is unknown. A diet with enough iodine will help prevent some nodules.