Thyroid nodules are abnormal growths that develop in the thyroid gland, and they can have a variety of causes, symptoms, and potential impacts.
Thyroid nodules are lumps or growths that form in the thyroid gland, which is located in the neck. They can be either non-cancerous or cancerous. Medically non-cancerous is said to be benign, and cancerous is termed malignant. The most common type of thyroid nodule is a benign nodule, which is usually harmless and does not require treatment.
The thyroid gland is an important part of the endocrine system of our body, which is responsible for producing hormones that regulate many of the body’s functions. It is a small, butterfly-shaped gland present in the front of the neck. The thyroid gland produces two main hormones: triiodothyronine (T3) and thyroxine (T4). These hormones are responsible for regulating the body’s metabolism, which is the process of converting food into energy, heart rate, and many other body functions. A thyroid nodule is a growth or lump which occurs in the thyroid gland. Thyroid nodules are a common medical condition, and their causes can range from benign cysts or goitres to malignant (cancerous) growths.
Causes of thyroid nodules
Thyroid nodules can be a concerning health issue, and there are many potential causes that should be considered.
The role of genetics in the development of thyroid nodules has been extensively researched in recent years, with evidence suggesting a strong correlation between the two.1,2 I Common genetic alterations associated with the development of thyroid nodules have been observed as s mutations in the BRAF, RET, and RAS genes.
Hormones play a significant role in the development of thyroid nodules.3 It has been found that female hormones were more influential in the development of thyroid nodules than male hormones. It has been observed that women with higher levels of female hormones developed larger nodules than those with lower levels. This could be due to the higher levels of female hormones that naturally occur in women and due to the varying levels of hormones in women throughout the menstrual cycle, with higher levels of hormones resulting in more thyroid nodules than men. These findings demonstrate that hormones have an important role in the development of thyroid nodules and, thus, should be taken into consideration when assessing and treating patients with thyroid nodules. Many cases of thyroid nodules are caused by an underlying imbalance of hormones or an irritation of the thyroid gland caused by certain conditions, such as Hashimoto's thyroiditis:
- Certain medications, such as lithium
- Inherited gene mutations:
In some cases, a nodule can be caused by an inherited gene mutation, such as a familial form of medullary thyroid carcinoma
- Radiation exposure:
Studies have suggested that radiation exposure or high iodine intake may also be linked to thyroid nodules. Therefore, individuals with a family history of thyroid nodules or those who have been exposed to radiation should be monitored periodically to ensure that any changes in their condition are addressed appropriately.
Signs and symptoms of thyroid nodules
Signs and symptoms of thyroid nodules vary depending on the type and size of the nodule.
Common signs and symptoms of benign thyroid nodules thyroid nodules include:
- A lump or swelling in the neck
- A feeling of fullness in the neck
- Difficulty swallowing
- Pain in the neck or throat
If the nodule is large enough, it can cause compression of the surrounding structures, such as the trachea or oesophagus, resulting in difficulty breathing or swallowing.
Malignant thyroid nodules, cancerous thyroid nodules, may cause the same signs and symptoms as benign nodules, but they may also cause additional symptoms, such as:
- Unexplained weight loss
- Night sweats
- Enlarged lymph nodes in the neck
If you experience any of these signs and symptoms, it is important to see your doctor for a diagnosis. Your doctor will perform a physical exam and may order blood tests, imaging tests, or a biopsy to determine if the nodule is benign or malignant. Treatment for thyroid nodules depends on the type and size of the nodule, as well as the patient’s overall health.
Management and treatment for thyroid nodules
Management and treatment for thyroid nodules is a complex process that requires careful consideration of the individual patient's medical history, symptoms, and risk factors. The primary goal of management and treatment is to identify and address any underlying causes of the nodules, as well as to reduce the size of the nodules and prevent further growth.
The first step in the management and treatment of thyroid nodules is to determine the cause of the nodules. This is typically done through a combination of imaging tests, such as ultrasound, CT scan MRI, and blood tests. Depending on the results of these tests, the doctor may recommend further testing, such as a biopsy or fine needle aspiration, to determine if the nodules are benign or malignant.7
Once the cause of the nodules has been determined, the doctor will recommend a course of treatment. For benign nodules, the doctor may recommend a “watch and wait” approach, where the patient is monitored for any changes in the size or shape of the nodules. If the nodules remain stable, no further treatment may be necessary. However, if the nodules grow or become symptomatic, the doctor may recommend further treatment, such as surgery or hormone therapy.
For malignant nodules, the doctor will typically recommend surgery to remove the nodules. Depending on the size and location of the nodules, the doctor may also recommend radiation therapy or chemotherapy. In some cases, the doctor may also recommend hormone therapy to reduce the size of the nodules.
