A thyroid nodule is a lump in your thyroid gland. It can be solid or filled with fluid. You can have a single nodule or a cluster of nodules. Thyroid nodules are common and rarely cancerous.
Your thyroid is a small butterfly-shaped gland that is located near your larynx (voice box). Your thyroid produces two hormones and secretes them into your bloodstream.
The two thyroid hormones affect your heart rate, body temperature, and many body processes—a group of chemical reactions that, together, are called “metabolism.”
Thyroid nodules are classified cold, warm, or hot, depending on whether they produce thyroid hormones or not.
Cold nodules don’t produce thyroid hormones. Warm nodules act as normal thyroid cells. Hot nodules overproduce thyroid hormones.
Most thyroid nodules are not serious and don’t cause any symptoms. It’s possible for you to have a thyroid nodule without knowing it.
Unless it becomes large enough to press against your windpipe and hamper your breathing, you may have no symptoms. Your doctor may be able to feel it during a physical exam.
According to the American Thyroid Association, about 90 percent of all thyroid nodules are benign—in other words, noncancerous.
What Causes Thyroid Nodules?
The majority of thyroid nodules are an overgrowth of normal thyroid tissue. What causes the overgrowth of tissue is not known.
Nodules are often found in people who have Hashimoto’s disease, an autoimmune disease that leads to hypothyroidism. Individuals who have thyroiditis (chronic inflammation of the thyroid) are also prone to developing thyroid nodules
. If you have a diet low in iodine, you may develop thyroid nodules. This isn’t as common in the United States as it is in other countries because of the wide use of iodized salt and iodine-containing multivitamins.
What Are the Risk Factors for Developing Thyroid Nodules?
People who had X-rays performed on their thyroid in infancy or childhood are more likely to develop thyroid nodules (Johns Hopkins).
Having a preexisting thyroid condition or a family history of thyroid nodules can increase your chances of having nodules.
Thyroid nodules are more common in women; in men, nodules are more likely to be cancerous.
The likelihood of developing a thyroid nodule increases with age. According to the American Thyroid Association, about one-half of people aged 60 years old and older develop nodules.
How do I know if I have thyroid nodules?
Most thyroid nodules do not produce any symptoms. However, large nodules or multiple nodules may be visible. Although rare, nodules can press against other structures in the neck and cause symptoms including:
- Difficulty swallowing
- Difficulty breathing
- Hoarseness or voice change
- Pain in neck
- Goiter (enlargement of the thyroid gland)
Hyperfunctioning thyroid nodules will sometimes, but not always, cause symptoms of hyperthyroidism.
Hyperthyroidism results from an overproduction of thyroid hormone. This causes the levels of thyroid hormone in the blood to be too high. Symptoms of hyperthyroidism include:
- Muscle weakness/tremors
- Light or missed menstrual periods
- Weight loss
- Difficulty sleeping
- Enlarged thyroid gland
- Vision problems or eye irritation
- Heat sensitivity
- Increase or decrease in appetite
- Shortness of breath
- Itchy skin/clammy skin
- Thinning hair
- Skin flushing (sudden reddening of face, neck or upper chest)
- Heart palpitations
Thyroid nodules sometimes result from Hashimoto’s disease and may be associated with symptoms of hypothyroidism.
Hypothyroidism is a condition that results from an underactive thyroid gland. This causes the levels of thyroid hormone in the blood to be too low. Symptoms of hypothyroidism include:
- Frequent, heavy menstrual periods
- Weight gain
- Dry, coarse skin and hair; hair loss
- Hoarse voice
- Cold intolerance
Are there factors that increase my risk of getting thyroid nodules?
Risk factors for developing thyroid nodules include:
- Family history. Having parents or siblings who have had thyroid nodules or thyroid or other endocrine cancers increases your chance of developing nodules. The endocrine system is made up of glands that secrete various hormones into the bloodstream. These hormones manage all the bodily functions necessary for life.
