Diagnosis & treatment
Although you sometimes may see or feel a thyroid nodule yourself - usually just below and to the right or left of your Adam's apple - most are discovered when your doctor checks your neck during a routine medical exam. Once a nodule is discovered, your doctor will want to determine whether it's malignant or associated with thyroid dysfunction by the following tests
- Thyroid function tests
- Fine-needle aspiration (FNA) biopsy
Depending on the type of thyroid nodule you have, your options may include:
- Watchful waiting:
If an FNA biopsy shows you have a benign thyroid nodule, your doctor may suggest simply watching your condition, which usually means having a physical exam and thyroid function tests at regular intervals. You're also likely to have another biopsy if the nodule grows larger. If a benign thyroid nodule remains unchanged, you may never need treatment beyond careful monitoring. Talk to your doctor if you're not comfortable with this approach or want more information on other options.
- Thyroid hormone suppression therapy:
This involves treating a benign nodule with levothyroxine (Levoxyl, Synthroid), a synthetic form of thyroxine that you take in pill form. The idea is that supplying additional thyroid hormone will signal the pituitary to produce less TSH, the hormone that stimulates the growth of thyroid tissue. Although this sounds good in theory, levothyroxine therapy is a matter of some debate. There's no clear evidence that the treatment consistently shrinks nodules or even that shrinking small, benign nodules is necessary.
What's more, levothyroxine therapy isn't without risks. Excess doses can lead to heart problems and osteoporosis, although these problems can usually be avoided with careful monitoring. In addition, levothyroxine therapy isn't recommended for older adults or for people with thyroid cysts or nodules that produce thyroid hormone.
- Radioactive iodine:
Doctors often use radioactive iodine to treat hyperfunctioning adenomas or multinodular goiters. Taken as a capsule or in liquid form, radioactive iodine is absorbed by your thyroid gland, causing the nodules to shrink and signs and symptoms of hyperthyroidism to subside, usually within two to three months.
Because thyroid hormone is released into your bloodstream as the nodules are destroyed, in rare cases your symptoms may worsen for a few days or weeks after therapy. You also might experience neck tenderness or a sore throat. And because this treatment eventually causes thyroid activity to slow considerably, you may develop hypothyroidism.
The usual treatment for malignant nodules is surgical removal, often along with the majority of thyroid tissue — a procedure called near-total thyroidectomy. Occasionally, a nodule that's clearly benign may require surgery, especially if it's so large that it makes it hard to breathe or swallow. Surgery is also considered the best option for people with large multinodular goiters, particularly when the goiters constrict airways, the esophagus or blood vessels. Nodules diagnosed as indeterminate or suspicious by FNA biopsy also need surgical removal so that they can be examined more thoroughly for signs of cancer.
Risks of thyroid surgery include damage to the nerve that controls your vocal cords and damage to your parathyroid glands — four tiny glands located on the back of your thyroid gland that help control the level of calcium in your blood. After thyroidectomy, you'll need lifelong treatment with levothyroxine to supply your body with normal amounts of thyroid hormone.
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