Thyroid Nodules: When Should They Be Removed?

What are Thyroid Nodules?

Thyroid nodules are small lesions, either solid or fluid-filled, that form in the thyroid gland located at the base of the neck. Most often, these nodules have no symptoms and are discovered incidentally during a health check-up. They are usually benign and do not pose a major health problem. However, a small proportion may be cancerous.

 

What are the Symptoms of Thyroid Nodules?

Symptoms associated with thyroid nodules vary depending on their function and size. In some cases, nodules may enlarge and become visually and/or palpably noticeable in the neck. In more severe cases, they may put pressure on the trachea or esophagus, leading to respiratory problems (dyspnea) or swallowing difficulties (dysphagia).  

In terms of function, some nodules may produce an excess of thyroid hormones (called thyroxine or T4), leading to the following symptoms:

  • Unexplained weight loss;
  • Increased sweating;
  • Tremors;
  • Tachycardia or irregular heartbeat;
  • Feeling restless, impatient;

Most thyroid nodules are generally inactive, meaning they do not cause any symptoms, and even if malignant, they progress slowly and can be detected while still small. Aggressive forms of thyroid cancer are rare: in these situations, nodules may be large, firm, and rapidly growing.

To ensure your health, it is essential to consult a doctor if you notice any unusual or unexplained swelling or nodule in your neck. This is particularly important if these symptoms are accompanied by breathing or swallowing difficulties.

 

Furthermore, it is crucial to consult a doctor as soon as symptoms and signs of hyperthyroidism appear, such as:

  • Sudden weight loss despite normal or increased appetite;
  • Palpitations;
  • Difficulty sleeping;
  • Tremors;
  • Muscle weakness;
  • Easy irritability;

The patient may also exhibit signs of hypothyroidism, such as:

  • Decreased reflexes;
  • Weakness;
  • Slow heart rate;
  • Dry skin;
  • Facial swelling;

The Difference Between a Cyst and a Thyroid Nodule

Thyroid cysts account for between 15 and 25% of all thyroid nodules and are usually identified through a biopsy with fluid aspiration from a nodule. Indeed, unlike solid nodules, thyroid cysts are filled with a mixture of liquid and solid matter.

 Generally, they are created by the degeneration of a thyroid adenoma, a benign tumor that forms from a cell of the thyroid tissue. Cystic thyroid nodules are usually benign (90 to 95%), but it is crucial to always rule out the possibility of transformation into a malignant tumor.  

Diagnosis of Thyroid Nodules

Thyroid Ultrasound

Thyroid ultrasound is a simple, non-invasive procedure that detects irregularities such as nodules, cysts, and tumors.

When an abnormal growth of the thyroid gland is detected during the examination, the endocrinologist is often asked to verify whether it is a case requiring treatment.

Another use of thyroid ultrasound is to monitor the evolution of the gland in case of decreased or increased activity.

You do not need to prepare for the examination, and it is completely safe. Thus, even pregnant women can undergo it safely.

During the examination, the patient lies on a couch while the specialist, having applied gel, inspects their neck using an ultrasound probe whose images are transmitted to a screen.

The process generally lasts about 10 minutes, and the verdict is available immediately after the examination.

 

Laboratory Tests

After discovering a nodule, your doctor will assess the overall health of the thyroid gland to determine if it has been affected by a broader disease, such as hyperthyroidism or hypothyroidism.

Initial laboratory tests may include measuring thyroid hormone (thyroxine or T4) and thyroid-stimulating hormone (TSH) in the blood to determine if the thyroid is functioning normally.

 

In fact, thyroid nodules are capable of producing excessive amounts of thyroid hormones, leading to hyperthyroidism, which can be detected through thyroid function tests, such as TSH. This overproduction of hormones could have a negative impact on health and require appropriate medical measures.

 

When it comes to determining whether a thyroid nodule is cancerous, it is often difficult to obtain an accurate diagnosis based solely on a physical examination and blood tests. This is why the evaluation of thyroid nodules always includes instrumental examinations such as thyroid ultrasound and thyroid fine-needle aspiration biopsy. These procedures are essential for achieving a reliable and comprehensive diagnosis.

 

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When to Remove a Thyroid Nodule?

In the presence of a malignant form, the fine-needle aspiration method is strongly recommended to determine whether or not a tumor is present.

If the result is positive, it is imperative to remove the thyroid nodule. If the diameter is less than 10 mm and the neoplasm has not spread to other organs, the doctor will remove only the right or left lobe (hemithyroidectomy).

 

If, on the other hand, the diameter exceeds 40 mm and the tumor has spread to several parts, the doctor will opt for a total removal with removal of the neck lymph nodes, in the most severe cases.

 

Sometimes benign nodules need to be removed, especially when they cause significant goiters that may compress the trachea and cause discomfort (such as deviation or stenosis).

 

Prevention

When iodine deficiency is endemic in a region, cases of thyroid tumors are more frequent. To prevent these health problems, it is recommended to use iodized salt (easily available in supermarkets) instead of regular salt. This simple habit helps reduce the risk of goiter and other benign thyroid disorders.

 

However, there is no point in carrying out screening, as no specific marker has been identified in the blood. Moreover, the thyroid is an easily accessible organ where hypertrophy can be detected in most cases. Although these tumors can remain silent for a long time, it is recommended to have your thyroid gland checked by a doctor at least once a year to detect any nodular formation. If in doubt, a thyroid ultrasound can be performed. Thyroid palpation should always be integrated into a complete internal medicine clinical examination.

 

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