Nodules - Management Options
Management Options for Thyroid Nodules
Written by Monique Atkinson and endorsed by Dr Hieu Nguyen
If the nodule is benign and does not cause any symptoms then the nodule can be self checked on a regular basis. An ultrasound can be used to see if the nodule is growing in size. If the nodule increases in size or produces symptoms, such as swallowing and breathing difficulties, then you should consider surgical removal.
The Thyroid Neck Check - Self Monitoring
- The best way to check for thyroid "lumps" is to sit in front of the mirror with a glass of water.
- Look into the mirror and make sure you can clearly see your neck. Your thyroid gland (a butterfly shaped gland) is located just above the collarbone and just below your Adam's apple.
- Tip your head back and keep looking at your thyroid gland.
- Take a sip of water and swallow. While you swallow the water, focus on the area below the Adam's apple and watch for any lumps, bulges, enlargements or unusual appearances. A thyroid nodule is likely to move while you swallow.
- If you find anything unusual report it to your doctor right away.
Few doctors still prescribe thyroxine (thyroid hormone) in the hope that a benign nodule decreases in size. However the results have been disappointing and it is no longer mainstream treatment.
Hyperthyroidism caused by hot nodules can be treated with radioactive iodine which may shrink the nodules. However the radioactive iodine may damage adjacent thyroid tissue. If too much thyroid tissue is destroyed then the patient may become hypothyroid and will need thyroid hormone replacement therapy for life.
Another treatment for hot nodules is alcohol ablation. Alcohol (ethanol) is injected into the nodules which makes them shrink. It can cause significant pain and discomfort. Escape of the alcohol may also cause recurrent nerve injury (causing voice impairment). You may need one to eight injections depending on the size of the nodule. This treatment does not cause increased risk of hypothyroidism.
Surgery is usually recommended for a large multinodular goitre that causes breathing or swallowing difficulties. It is often the treatment of choice for "hot" (toxic) nodules as it does not cause collateral damage to the contralateral lobe of the thyroid, hence no increased risk of hypothyroidism. If the whole thyroid gland is removed then the person will need thyroid hormone replacement therapy for life. The surgery should be performed by an experienced endocrine surgeon. If the nodule is cancerous then surgery is always recommended. See treatment for thyroid cancer.
Algorithm for assessing a thyroid nodule
"Mackenzie EJ and Mortimer RH. 6: Thyroid Nodules and Thyroid Cancer. MJA 2004; 180: 242-247. © Copyright 2004. The Medical Journal of Australia - reproduced with permission"