- Age. The chance of developing nodules increases with age
- Gender. Women are more likely than men to develop thyroid nodules.
- Radiation exposure. A history of radiation exposure to the head and neck (from medical treatments but not from diagnostic procedures — such as a CT scan) increases your risk of developing nodules.
Risk factors for developing cancerous thyroid nodules include:
- Family history of nodules
- Having a nodule that is hard
- Having a nodule that is stuck to nearby structures
- Male gender
- Age younger than 20 and older than 70
- Radiation exposure
How are thyroid nodules diagnosed?
Sometimes you can feel the nodule yourself or your doctor may discover it during an exam. However, your doctor will usually need to order one or more of the following tests:
Thyroid hormone level test. This blood test checks the levels of hormones secreted by the thyroid gland. Most often, the hormone levels are normal despite the presence of nodules. However, there are times when abnormal hormone levels are also benign.
Therefore your doctor will likely order other tests.
- Fine-needle biopsy of the thyroid gland. With this test, done in the doctor’s office, a very thin needle is used to withdraw a sample of cells from one or more thyroid nodules. The samples are then sent to a laboratory. Most nodules diagnosed using this method turn out to be noncancerous.
However, if the test results to be “suspicious,” your doctor may repeat this test or may refer you for surgery to have the nodules removed to make an accurate diagnosis.
- Thyroid ultrasound. This test uses sound waves to determine if a nodule is solid or a fluid-filled cyst. (The risk of cancer is higher in solid nodules.)This test also monitors the growth of nodules and it helps find nodules that are difficult to feel. In addition, thyroid ultrasound is sometimes used to help guide needle placement during a fine needle biopsy.
- Thyroid scan.In this test, a small amount of radioactive iodine is injected into a vein. The degree to which the radioactive iodine is absorbed by the nodules compared with normal thyroid tissue helps determine if the nodules are benign or malignant. This test is ordered infrequently since it is only useful in certain circumstances.
How are thyroid nodules treated?
Treatment depends on the type of thyroid nodule. Treatment options include:
- No treatment/”watchful waiting.” If the nodules are not cancerous, you and your doctor may decide that no treatment is needed at this time. The nodules will be closely watched for any changes through frequent check-ups.
- Thyroid hormone suppression therapy. Some doctors treat noncancerous nodules with levothyroxine, a synthetic form of the thyroid hormone thyroxine. The medical theory is that this drug signals the pituitary to produce less of another thyroid hormone responsible for thyroid tissue growth. (The pituitary is a small gland in the brain that controls the thyroid gland.) The goal of levothyroxine treatment is to shrink the thyroid nodules. Doctors and researchers are still studying if this treatment actually works to shrink nodules.
- Radioactive iodine. Your doctor may use radioactive iodine to treat hyperfunctioning thyroid nodules and multinodular goiters. The radioactive iodine is absorbed into the thyroid gland, causing the nodules to shrink. Pregnant women and women trying to become pregnant should not undergo this treatment.
- Surgery. Surgery to remove nodules is the best treatment for nodules that are cancerous, that cause symptoms (eg, are so large that they make breathing or swallowing difficult), and that are “suspicious” (ie, cannot be diagnosed as cancerous or noncancerous without being surgically removed and examined).
Thyroid Nodule Fast Facts
- Thyroid nodules are very common. They occur in about 4 percent of women.
- About 95 percent of thyroid nodules are benign
- Thyroid screening is a simple exam of the neck done by a health care professional to detect enlargement of the thyroid (goiter) or thyroid nodules. This exam is recommended for people who have a family history of thyroid disease or previous history of radiation to the face or neck.
Prevention and Long-Term Outlook
There is no way to prevent the development of a thyroid nodule. Once you are diagnosed, your endocrinologist will check your condition through regular blood testing and annual ultrasounds.
Treatment measures are used for hot or warm nodules that affect thyroid hormone production. However, the majority of noncancerous nodules aren’t harmful, and many don’t need treatment.