Thyroid nodules are abnormal lumps or growths of tissue within the thyroid gland. They may be solid, fluid-filled, or mixed. Very few are cancerous and do not require surgery for removal. Some, however, can cause discomfort, can impair the functioning of the thyroid or can signal the presence of cancer. Physicians take various factors into account before recommending treatment by surgery, such as the size of the nodules, ultrasound tests, biopsy results, and symptoms. Dr Nikunj Jain (Co-Founder & Head of Nuclear Medicine Department), Molecular Diagnostics & Therapy, gives expert opinions on thyroid testing and thyroid therapy.
What Are Thyroid Nodules?
Thyroid nodules are lumps of tissue that are abnormal in the thyroid. They may contain solids or liquids, or solids that have been dissolved in liquid. Some are found when they are being routinely checked; some are found by using imaging tests. Common symptoms include:
A lump or swelling in the neck.
Difficulty swallowing.
Pressure in the throat.
Persistent hoarseness.
Breathing difficulties when the nodule is large.
Many nodules do not cause noticeable symptoms.
When Does a Thyroid Nodule Need Surgery?
Not all thyroid nodules will need to be removed by surgery. Surgery is advised when the benefits of the procedure are greater than any risks involved with the monitoring or alternative treatments.
1. When Biopsy Results Suggest Cancer
A fine needle aspiration (FNA) biopsy is performed whereby a fine needle is inserted into the thyroid nodule and cells are removed. These are examined and graded according to the Bethesda System for Reporting Thyroid Cytopathology. The results can show if the sample is non-diagnostic, benign, atypical, suspicious, or malignant.
2. When the Nodule Is Large or Growing
Large nodules can cause friction with other parts of the body, such as the windpipe and food pipe (esophagus). This can cause problems with breathing, eating, pain and cause issues in the neck. However, the nodule will need to be assessed.
3. When Ultrasound Shows Suspicious Features
During a thyroid ultrasound, the size, shape, features, and margins of the nodule will be assessed. If the nodule is taller than wide, has irregular margins, and microcalcifications, then this can indicate that it is cancerous. Further investigations may be advised.
4. When the Nodule Causes Hyperthyroidism
Patients may experience symptoms such as increased heart rate, weight loss, sweating, tremors, and anxiety. Depending on the patient's condition, this can be treated with medication, radioactive iodine, or surgery.
5. When There Is Pressure on Nearby Structures
Large nodules can cause long-term issues with voice, swallowing, breathing, and throat pain. If it is confirmed that the symptoms are due to compression, then surgery may be offered to relieve pressure.
6. When Biopsy Results Are Unclear
Sometimes FNA can show non-diagnostic or indeterminate results. This means it is unclear if the nodule is benign or malignant. Depending on the results and risk factors, further investigations may be advised, repeat biopsy, or monitoring. Or diagnostic surgery may be advised.
What Tests Are Done Before Thyroid Nodule Surgery?
Doctors might suggest some of the following investigations:
Thyroid Function Tests (TSH, T3, T4): These help to determine levels of thyroid hormone.
Thyroid Ultrasound: This determines the size, shape, and concerning features of the nodule.
Molecular Testing: May give further genetic information in some cases where the biopsy doesn't give enough information.
Role of Nuclear Medicine in Thyroid Nodule Management
Nuclear medicine helps evaluate the functioning of the thyroid gland. Treatment with radioiodine is a treatment option for certain people who have hyperthyroidism. Nevertheless, there is a difference between the use of thyroid scintigraphy and biopsy. A scan determines how active the thyroid is, and a biopsy will test the cells to see if they show any abnormalities. Dr. Nikunj Jain, who is the Co-Founder & Head of the Nuclear Medicine department at Molecular Diagnostics and Therapy, has more than 18 years of experience in the field, with his involvement in more than 75,000 PET-CT examinations that he has conducted, along with extensive nuclear medicine procedures. His knowledge enables patients to comprehend suitable investigations and treatments. Can Every Thyroid Nodule Be Treated Without Surgery?
No. If you have several benign thyroid nodules, you would be regularly monitored with ultrasound. If there are other clinical issues or significant symptoms and/or concerning biopsy results, then you may require surgery. Depending on what is found, you may be monitored, prescribed medication, given radioactive iodine, or require surgery. Conclusion Based on the results of the biopsies, ultrasounds, size, rate of growth, and symptoms of the tumour, some patients may not require surgery. Doctors will give recommendations based on these factors. Dr Nikunj Jain is a specialist in using nuclear medicine to make decisions regarding thyroid assessment and management. If the patient receives timely medical advice, they will be aware of their condition and will be able to make decisions to treat it.