Thyroid Nodules: What to Know and What to Expect

Thyroid nodules are common, but they may still require testing and medical imaging to rule out certain conditions or determine the next steps. This article will discuss what thyroid nodules are, the different nodule types and symptoms and the imaging techniques used to help diagnose them.

While this article provides helpful information, if you have a thyroid nodule, your doctor or other members of your care team will interpret your results and recommend treatment. However, if you’d like early access to your results, PocketHealth offers secure, instant access to your report when it is available. This provides improved understanding and allows you to review the findings before your follow-up appointment and prepare any questions in advance.

 

 

What are thyroid nodules?

A thyroid nodule is a bump or lump that forms on the thyroid, a gland in the neck involved in the endocrine system. These nodules may be filled with fluid or be solid, depending on their type. The butterfly-shaped thyroid gland helps regulate processes such as metabolism and heart rate through hormone production.

When thyroid cells grow uncontrollably, they may form a nodule. The vast majority of these nodules are benign (non-cancerous), but in rare cases, they can become cancerous (malignant), requiring treatment. Fortunately, most thyroid cancers have a high success rate for recovery. Depending on the type of thyroid nodule, it may grow over time, shrink or remain stable. Repeat imaging is often performed regularly to monitor any changes in size.

 

Thyroid nodule types

There are several types of nodules that may develop on the thyroid gland, including:

• Cysts: Fluid-filled growths on the thyroid that are very rarely cancerous.
• Toxic adenoma: A type of nodule that causes the thyroid to produce excess hormones, resulting in hyperthyroidism. This is also rarely cancerous.
• Thyroid adenoma: Benign nodules that usually don’t need treatment. Most doctors will simply monitor them over time for any changes.
• Colloid nodules: These benign nodules result from the overgrowth of thyroid tissue. They can grow large in size but are non-cancerous and are among the most common nodule types.
• Multinodular goiters: A goiter isn’t technically a nodule. It occurs when the thyroid becomes swollen, typically due to iodine deficiency (a mineral found in certain foods or table salts) or caused by autoimmune factors. Goiters only require treatment when they become symptomatic. A multinodular goiter, however, occurs when the thyroid is both swollen and has growths. These growths are usually non-cancerous, but testing for cancer is typically done to be certain.
• Inflammatory nodules: Chronic inflammation in the thyroid can lead to the development of these types of nodules.
• Thyroid cancers: Four types of thyroid cancer may develop from cancerous cells: papillary, follicular, medullary, and anaplastic. Treatment varies depending on the type. While a cancer diagnosis can be stressful, thyroid cancer occurs at a much lower rate than many other types of cancer. Additionally, the majority of cases have an excellent prognosis and high rates of successful treatment.

 

What are the symptoms of thyroid nodules?

The majority of thyroid nodules are symptomless and only discovered through routine exams or unrelated tests. When these nodules do cause symptoms, they may include:

• A lump located on the patient’s neck
• Ear, jaw or neck pain
• Breathing difficulties from a large nodule
• Vocal changes such as hoarseness
• Thyroid swelling

If the nodule is causing an overactive thyroid that produces too many hormones (hyperthyroidism), these symptoms may include:

• Unexplained weight loss
• Diarrhea
• Menstrual irregularities
• Anxiousness
• Heart palpitations
• Disordered sleeping
• An increase in appetite

If the nodule is causing lower thyroid hormones (hypothyroidism), symptoms may include:

• Unexplained weight gain
• Hand numbness or tingling
• Heavier and more frequent menstrual cycles
• Unexplained fatigue
• Hair and skin dryness
• Constipation

 

What causes thyroid nodules?

It is currently unknown what causes thyroid nodules to form, but they are a common occurrence and are usually benign. Some factors that may contribute to these nodules forming include:

• Iodine deficiency (uncommon in the U.S. and Canada): This occurs when someone doesn’t get enough of this mineral in their diet. Most table salts have iodine added to them, as do many processed foods, which is why this is less common in countries with highly processed diets.
• Hashimoto’s disease: This autoimmune disease causes the body to attack the thyroid gland, leading to inflammation, nodules and hypothyroidism.
• Family history: Having family members who have experienced thyroid nodules can increase the patient’s risk of developing them. However, it’s important to remember that nodules are very common regardless.
• Radiation exposure: Patients with previous radiation exposure, such as from medical therapies, may be more prone to developing thyroid nodules.
• Assigned sex at birth: Patients who were assigned female at birth tend to have higher rates of thyroid nodules.

