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Thyroid nodules
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Thyroid nodules

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DIABETES AND ENDOCRINE SYSTEM

Endocrine System

 

Screening and diagnosis

Although you sometimes may see or feel a thyroid nodule yourself — usually just below and to the right or left of your Adam's apple — most are discovered when your doctor checks your neck during a routine medical exam. You'll likely be asked to swallow while your doctor examines your thyroid because a nodule in the thyroid gland will usually move up and down during swallowing, whereas a nodule that forms in other parts of your neck won't.

Sometimes a thyroid nodule is detected when you have an imaging test such as an ultrasound, computerized tomography (CT) scan or magnetic resonance imaging (MRI) to evaluate another condition in your head or neck. Nodules detected this way are usually smaller than those found during a physical exam.

Once a nodule is discovered, it's important to determine whether it's malignant or associated with thyroid dysfunction. For that reason, you're likely to have one or more of the following tests:

  • Thyroid function tests. Your thyroid gland produces two main hormones, thyroxine and triiodothyronine. The rate at which these hormones are released is part of a carefully controlled feedback system involving your thyroid gland, your pituitary gland and your hypothalamus — an area at the base of your brain that acts as a thermostat for this system. Here's how the process works:

  • The hypothalamus signals your pituitary gland to make thyroid-stimulating hormone (TSH). Your pituitary gland then releases TSH — the amount depends on how much thyroxine and triiodothyronine are in your blood. Finally, your thyroid gland regulates its production of hormones based on the amount of TSH it receives. For that reason, tests that measure blood levels of thyroxine, triiodothyronine and TSH can indicate whether your thyroid is producing too much thyroxine (hyperthyroidism) or too little (hypothyroidism). Although not definitive, this information is helpful because thyroid nodules are more often benign when blood levels of thyroid hormone are abnormal.

  • Thyroid scan. Sometimes you may have a thyroid scan to help evaluate thyroid nodules. During this test, an isotope of radioactive iodine is injected into the vein on the inside of your elbow. You then lie on a table while a special camera produces an image of your thyroid on a computer screen. Nodules that produce excess thyroid hormone — called "hot" nodules — show up on the scan because they take up more of the isotope than normal thyroid tissue does. "Warm" nodules look and function like normal tissue, while "cold" nodules are nonfunctioning and appear as defects or holes in the scan. Hot nodules are almost always benign, but a small percentage of warm or cold nodules are malignant. The disadvantage of a thyroid scan is that it can't distinguish between benign and malignant warm and cold nodules. The length of a thyroid scan varies, depending on how long it takes the isotope to reach your thyroid gland. The procedure is generally painless, although you may have some neck discomfort because your neck is stretched back during the scan. You're also exposed to a small amount of radiation.

  • Fine-needle aspiration biopsy. This test is the most sensitive for distinguishing between benign and malignant thyroid nodules. During the procedure, your doctor inserts a thin needle — much smaller than the needles used to draw blood — in the nodule and removes a sample of cells. The procedure, which is carried out in your doctor's office, takes about 20 minutes and has few risks. Your doctor is likely to take several samples from a single nodule. If you have more than one nodule, your doctor will usually take samples from these as well. Sometimes, especially in the case of complex cysts, your doctor may use ultrasound to help guide the placement of the needle. The samples are then sent to a laboratory and analyzed under a microscope.

  • Most nodules diagnosed using FNA biopsy are benign. These nodules may grow, but they aren't cancerous and won't spread beyond the thyroid gland. A small percentage of biopsied nodules are malignant. This diagnosis is based on the characteristics of individual cells and patterns in clusters of cells that are different from normal thyroid tissue. In some cases, a pathologist can determine specific types of cancer from an FNA biopsy sample.

  • Sometimes there may not be enough cells in a sample to accurately determine whether a nodule is benign or malignant. In that case, you're likely to have the test repeated. And in some FNA biopsies, the test results are considered suspicious or indeterminate, which means there's no definitive way to tell from the biopsy sample whether the nodule is cancerous. Repeat biopsies usually aren't helpful in suspicious cases, so the next step is often surgery to remove the nodule for a definitive diagnosis.

  • Ultrasonography. This imaging technique uses high-frequency sound waves rather than radiation to produce images. It may be used to help distinguish cysts from solid nodules and to guide your doctor in performing an FNA biopsy.

Complications

Although most thyroid nodules are benign, they sometimes can cause serious complications. Large nodules or a multinodular goiter can interfere with swallowing or breathing. More serious problems occur when a nodule or goiter produces thyroid hormone, leading to hyperthyroidism.

In addition to signs and symptoms such as unintended weight loss, muscle weakness, heat intolerance and anxiousness or irritability, hyperthyroidism can also cause the following:

  • Heart-related complications. These include a rapid heart rate, atrial fibrillation and congestive heart failure — a condition in which your heart becomes too weak to circulate enough blood to meet the needs of your body.

  • Weak, brittle bones (osteoporosis). The strength of your bones depends, in part, on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with your body's ability to incorporate calcium into your bones. In fact, hyperthyroidism often affects your bones before you have any other signs or symptoms of the disorder. This is especially true of postmenopausal women who are already at high risk of osteoporosis.

  • Thyrotoxic crisis. This is a sudden and potentially life-threatening intensification of your symptoms that requires immediate medical care.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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Last Modified : 03/15/08 02:26 AM