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Thyroid Nodules
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Thyroid nodules

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DIABETES AND ENDOCRINE SYSTEM

Endocrine System

Thyroid nodules are lumps which commonly arise within an otherwise normal thyroid gland.

The thyroid is a butterfly-shaped gland located at the base of your neck, just below your Adam's apple - about where you'd put a bow tie. Although it weighs less than an ounce, the thyroid gland produces hormones that regulate every aspect of your metabolism, from your heart rate to how quickly you burn calories.

Sometimes normal thyroid tissue begins to grow, causing one or more nodules to develop within the gland. The great majority of these solid or fluid-filled lumps are noncancerous (benign) and don't cause any symptoms. In fact, you often won't know you have a nodule until your doctor discovers it during a routine medical exam.

Some nodules, however, may become large enough to press on your windpipe (trachea) or your esophagus, making it uncomfortable or difficult to swallow. A few may begin producing excess amounts of thyroid hormone, leading to hyperthyroidism, a condition marked by unintended weight loss, sleep problems and irritability. And about 5 percent of nodules may be cancerous (malignant).

Treatment depends on the type of nodule you have. Small, benign nodules may only require careful watching, whereas growing or painful nodules may need to be suppressed with synthetic thyroid hormone. When tests can't determine whether a nodule is benign, the nodule may be surgically removed. In the rare cases when a thyroid nodule is malignant, the prognosis is often excellent.

Signs and symptoms

Most thyroid nodules don't cause signs or symptoms. Occasionally, however, some may become so large that you can feel or even see the swelling at the base of your neck, especially when you're shaving or putting on makeup. Men sometimes become aware of a nodule because their shirt collars suddenly feel too tight.

Some nodules produce too much thyroxine, a hormone secreted by your thyroid gland. The extra thyroxine can cause signs and symptoms such as sudden, unexplained weight loss, nervousness and a rapid or irregular heartbeat.

A thyroid nodule is more likely to be malignant if it:

  • Grows quickly or feels hard

  • Causes you to be hoarse or to have trouble swallowing or breathing

  • Causes enlarged lymph nodes under your jaw or in your neck

Causes

Your thyroid gland consists of two lobes that resemble the wings of a butterfly. The lobes are separated by a thin section — think of it as the butterfly's body — called the isthmus. The thyroid takes up iodine from food you eat and uses it to manufacture two main hormones, thyroxine (T-4) and triiodothyronine (T-3). These hormones maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate and help regulate the production of protein. Your thyroid gland also produces calcitonin, a hormone that regulates the amount of calcium in your blood.

Just why normal thyroid tissue develops into nodules isn't clear. What is known is that several types of nodules can develop in the thyroid gland:

  • Colloid nodule. Most thyroid nodules are colloid nodules — benign overgrowths of normal thyroid tissue. You may have just one colloid nodule or many. Although these nodules may grow larger, they don't spread beyond the thyroid gland.

  • Follicular adenoma. This type of nodule also is benign. Unfortunately, doctors can't distinguish between a benign follicular adenoma and follicular cancer without surgically removing the nodule. Normally, a nonsurgical procedure called fine-needle aspiration (FNA) biopsy is the most sensitive way to determine whether a nodule is benign or malignant. But FNA biopsy doesn't provide a definitive answer in cases of follicular adenomas.

  • Thyroid cyst. These fluid-filled areas of the thyroid can range in size from less than 1/3 inch to 1 inch or more in diameter. Many thyroid cysts are entirely filled with fluid, but some cysts, called complex cysts, also have solid components. Fluid-filled cysts are usually benign, but complex cysts are sometimes malignant.

  • Inflammatory nodule. This occasionally develops as a result of chronic inflammation of the thyroid gland (thyroiditis). One rare type of thyroiditis — subacute thyroiditis — causes severe pain in the thyroid gland. Other types are painless and sometimes occur after pregnancy (postpartum thyroiditis).

  • Thyroid cancer. Only about 5 percent of thyroid nodules are cancerous. Although the chances that a nodule will be malignant are small, you're at higher risk if you have a family history of thyroid or other endocrine cancers, are younger than 20 or older than 60, are a man, or have a history of head or neck radiation. Malignant nodules are usually large and hard and may cause neck discomfort or pain.

  • Multinodular goiter. Goiter is a term used to describe any enlargement of the thyroid gland. Several factors can lead to a goiter, including the presence of a number of thyroid nodules. This condition, called multinodular goiter, can cause a tight feeling in your throat and difficulty breathing or swallowing.

  • Hyperfunctioning thyroid nodule (toxic adenoma, toxic multinodular goiter, Plummer's disease). These nodules grow and produce thyroid hormones independent of the influence of thyroid-stimulating hormone (TSH), a substance released by the pituitary gland, which normally regulates the production of thyroid hormones. Hyperfunctioning thyroid nodules cause high blood levels of thyroxine and low or non-existent levels of TSH. A genetic defect of the TSH receptors may play a role in the overactivity of these nodules.

Risk factors

Although the exact cause of most thyroid nodules isn't known, certain factors appear to increase your risk:

  • Heredity. If a parent or sibling has thyroid nodules, you have a greater chance of developing them as well.

  • Age. Because the likelihood of developing thyroid nodules increases as you grow older, some changes in thyroid tissue may occur as a normal part of aging.

  • Sex. Women are more likely to develop thyroid nodules than men are.

  • Radiation exposure. In the 1940s and 1950s, children, teenagers and even newborns were often treated with radiation for benign conditions such as acne or enlarged tonsils. If you once had radiation therapy to your neck or head for conditions such as acne, you have an increased risk of developing thyroid nodules.

  • You're also at increased risk if you were exposed to radioactive particles released into the air during atomic weapons testing or in nuclear power plant accidents, such as the 1986 Chernobyl disaster in the former Soviet Union. Radiation not only affects people, animals and crops in the immediate vicinity of the release but also can affect areas thousands of miles away.

  • Certain thyroid conditions. Nodules are more likely to form in people who have or have had thyroiditis — a chronic inflammation of the thyroid gland.

When to seek medical advice

See your doctor if you notice any unusual swelling in the lower front of your neck, if you have trouble breathing or swallowing, or if you feel as if you have a lump in your throat. Also seek medical care if you develop signs and symptoms of hyperthyroidism, such as sudden weight loss even though your appetite is normal or has increased, a pounding heart, trouble sleeping, muscle weakness, and nervousness or irritability. It's important to completely describe the changes you've observed, because many signs and symptoms of hyperthyroidism may be associated with a number of other conditions.

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