 

How are thyroid nodules diagnosed?

Thyroid nodules can be discovered in multiple ways. Here is a brief overview of the most common methods.

Physical examination

Some patients may discover a lump on their thyroid while examining their neck. When this happens, it is often recommended that they follow up with a physician for additional testing.

Other times, the lump is discovered by a physician during a routine exam or if the patient has concerns. The physician will likely ask the patient to swallow during the examination, as the nodule often moves up and down during this action, which can help indicate the condition. If a lump is found, additional testing is common. Meanwhile, the physician may also check for signs of hyperthyroidism or hypothyroidism, such as faster or slower heart rates than expected.

Blood test

Blood tests help determine if thyroid hormone levels are within expected baselines. Higher or lower levels than typical may indicate a thyroid disorder, such as hyperthyroidism. This is also a cause for progressing to next steps, such as an ultrasound appointment.

Thyroid ultrasound

Ultrasounds are an imaging method that uses high-frequency sound waves to evaluate internal structures. The ultrasound technician uses a hand-held wand-like device called a transducer, which emits these sound waves as it is moved along the area being scanned, which in the case of thyroid nodules would be the neck.

Sound waves bounce off internal organs and tissues, echoing back to create images that can be captured and studied. In this case, hypoechoic thyroid nodules and cysts would be visible, allowing physicians to better understand their location and type. It is not uncommon for patients to have regular thyroid ultrasounds, especially if results are inconclusive or the provider wants to watch for changes in size or nodule features.

Thyroid scan

Thyroid ultrasounds are the most common imaging technique for nodules; however, nuclear scans may be helpful if more details are required. In this procedure, a small amount of radioactive iodine is injected into the patient’s bloodstream and absorbed by their body’s tissues. A gamma camera is then used to capture images of how this radiotracer is absorbed, which helps determine how the nodules behave.

Hot nodules produce extra thyroid hormone, so they absorb more of the radiotracer than normal. These are nearly always benign but may indicate hyperthyroidism. Cold nodules absorb less of the isotope than expected, which may sometimes be a sign of cancer. However, even cold nodules are often benign. The scan serves as a starting point for the provider to suggest additional testing or recommendations, as the scan itself cannot determine if the nodule is cancerous.

Biopsy

One of the more reliable ways to test for thyroid cancer is through a biopsy, which allows the nodule cells to be evaluated. This is done by inserting a very thin needle into the nodule to collect cells for laboratory analysis. This procedure is often performed with the guidance of an ultrasound to direct the needle to the correct area.

While it may sound stressful, most patients return to their routine immediately afterward and often with no required preparations in advance. However, patients expecting to have a thyroid nodule biopsy should consult their physician for instructions. It is not uncommon to have a repeat biopsy if there are inconclusive results.

 

How are thyroid nodules treated?

Thyroid nodule treatment methods depend on the type of nodule the patient has. Watchful waiting and monitoring through diagnostic imaging is a common approach since most thyroid nodules are benign and many cause no symptoms or problems. This means the nodule may be regularly assessed to monitor for growth (such as through repeat ultrasounds and bloodwork) or the development of symptoms, but otherwise, it will be left alone. Other possible treatments include:

• Medications for hypothyroidism: If a thyroid disorder is causing lower thyroid hormone levels, hormone therapies are commonly used to correct this.
• Medications for hyperthyroidism: Radioactive iodine is a common treatment for this condition. The thyroid absorbs this iodine, shrinking the size of the nodules and helping symptoms improve. Other medications, such as methimazole, may also be used for similar purposes.
• Surgery: If a thyroid nodule is non-cancerous but causing obstructions with breathing or swallowing, it can be surgically removed. Cancerous nodules may also be surgically removed, or even part or the entire thyroid gland if needed. If necessary, a medical dose of thyroid hormone can be taken long-term following thyroid surgery.
• Alcohol ablation: This is a way to manage small thyroid nodules that are benign or cancerous. The physician injects a tiny amount of alcohol into the nodule, effectively destroying it.

 

Getting my results

The scanning or ultrasound technician is not generally allowed to discuss results during the scan. They can answer questions about the appointment but not the imaging results. Here are some common questions regarding getting thyroid imaging results back.

When will I get my results?

Turnaround times for imaging results can vary widely depending on the facility and your doctor’s availability. Often, patients wait a week or more and receive their results during a follow-up appointment. With PocketHealth, you don’t have to wait as long—your results are securely accessible as soon as the report is available, allowing you to review them often before your follow-up visit.

