Thyroid nodules are abnormal masses or lumps within the thyroid tissue that can develop in different structures and various sizes. The majority of nodules are benign as well as harmless. Nodules usually show no symptoms or signs and need to reach a diameter of 2 cm to be recognized. Nodules can develop due to different diseases or they can be a problem on their own. Treatment depends on the type of nodule.
Nodules are known to carry a cancer risk of between 5 and 10 percent. Depending on this rate, they should be imaged with ultrasound and different diagnostic methods to distinguish them from benign nodules. If there are no other underlying causes as a result of the evaluation, treatment planning is made.
Why Do Thyroid Nodules Occur?
Among the causes of thyroid nodules, iodine deficiency is the most important factor. Depending on geographical conditions, the incidence is also high in people living in regions with high iodine deficiency. It is one of the most common thyroid gland diseases and is widely seen.
In addition to iodine deficiency, some environmental factors such as natural goitrogens are also effective in its development. It is also a condition that can be passed down through the family. Therefore, genetic factors are also effective in its formation.
What are the Symptoms of Thyroid Nodules?
While most thyroid nodules do not cause symptoms and signs, some nodules have a chance to show symptoms depending on their size.
- Trouble swallowing or breathing and having difficulty
- Hoarseness or voice changes
- Pain and discomfort in the anterior part of the neck
- Enlargement of the thyroid gland (goiter)
What are the Types of Thyroid Nodules?
Nodules that develop in the thyroid gland can be classified under three main headings according to their structure;
- Solid nodules (solid)
- Mixed semi-solid and semi-liquid nodules (semi-solid)
- Liquid (cystic) nodules, simple thyroid cysts
Increased Suspicion of Cancer in Nodules
In some cases, the likelihood of cancer increases. The suspicion of cancer may increase in cases such as a rapid increase in the size of the nodules, swelling of the lymph nodes in the neck, the presence of a very hard nodule adhering to the surrounding tissues, and hoarseness or thickening in the patient's voice.
The risk of thyroid cancer may increase in cases such as exposure to radiation, radiotherapy to the neck area, and the presence of thyroid cancer in the family. In addition, people under the age of 20 and over the age of 70 are also seen as risk factors.
Diagnosis of Thyroid Nodules
Thyroid nodules are diagnosed by specialized doctors. For the diagnosis, the patient's medical history is learned in detail and a physical examination is performed by the specialist. If deemed necessary, some blood tests are performed.
The specialist may utilize imaging techniques in the diagnostic process. In almost all cases, nodules, even if benign, have the possibility of becoming cancerous. Therefore, they should always be checked and evaluated. The tests and examinations are as follows:
Thyroid Blood Test
It is a test to determine the level of thyroid hormone in the blood. In the presence of nodules, there may be no difference in hormone levels. However, in some cases, abnormal results may be encountered and may indicate thyroid disease.
Thyroid Ultrasound
It is a test used to visualize the thyroid gland. It is done to determine whether the nodules are solid or a fluid-filled cyst. It is useful to check whether the nodules are growing. Also, in some cases, specialists use ultrasound to guide the placement of the needle during a fine needle biopsy.
Fine Needle Biopsy
A fine needle is used to take a cell sample from the nodules. It is sent to a laboratory for evaluation. This test can be repeated to determine that nodules, which are usually benign, do not carry any cancer risk.
Treatment of Thyroid Nodules
Nodules filled with tissue are more at risk of cancer than those filled with fluid, and those that do not produce hormones are more at risk than those that do. Nodules that are enlarged, painful and hard increase the risk of cancer.
The patient may experience complaints such as difficulty in swallowing and hoarseness. Depending on the results of the fine needle biopsy, surgical intervention is required for nodules that are cancerous or potentially cancerous.
It is important that the nodules with good biopsy results are re-examined and continued to be monitored. Surgical intervention may be necessary when growth is observed in the nodules.
Since hot nodules are usually not malignant, needle biopsy is not performed. In this case, they can be treated with radioactive iodine. However, if they are 2 cm or more in size or if there are too many hot nodules, surgery may be performed.
As a result of the presence of the mass, there may be pressure on the trachea and in this case, surgical removal may be recommended. If the thyroid hormone level is normal, surgery can be performed immediately. However, in case of enlargement and excessive hormone production, medication is applied. In cases where hormone levels are normalized, surgery can be performed.
