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Thyroid nodules: Treatment, symptoms, advice and help

About thyroid nodules

Thyroid nodules are discrete swellings that arise in the thyroid gland.

Thyroid nodules: Incidence, age and sex

Thyroid nodules are common and are present in 3-4% of the adult population in the UK and the USA. They are three to four times more frequent in women than men.

Signs & Symptoms of thyroid nodules: Diagnosis

A discrete swelling in an otherwise impalpable gland is called a solitary nodule, whereas a similar swelling in a gland with clinical evidence of generalized nodularytis called a dominant nodule. About 70% of thyroid swellings are clinically solitary and 30% are dominant. Some 15% of isolated swellings prove to be malignant and an additional 30-40% are follicular adenomas. The remainder are non-neoplastic, largely consisting of areas of colloid degeneration, thyroiditis or cysts. After a nodule is found during a physical examination an ultrasound is performed to confirm the presence of a nodule, and assess the status of the whole gland. Measurement of thyroid stimulating hormone and anti-thyroid antibodies will help decide if a functional thyroid disease such as Hashimoto's thyroiditis is present. Fine needle biopsy (FNB) for histopathology is also used.

Causes and prevention of thyroid nodules

Neoplastic nodules are more common with a family history of thyroid cancer and prior radiation to the head and neck such as in Hodgkin's lymphoma.

Thyroid Nodules: Complications

Worrisome signs and symptoms may include voice hoarseness, rapid increase in size, compressive symptoms (such as dyspnoea or dysphagia) and appearance of lymphadenopathy.

Thyroid Nodules: Treatment

Most thyroid nodules associated with benign cytopathology on FNB need only follow-up and repeat FNAB for confirmation 6-12 months after an initial diagnosis.

Surgery should be performed in cases of size in excess of 4 cm, complex cyst on thyroid ultrasound (showing solid and cystic components), compressive symptoms and signs of malignancy (vocal cord dysfunction, lympadenopathy).