Thyroid nodules

Diagnosis

To properly diagnose the lump or nodule, the following test and procedure are undergone:

• Physical examination: During physical examination the patient will be advice to swallow, because swallowing typically causes a thyroid nodule to move up and down. Other signs and symptoms will be assessed by the specialist to rule out hyperthyroidism or hypothyroidism.
• Thyroid function test: Thyroid-stimulating hormone and hormone produced by thyroid gland is a laboratory test that measures the blood level of the body and determine if the patient have hyperthyroidism or hypothyroidism.
• Thyroid ultrasound: This imaging procedure takes images of the thyroid gland using high-frequency sound waves. It can establish if a nodule is solid or a cyst filled with fluid. The best way to learn about the structure and shape of thyroid nodules is with a thyroid ultrasound. This procedure is also being used as a guide during fine-needle aspiration biopsy.
• Fine-needle aspiration biopsy: Using a very thin needle, the doctor extracts sample cells from one or more thyroid nodules. The samples are thereafter sent to a laboratory for further analysis.
• Thyroid scan: A radioactive iodine isotope is injected into a vein in your arm during this test. A camera then displays an image of your thyroid on a computer screen while the patient is lying on the bed.
  • Hot nodules: non-cancerous, takes more isotope than normal thyroid tissues.
  • Cold nodules: cancerous in some cases.

Treatment

Treatment for non-cancerous thyroid nodules include:

• Observation: physical examination and thyroid function test on a regular basis is recommended. In case that the nodule grows large, then a biopsy is needed. If the thyroid nodule is still the non-cancerous then no further treatment is necessary.
• Thyroid hormone therapy: this treatment is necessary if the result of the thyroid-function test shows that the thyroid gland is not producing enough amount of thyroid hormones for the body.
• Surgery: If a noncancerous nodule grows to a size that it interferes with breathing or swallowing, surgery may be required. The large multinodular goiters may also require surgical intervention, especially if they obstruct blood flow, the esophagus passage, or the airways. Surgical removal of the nodules is also needed if the nodules is indetermine or suspicious by the biopsy.

Treatment for cancerous thyroid nodules include:

• Observation: Small nodules have low risk for
  developing into malignant cells and therefore are closely monitored before providing any treatment. Ultrasound and blood tests and needed for the observation routinely.
• Surgery: Surgical excision of the nodule is the common treatment for cancerous thyroid nodules. Removal of most of the thyroid tissue is called near-total thyroidectomy and this procedure is used depending on the severity of the condition.

Despite the necessity of surgical procedure, there are also risks of undertaking the procedure, such as nerve damage to the vocal cords, and damage to the parathyroid glands.

Lifelong treatment is necessary after the surgery. Specialist will prescribe levothyroxine to provide the body with the needed thyroid hormone.

• Alcohol ablation: this type of procedure will help treating small malignant nodules by injecting a small amount of alcohol that will destroy the malignant thyroid nodule.

Treatment for thyroid nodule that excess thyroid hormone production resulting in hyperthyroidism includes:

• Radioactive iodine: thyroid glands absorbs radioactive iodine that can be taken orally. Within two to three months, this causes the nodules to decrease in size therefore will reduce symptoms of hyperthyroidism.
• Anti-thyroid medications: Methimazole is recommended to some cases by reducing the symptoms of hyperthyroidism.
• Surgery: If radioactive iodine therapy or anti-thyroid medications are not an option for the patient, then the patient might be a candidate for surgical removal of the hyperactive thyroid nodule. Prior to surgery, the specialist will discuss the risk of the procedure.