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Sydney Endocrinology, Diabetes, Metabolism and Podiatry

Thyroid nodules & thyroid cancer

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Thyroid nodules & thyroid cancer Sydney Endocrinology

What are thyroid nodules?

The thyroid gland is a butterfly-shaped gland in the lower front of the neck. The thyroid makes thyroid hormones which help us use energy, stay warm and keep the brain, heart, muscles and other organs working properly. Thyroid hormones pass through the blood to every tissue in the body.

A thyroid nodule is an abnormal growth of thyroid cells that form a lump within the thyroid gland. Most thyroid nodules are benign. A small proportion contain thyroid cancer which is why we look closely at all thyroid nodules to detect any problems early.

Am I at risk for thyroid nodules?

Thyroid nodules are extremely common. We don’t exactly know what causes them but by age 60 about 50% of people will have them. Fortunately, over 90% are benign.

Some conditions of the thyroid are associated with an increased risk of thyroid nodules. For example, Hashimoto's disease can cause thyroid inflammation and result in enlarged nodules.

Iodine deficiency can also cause your thyroid gland to develop nodules. Australians are at low risk of iodine deficiency because we tend to get enough iodine from our food and table salt.

What are the symptoms of thyroid nodules?

Most thyroid nodules don’t cause symptoms. They are often discovered incidentally during a physical exam or on imaging tests (eg CT scans or neck ultrasound) for something completely unrelated.

If present, physical symptoms may include:

  • A lump in your neck

  • Pain in the neck, jaw or ear (less common)

  • Difficulty with breathing, swallowing or cause a tickle in the throat – if the nodule is large enough to compress the windpipe or oesophagus

  • A hoarse voice – this can indicate that the nodule has invaded the nerve that controls the vocal cords, which may be related to thyroid cancer

How are thyroid nodules diagnosed?

If you have a lump or nodule in your neck, we need to rule out the possibility of cancer and check if your thyroid is functioning properly. Tests to diagnose thyroid nodules include:

  • A physical exam – a nodule in your thyroid gland will usually move up and down when you swallow; we also check for signs of underactive or overactive thyroid

  • Thyroid function tests – are blood tests that measure levels of thyroid-stimulating hormone (TSH) and hormones produced by your thyroid gland

  • Ultrasound scan – to distinguish cysts from solid nodules or to determine if multiple nodules are present

  • Fine-needle aspiration biopsy – a very thin needle inserted in the nodule to remove a sample of cells to check for cancer

  • Thyroid uptake scan – a solution is injected into a vein in your arm while a special camera produces an image of your thyroid on a screen to check how nodules respond (cancerous nodules behave differently to noncancerous ones).

What should you do if you think you have a thyroid nodule?

Although most thyroid nodules are noncancerous and don't cause problems, see your GP if you notice any unusual swelling in your neck, especially if you have trouble breathing or swallowing.

Your GP will be able to arrange blood tests and scans if needed. Remember that thyroid nodules don’t generally causes symptoms so it’s important to follow through with any recommended tests.

You should also see your doctor if you develop any symptoms that may mean your thyroid gland isn't making enough thyroid hormone (hypothyroidism) or making too much thyroid hormone (hyperthyroidism).

How are thyroid nodules treated?

Thyroid nodules are treated in different ways depending on their cause. Thyroid nodules found to contain thyroid cancer, or that are highly suspicious of containing a cancer, should be surgically removed. Most thyroid cancers are curable and rarely cause life-threatening problems.

Thyroid nodules that have been checked by fine needle aspiration – or are too small to biopsy – should be watched closely with ultrasound every 12 months to check for signs of growth.

Radioactive iodine therapy is used to destroy all or part of the thyroid gland and is useful for treating overactive nodules. This is a safe treatment taken as a capsule.

What does the surgical removal of thyroid nodules involve?

Your endocrinologist will discuss whether you need to have all or part of your thyroid removed. These procedures are known as a partial thyroidectomy or a total thyroidectomy.

