From the Guidelines
Most thyroid nodules are asymptomatic, but some can cause noticeable symptoms depending on their size, location, and whether they produce excess thyroid hormones, and according to the most recent study 1, symptoms may include difficulty swallowing, breathing, voice changes, or hoarseness.
Symptoms of Thyroid Nodules
The symptoms of thyroid nodules can vary depending on several factors, including the size and location of the nodule, as well as whether it produces excess thyroid hormones.
- Large nodules may create a visible swelling in the neck or cause a feeling of fullness, pressure, or discomfort in the neck.
- Some patients experience difficulty swallowing (dysphagia) or breathing, particularly when lying down, if the nodule presses on the esophagus or trachea.
- Voice changes or hoarseness can occur if the nodule affects the laryngeal nerves.
- If a nodule produces excess thyroid hormones (hyperthyroidism), symptoms may include unexplained weight loss, increased appetite, tremors, anxiety, rapid or irregular heartbeat, increased sweating, and heat intolerance.
- Conversely, if a nodule impairs normal thyroid function (hypothyroidism), symptoms might include fatigue, weight gain, cold intolerance, dry skin, and constipation.
- Pain in the thyroid area is uncommon but may indicate inflammation or bleeding into a nodule.
Importance of Medical Evaluation
Any persistent neck symptoms or signs of thyroid dysfunction should prompt medical evaluation to determine if a thyroid nodule is present and whether treatment is needed, as stated in the study 1. It is essential to note that the diagnosis and treatment of thyroid nodules should be guided by the most recent clinical practice guidelines, such as those published by the European Society for Medical Oncology (ESMO) 1.
Diagnosis and Treatment
The diagnostic work-up of thyroid nodules typically involves a combination of clinical evaluation, imaging studies, and fine-needle aspiration cytology (FNAC), as recommended in the study 1. The treatment of thyroid nodules depends on the underlying cause and may include surgery, radioactive iodine therapy, or observation, as stated in the study 1. In summary, thyroid nodules can cause a range of symptoms, and prompt medical evaluation is essential to determine the underlying cause and guide treatment, as emphasized in the most recent study 1.
From the Research
Symptoms of Thyroid Nodules
- Compressive symptoms, which occur in approximately 5% of cases 2
- Symptoms of mass effect, such as difficulty swallowing or breathing, which may be present in larger nodules 3, 4
- Thyrotoxicosis, which can occur in some patients with thyroid nodules 3, 5
- No symptoms at all, as most thyroid nodules are benign and do not cause any symptoms 2, 4
Diagnostic Evaluation
- Thyroid function testing and ultrasonographic characteristics are used to guide the initial management of thyroid nodules 2
- Fine-needle aspiration biopsy (FNAB) may be performed for nodules ≥ 1.0 cm depending on clinical and sonographic risk factors for thyroid cancer 3, 6
- Molecular analysis of indeterminate FNA samples has potential to better discriminate benign from malignant nodules and thus guide management 3, 4
Management
- Management includes simple observation, local treatments, and surgery, and should be based on the estimated risk of malignancy and the presence and severity of compressive symptoms 2, 3, 4
- Active surveillance or local ablative treatments might be beneficial for appropriately selected patients 4
- Surgery is indicated for FNA findings of malignancy or indeterminate cytology when there is a high risk clinical context 3