Thyroid Nodules and their Evaluation

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Symptoms of a Thyroid Nodule
Evaluating a Nodule and Diagnosing Cancer
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Symptoms of a Thyroid Nodule

  • Thyroid nodules are very common. Most are benign (not cancerous).
  • Less than 5% of thyroid nodules in adults are cancerous.  In children, 20% to 30% of thyroid nodules are proven to be cancerous.
  • Thyroid cancer is usually painless and without symptoms in its early stages.
  • Unless there is an obvious neck mass that can be seen, most nodules are detected by chance during a routine physical examination or during a doctor visit for an unrelated purpose.
  • Some symptoms that may appear include:
    • Hoarseness that has no known cause and does not go away
    • Difficulty breathing or shortness of breath
    • Difficulty swallowing or an unusual sensation (a “lump”) when swallowing
    • Nodule (lump) or growth in the neck
    • An abnormally large lymph node (a “swollen gland”) that fails to spontaneously shrink over a few months' time

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Evaluating a Nodule and Diagnosing Cancer

Steps in evaluating a thyroid nodule may include:

  • Physical examination. This should include a laryngeal exam (checking the vocal cords).
  • Neck ultrasound
  • Fine needle aspiration (FNA) biopsy, often under ultrasound guidance
  • Thyroid function lab tests—blood tests
  • Chest X-ray
  • CT (computerized tomography) without iodine contrast—or other imaging techniques
  • Thyroid scan with low-dose radioactive iodine or technetium
  • Other blood testing involving molecular markers, for patients with indeterminate thyroid nodules

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Points to keep in mind:

  • Your doctor will determine the diagnostic tools to use for you. Don’t hesitate to ask questions about the merits of each tool.
  • The fine needle aspiration (FNA) is the most reliable way to determine whether a nodule is benign, definitely cancerous, or possibly cancerous.
  • The FNA cannot always determine whether cancer is definitely present. In this situation, the tissue analysis after thyroid surgery is used to determine the diagnosis.

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Last updated: April 1, 2023