In addition to the above treatments, the doctor may also recommend lifestyle changes to help reduce the risk of developing thyroid nodules. These changes may include eating a healthy diet, exercising regularly, and avoiding smoking and alcohol.
How are thyroid nodules diagnosed?
Thyroid nodules are abnormal growths that can develop in the thyroid gland and can cause a variety of symptoms.
Thyroid nodules are a common medical condition that can affect anyone of any age. The diagnosis of thyroid nodules can be tricky and is often performed using a combination of tests. The most common method of diagnosis is imaging, which includes ultrasound and computed tomography scans.4 Ultrasound is often used to determine the size of the nodule and can detect changes in the nodule's internal structure. Meanwhile, computed tomography scans are used to identify the nodule’s exact location and shape. In some cases, further tests such as fine needle aspiration or biopsy may be used to confirm the diagnosis. These tests are usually done to check for any suspicious changes in the nodule’s cells. Thyroid nodules can cause a range of symptoms, so it is important to get an early and accurate diagnosis in order to start treatment as soon as possible.
How can I prevent thyroid nodules?
Prevention of thyroid nodules is not always possible, but you can reduce your risk factors by maintaining a healthy lifestyle, avoiding overexposure to radiation from medical treatment, and visiting the doctor regularly for checkups.
Who is at risk of thyroid nodules?
Thyroid nodules are a common condition, but who is at risk of developing them is still a subject of ongoing research. The most significant risk factors for developing thyroid nodules have been found to be age and gender. Specifically, the odds of having a thyroid nodule increase for patients over 50 years old and for female patients.5 Additionally, factors like smoking, alcohol consumption, and diabetes all correlate with an increased risk of having a thyroid nodule.
How common are thyroid nodules?
Thyroid nodules are a common condition, with six to seven per cent of adults in the United States currently living with a diagnosed thyroid nodule.6
When should I see a doctor?
If you experience any signs or symptoms of a possible thyroid nodule, such as abnormal lumps or swelling in the neck area, it is best to see your doctor right away. Diagnosing a thyroid nodule typically involves a physical exam, imaging tests such as ultrasound, and blood tests.
Most thyroid nodules are benign and do not cause any symptoms. However, some nodules can cause symptoms such as difficulty swallowing, hoarseness, or a feeling of fullness in the neck. In some cases, a nodule can cause the thyroid gland to produce too much or too little of the hormones it produces.
If a thyroid nodule is found, it is important to have it evaluated by a doctor. The doctor may order tests such as a thyroid ultrasound, a thyroid scan, or a biopsy to determine if the nodule is benign or malignant.
If the nodule is benign, the doctor may recommend monitoring it with regular check-ups. If the nodule is malignant, the doctor may recommend surgery to remove the nodule and some of the surrounding tissue. In some cases, radiation therapy or chemotherapy may also be recommended.
Generally, thyroid nodules are not life-threatening and can be managed with proper medical care. However, it is important to have any nodules evaluated by a doctor to ensure that they are not cancerous.
- Nikiforov YE. Role of molecular markers in thyroid nodule management: then and now. Endocrine Practice [Internet]. 2017 Aug 1 [cited 2023 Aug 9];23(8):979–89. Available from: https://www.sciencedirect.com/science/article/pii/S1530891X20358493
- Prete A, Borges de Souza P, Censi S, Muzza M, Nucci N, Sponziello M. Update on fundamental mechanisms of thyroid cancer. Front Endocrinol (Lausanne) [Internet]. 2020 Mar 13 [cited 2023 Aug 9];11:102. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082927/
- Zeng Q, Chen GG, Vlantis AC, Van Hasselt CA. Oestrogen mediates the growth of human thyroid carcinoma cells via an oestrogen receptor – ERK pathway. Cell Prolif [Internet]. 2007 Nov 15 [cited 2023 Aug 9];40(6):921–35. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC649589
- http://www.ajnr.org/content/34/9/1812.short”-XV Nguyen., KR Choudhury."Incidental thyroid nodules on CT: evaluation of 2 risk-categorization methods for work-up of nodules. "
- Chng CL, Kurzawinski TR, Beale T. Value of sonographic features in predicting malignancy in thyroid nodules diagnosed as follicular neoplasm on cytology. Clin Endocrinol [Internet]. 2015 Nov [cited 2023 Aug 9];83(5):711–6. Available from: https://onlinelibrary.wiley.com/doi/10.1111/cen.12692
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- Zamora EA, Khare S, Cassaro S. Thyroid nodule. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Aug 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK535422/
- Tamhane S, Gharib H. Thyroid nodule update on diagnosis and management. Clinical Diabetes and Endocrinology [Internet]. 2016 Oct 3 [cited 2023 Aug 10];2(1):17. Available from: https://doi.org/10.1186/s40842-016-0035-7