What is the recovery like after thyroid surgery?

After your thyroid surgery, you’ll need to take a break from strenuous physical activities for a few days or weeks while your wound heals but you can resume normal activity soon after surgery.

Some people become hypothyroid following thyroid surgery, requiring treatment with thyroid hormone, especially if you had your whole thyroid gland removed. Generally, you’ll start taking thyroid hormone medication the day after surgery.

What are the risks involved in thyroid surgery? 

There are risks with any surgical procedure, including anesthetic risks and those related to your specific procedure. Your endocrinologist will discuss all the risks with you prior to your operation, and will refer you to a thyroid surgeon who will perform the surgery. 

Thyroid cancer

What is thyroid cancer?

Thyroid cancer develops when thyroid cells divide in an abnormal way and become malignant. There are four main types of thyroid cancer – papillary, follicular, medullary and anaplastic:

  • Papillary cancer – the most common type of thyroid cancer which develops from the thyroid’s follicular cells

  • Follicular cancer – the second most common type of thyroid cancer, also develops from the thyroid’s follicular cells

  • Medullary cancer – less common, this cancer develops from the C-cells and can be linked to an inherited faulty gene or occur sporadically

  • Anaplastic cancer – a very rare form of thyroid cancer, most common in elderly people, that develops from the follicular cells, or may develop from undiagnosed papillary or follicular thyroid cancer

Am I at risk for thyroid cancer?

For most patients, we don’t know why thyroid cancer develops. With early diagnosis and treatment, 95% of thyroid cancers can be cured.

Thyroid cancer is more common in people who have a history of exposure to high doses of radiation, have a family history of thyroid cancer and are over 40.

Even though the diagnosis of cancer is scary for most people, the treatment outcome is excellent for most patients. Even when thyroid cancer is more advanced, effective treatment is available for the most common forms of thyroid cancer.

What are the symptoms of thyroid cancer?

The most common sign of thyroid cancer is a lump in or on the thyroid gland or swelling of the gland. Other symptoms include hoarseness of the voice, difficulty in swallowing and swelling of the lymph glands in the neck.

How is thyroid cancer diagnosed?

A thyroid ultrasound and a fine needle aspiration biopsy of a thyroid nodule usually provides a good indication if thyroid cancer is present. A definitive result is known after the nodule is surgically removed and tested. Blood tests generally don’t help to find thyroid cancer as results are usually normal.

What should you do if you think you have a thyroid cancer?

See your GP if you notice any unusual swelling in your neck, especially if you have trouble breathing or swallowing. Your GP will be able to arrange scans and a referral to see an endocrinologist if needed. 

Remember that while thyroid nodules are very common, less than 1 in 10 will be a thyroid cancer.

How is thyroid cancer treated?

Treatment for thyroid cancer is surgical removal of part or all of the thyroid gland, usually followed by radioactive iodine therapy and taking thyroid hormone replacement therapy.

What does the surgical removal of the thyroid gland involve?

Your endocrinologist will discuss whether you need to have all or part of your thyroid removed. These procedures are known as a partial thyroidectomy or a total thyroidectomy. Your endocrinologist will refer you to a thyroid surgeon who will perform the surgery. The extent of surgery will depend on the size of the tumour and if the tumour is confined to the thyroid.  

What is the recovery like after thyroid surgery?

After your thyroid surgery, you’ll need to take a break from strenuous physical activities for a few days or weeks while your wound heals but you can resume normal activity soon after surgery.

Some people become hypothyroid following thyroid surgery, requiring replacement of thyroid hormone with tablets, especially if you had your whole thyroid gland removed.

Generally, you’ll start taking thyroid hormone medication the day after surgery.

What are the risks involved in thyroid surgery? 

There are risks with any surgical procedure, including anesthetic risks and those related to your specific procedure. Your endocrinologist will discuss all the risks with you prior to your operation.