Thyroid Nodules: Get the Facts

Thyroid nodules are a common occurrence. Their prevalence increases with age – 5% to 15% of the adult population may have a clinically significant nodule that needs evaluation. Presently, no known environmental factor has been identified to explain why this increase occurs.

Although the majority of thyroid nodules have no symptoms, they still require evaluation primarily because of their risk of thyroid cancer and its potential dangers. The incidence of malignancy increases when thyroid nodules are larger than 1 cm in diameter. Even if benign, large nodules may also cause obstructive symptoms, such as difficulty swallowing, tightness throughout the front of the neck or sometimes dyspnea due to airway obstruction.

Thyroid nodule evaluation and assessment are usually performed by endocrinologists or surgeons, though a multidisciplinary team is often required for optimal care of the affected patients. Radiologists, pathologists, and other interventionists are integral members of the care team. Patients with benign nodules of average size usually require no further evaluation and conservative management is recommended. However, large nodules and those with suspicion or evidence of malignancy usually require further surgical management.

The most common way suspect thyroid nodules are evaluated further are with blood tests, including thyroid function, thyroid specific immunoglobulin, and thyroid ultrasound. Thyroid ultrasound allows for optimal radiologic visualization of the thyroid and associated nodules. Further evaluation tests include radioisotope thyroid scintigraphy, fine-needle aspiration (FNA) for cytopathology, contrast-enhanced CT, and serum detection of molecular markers. Evaluation goals for patients with thyroid nodules are to optimally assess risk that is inclusive of the disease, diagnostic tests, and all possible treatments, including surgery for patients who require it. Based on the status of the thyroid disease, surgical management may employ open, minimally invasive, and laparoscopic procedures, all of which are widely used in modern medicine. Robotic procedures have seen greater use in recent years.

Shanghai United Family Hospital and Clinics has a multidisciplinary team that includes endocrinologists, radiologists, pathologists, and surgeons who have comprehensive knowledge and experience in thyroid disease management. They can provide high quality, systemic medical services for patients with thyroid issues.

References:

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5. Yip L, Wharry LI, Armstrong MJ, et al. A clinical Algorithm for fine-needle aspiration molecular testing effectively guides the appropriate extent of initial thytoidectomy. Ann Surg 2014;260:163.