Who interprets my results?

A radiologist—an expert in interpreting medical images—will carefully review your thyroid scans and provide a detailed report of any findings. This report is then sent to your referring doctor, who, with a deeper understanding of your medical history, can offer additional insights and recommendations based on the results. In the case of nodule biopsies, the laboratory that studies these cells should send your results to your referring provider.

 

Understanding your results

It’s common to find medical terminology somewhat confusing, but Report Reader helps you to better understand your report by offering clear, straightforward definitions for medical terms—simply tap or click on any underlined words to reveal their meaning.

For patients seeking to understand thyroid nodule results or their ultrasound report, this section will briefly cover common terminology in these tests. That said, your medical provider will provide any official interpretations of your results.

 

Normal vs abnormal thyroid nodule results

Much of the time, thyroid imaging such as ultrasounds or nuclear scans will indicate if the nodule is a cyst, a tumor or has other physical characteristics. Sometimes this is enough information for the provider to plan the next steps, such as if it is a benign cyst. If a biopsy is needed to rule out cancer or other conditions, the American Thyroid Association outlines typical biopsy results:

• Benign finding: Up to 80% of thyroid nodule biopsies end up being non-cancerous.
• Malignant finding: This is generally found in 5% of nodule biopsies, with papillary cancer being the most common type. Fortunately, this variety has very high cure rates.
• Indeterminate finding: This result occurs in up to 20% of biopsies and may indicate that the results can’t be definitively classified as benign or malignant. In 20-30% of these cases, it could be follicular cancer, but that diagnosis is only confirmed through surgery. Next steps may include removing part of the thyroid containing the nodule for further assessment or repeat evaluation such as another biopsy in the future.
• Nondiagnostic/inadequate finding: In fewer than 5% of biopsies, the number of cells collected is not enough to make a diagnosis. A follow-up biopsy is common, but medical providers will likely base their recommendations on the individual and their health history.

 

Getting support

Most thyroid nodules are benign, but for patients who do face a thyroid cancer diagnosis, the majority of these cancers have a very good prognosis. Still, being diagnosed with any type of cancer can feel overwhelming. Your physician will likely have local support resources available, but here are some online resources that may be helpful:

• Thyroid Cancer Survivors’ Association
• Cancer Care
• American Cancer Society
• Canadian Cancer Society

 

Frequently asked questions

Here are some common questions regarding thyroid nodules.

What is the outlook for thyroid nodules?

The overall outlook for thyroid nodules is very good, as the majority of nodules turn out to be benign, and the small cases of thyroid cancer are usually papillary types, which are highly treatable. There are rarer types of thyroid cancer that are more difficult to treat, but these cases are in the minority.

Do thyroid nodules cause weight gain?

Sometimes nodules cause weight gain. It depends on the type of nodule and how it behaves. If it is causing the thyroid gland to be underactive, called hypothyroidism, it may decrease metabolism and lead to weight gain or water retention. Thyroid nodules that cause the thyroid gland to be overactive (hyperthyroidism) may increase metabolism, which can make the patient feel hungrier than usual. If they consequently overeat, some patients may experience weight gain as well. Treatment for either condition often resolves this.

Can thyroid nodules disappear on their own?

Sometimes certain thyroid nodules may go away without surgical removal. This is more likely if it is a fluid-filled cystic nodule, if it is a smaller size or if it was caused by temporary underlying conditions, such as thyroid inflammation.

What features are suspicious on a thyroid ultrasound?

Features that may warrant investigation in a thyroid nodule include irregular borders instead of smooth ones, tissue breakdown or necrosis within the nodule, increased vascularity (meaning more blood flow to the growth) and microcalcifications that appear as tiny white spots. However, these aspects don’t necessarily indicate cancer; they are simply starting points for further evaluation and testing, such as a biopsy.

 

Take control of your health journey

PocketHealth makes it simple to keep track of your ultrasounds and other medical scans. All of your vital imaging is in one secure location and can be accessed online anytime. Reports can also be easily shared with other physicians in your care team if needed. When used in conjunction with your medical provider’s professional advice, it is a powerful tool for organizing and understanding your imaging results and your health.

PocketHealth MyCare Navigator gives personalized insights into your health and identifies any recommended follow-up steps. This feature can also generate individualized questions to ask your doctor based on the findings in your report, ensuring you make the most of your consultation.