Thyroid nodules are solid (i.e., solid) or cystic (fluid-filled) masses that form in the thyroid gland. Although they are usually benign, in some cases they may be a sign of thyroid disease or, rarely, thyroid cancer. Ultrasound scans reveal nodules in 20% to 76% of adults. Thyroid nodules should be carefully evaluated in surgical planning, particularly prior to thyroid surgery or neck region operations.
Causes and Risk Factors
The main factors that may contribute to the development of thyroid nodules include:
- Excessive growth of thyroid tissue (adenoma)
- Colloid cysts
- Thyroiditis (inflammation)
- Graves’ disease or Hashimoto’s thyroiditis
- Iodine deficiency or excess
- History of radiation exposure
- Family history of thyroid disease or nodules
They occur approximately four times more frequently in women than in men.
Clinical Manifestations
Most thyroid nodules are asymptomatic and are detected incidentally during routine examination. However, some nodules may cause the following symptoms:
- Swelling or lump sensation in the neck
- Difficulty swallowing
- Shortness of breath
- Voice changes
- Symptoms of hyperthyroidism (if the nodule is hormone-producing):
- Rapid heartbeat
- Nervousness
- Excessive sweating
- Weight loss
Diagnosis
The diagnostic process generally involves the following steps:
- Physical examination and ultrasonography: Evaluation of the size, structure, and number of nodules.
- TSH, T3, T4 levels: Assessment of thyroid hormone activity.
- Fine-needle aspiration biopsy (FNAB): Obtaining a cell sample from suspicious nodules to assess malignancy risk.
- Scintigraphy: Determines whether the nodule is “hot” (hormone-producing) or “cold” (non-hormone-producing).
Treatment Options
Treatment is determined based on the characteristics of the nodule and the patient’s symptoms:
- Observation
- Small, benign, asymptomatic nodules are monitored at regular intervals.
- Medical Therapy
- Antithyroid drugs may be used for hormone-producing nodules.
- Surgical Intervention
- Partial or total thyroidectomy may be performed for large, symptomatic, or suspicious nodules.
- Scarless “transoral” surgical techniques may be possible for selected patients.
- Radiofrequency Ablation (RFA)
- A minimally invasive, office-based procedure for benign nodules. Under ultrasound guidance, the nodule is reduced in size with heat, and most patients return to normal activities the following day.
Conclusion
Most thyroid nodules are benign and do not pose a serious health threat. However, some can affect thyroid function or, rarely, harbor cancer. Therefore, every patient with a detected nodule should be carefully evaluated, biopsied when indicated, and provided with an appropriate treatment plan.
In surgical practice, accurate diagnosis and management of thyroid nodules play a critical role in both patient safety and surgical success.
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