What are the implications of a thyroid nodule (thyroid gland abnormal growth)?

From the Guidelines

Thyroid nodules are common and usually benign, but about 5% can be cancerous, and if you discover a thyroid nodule, you should see a healthcare provider for evaluation, starting with a physical examination, thyroid function tests, and an ultrasound to determine the nodule's characteristics, as recommended by the most recent guidelines 1. The initial assessment of a thyroid nodule typically includes a physical examination, thyroid function tests, and an ultrasound to determine the nodule's characteristics.

• The ultrasound is used to evaluate the nodule's size, composition, and features that may suggest malignancy, such as hypoechogenicity, microcalcifications, and irregular borders, as noted in the guidelines 1.
• For suspicious nodules, a fine-needle aspiration biopsy is recommended to check for cancer cells, as it is a sensitive and specific test for diagnosing thyroid cancer, according to the guidelines 1.
• Treatment depends on whether the nodule is benign or malignant, its size, and if it causes symptoms, with benign nodules may simply be monitored with regular ultrasounds every 6-12 months, while cancerous nodules typically need surgical intervention, possibly followed by radioactive iodine treatment, as recommended by the guidelines 1. Some key points to consider when evaluating and managing thyroid nodules include:
• The majority of thyroid nodules are benign, but about 5% can be cancerous, as noted in the guidelines 1.
• The incidence of thyroid cancer has been increasing in many countries, but mortality has been slowly decreasing, likely due to improved diagnostic accuracy and treatment, as reported in the guidelines 1.
• Thyroid nodules are common, affecting about 50% of people by age 60, and develop due to irregular growth of thyroid cells, often influenced by factors like iodine deficiency, radiation exposure, or genetic predisposition, as discussed in the guidelines 1. The most appropriate course of action for a thyroid nodule is to follow the guidelines for diagnosis, treatment, and follow-up, as outlined in the most recent and highest quality study 1, which recommends a thorough evaluation and individualized treatment plan to ensure the best possible outcome.

From the Research

Implications of Thyroid Nodules

The implications of a thyroid nodule can be significant, as they may be malignant or cause thyroid dysfunction 2, 3. Some key points to consider include:

• Thyroid nodules are common in the general population, with a prevalence of up to 65% 4
• Most thyroid nodules are benign, but a small subgroup may harbor a clinically significant cancer or cause compressive symptoms 4
• The main goal of initial and long-term follow-up is to identify the small subgroup of nodules that require treatment or closer monitoring 4

Diagnostic Evaluation

The diagnostic evaluation of thyroid nodules typically involves:

• Thyroid function testing and ultrasonographic characteristics to guide initial management 4
• Fine-needle aspiration biopsy (FNA) to determine whether a nodule is benign or malignant 5, 6
• Molecular testing in selected cases, such as indeterminate cytology 4, 6
• Ultrasound features, such as solid composition, hypoechogenicity, irregular margins, and microcalcifications, can suggest a suspicious nodule that requires further evaluation 3, 4

Management and Treatment

Management and treatment of thyroid nodules depend on the estimated risk of malignancy and the presence and severity of compressive symptoms 4. Options include:

• Simple observation for benign nodules 4
• Local treatments, such as ethanol ablation or sclerotherapy, for selected cases 3
• Surgery for malignant or suspicious nodules, or for nodules that cause compressive symptoms 2, 3, 6
• Active surveillance for certain cases of papillary microcarcinoma 3