How can you tell if a thyroid nodule should be concerning?

The thyroid gland is a hormone gland located in the lower portion of the neck. It is basically shaped like a bow tie, with a left and right lobe as well as a small area in the center connecting the two sides. Typically, it should be small enough and soft enough that in most neck examinations it should not be palpable distinctly. The thyroid gland releases the thyroid hormone, which is in charge of our daily body energy levels.

Regardless if the gland is making too much or too little of the hormone, or just the right amount, patients may have nodules within the thyroid gland. These nodules are more common in female patients in their middle ages. Generally, 90 to 95% of these nodules are benign, and no intervention would be necessary beyond the initial diagnosis. Between 5 to10% of these nodules may be malignant, and surgery and additional treatments might be necessary.

Throughout history, many modalities have been used to assess if a certain nodule should be of concern or not. Various features on an ultrasound may be more worrisome than others. Previously, thyroid scans with radioactive material used to be performed to assess if a certain nodule was hyperactive or hypoactive. Hypoactive nodule was more suspicious for malignancy. In these days thyroid scans are not performed as routinely any more since we have better techniques.

The most reliable way to tell if a thyroid nodule is of concern or not is to perform a needle aspiration biopsy. Using a syringe and a needle, the tip of the needle is driven into the center of the nodule, and the content is aspirated into the core of the needle. These cells are then flushed into a microscope slide. The slides are looked at by a pathologist under the microscope to make a distinction about the nature of the nodule. In most cases, a diagnosis can be made with an adequate sample based on needle aspiration alone. Following that, further recommendation could be made for the patient if additional intervention should be necessary.

Occasionally, the information from the needle aspiration biopsy might not be sufficient. This could be either due to inadequacy of the sample obtained during the biopsy, or certain features of specific types of diagnosis that cannot be made strictly with aspiration biopsy alone. In these patients, a repeat biopsy or an open biopsy in the operating room might be necessary.

If a certain nodule is properly biopsied and is found to be negative, no additional intervention is necessary in most cases. Patients can then be followed up routinely with occasional follow-up ultrasounds. If there is a rapid change in the size of the nodule or any specific characteristic changes, a repeat biopsy might be necessary to rule out a transformation of the nodule from its earlier state.

Any person with a thyroid nodule should be followed up with their primary doctor, endocrinologist, or an ear, nose, and throat doctor.

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