Thyroid nodule
Thyroid tumor - nodule; Thyroid adenoma - nodule; Thyroid carcinoma - nodule; Thyroid cancer - nodule; Thyroid incidentaloma; Hot nodule; Cold nodule; Thyrotoxicosis - nodule; Hyperthyroidism - nodule
A thyroid nodule is a growth (lump) in the thyroid gland. The thyroid gland is located at the front of the neck, just above where your collarbones meet in the middle.
Causes
Thyroid nodules are growths of cells in the thyroid gland. These growths can be:
- Not cancer (benign) or thyroid cancer (malignant)
- Fluid-filled (cysts)
- One nodule or a group of small nodules
- Producing thyroid hormones (hot nodule) or not making thyroid hormones (cold nodule)
Thyroid nodules are more common in women than in men. A person's chance of getting a thyroid nodule increases with age.
Only a few thyroid nodules are due to thyroid cancer . A thyroid nodule is more likely to be cancer if you:
Thyroid cancer
Thyroid cancer is a cancer that starts in the thyroid gland. The thyroid gland is located inside the front of your lower neck.
- Have a hard nodule
- Have a nodule that is stuck to nearby structures
- Have a family history of thyroid cancer
- Have noticed a change in your voice
- Are younger than 20 or older than 70
- Have a history of radiation exposure to the head or neck
- Are male
Causes of thyroid nodules are not always found, but can include:
-
Hashimoto's disease
Hashimoto's disease
Chronic thyroiditis is caused by a reaction of the immune system against the thyroid gland. It often results in reduced thyroid function (hypothyroi...
- Lack of iodine in the diet
Symptoms
Most thyroid nodules do not cause symptoms.
Large nodules can press against other structures in the neck. This can cause symptoms such as:
-
A visible
goiter
(enlarged thyroid gland)
Goiter
A simple goiter is an enlargement of the thyroid gland. It is usually not a tumor or cancer.
-
Hoarseness or changing voice
Hoarseness or changing voice
Hoarseness refers to a difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or qualit...
- Pain in the neck
-
Problems breathing
, especially when lying down flat
Problems breathing
Breathing difficulty may involve:Difficult breathingUncomfortable breathingFeeling like you are not getting enough air
- Problems swallowing food
Nodules that produce thyroid hormones will likely cause symptoms of overactive thyroid gland , including:
Overactive thyroid gland
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.
- Warm, sweaty skin
- Fast pulse
-
Increased appetite
Increased appetite
Increased appetite means you have an excess desire for food.
- Nervousness
-
Restlessness
Restlessness
Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
- Skin blushing or flushing
-
Weight loss
Weight loss
Unexplained weight loss is a decrease in body weight, when you did not try to lose the weight on your own. Many people gain and lose weight. Uninten...
- Irregular menstrual periods
Older people with a nodule that produces too much thyroid hormone may have only vague symptoms, including:
- Fatigue
- Palpitations
- Chest pain
- Memory loss
Thyroid nodules are sometimes found in people who have Hashimoto's disease. This may cause symptoms of an underactive thyroid gland, such as:
- Dry skin
-
Face swelling
Face swelling
Facial swelling is the buildup of fluid in the tissues of the face. Swelling may also affect the neck and upper arms.
-
Fatigue
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
- Hair loss
- Feeling cold when other people do not
-
Weight gain
Weight gain
Unintentional weight gain is when you gain weight without trying to do so and you are not eating or drinking more.
- Irregular menstrual periods
Very often, nodules produce no symptoms. Health care providers find thyroid nodules only during a routine physical exam or imaging tests that are done for another reason. A few people have thyroid nodules that are big enough that they notice the nodule on their own, and ask a provider to examine their neck.
Exams and Tests
If a provider finds a nodule or you have symptoms of a nodule, the following tests may be done:
-
TSH level
and other thyroid blood tests
TSH level
A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It tells the thyroid gla...
-
Thyroid ultrasound
Thyroid ultrasound
A thyroid ultrasound is an imaging method to see the thyroid, a gland in the neck that regulates metabolism.
-
Thyroid scan
(nuclear medicine)
Thyroid scan
A thyroid scan uses a radioactive iodine tracer to examine the structure and function of the thyroid gland. This test is often done together with a ...
-
Fine needle aspiration biopsy
of the nodule or of multiple nodules
Fine needle aspiration biopsy
Fine needle aspiration of the thyroid gland is a procedure to remove thyroid cells for examination. The thyroid gland is a butterfly-shaped gland lo...
Treatment
Your provider may recommend surgery to remove all or part of your thyroid gland if the nodule is:
Surgery to remove all or part of your t...
Thyroid gland removal is surgery to remove all or part of the thyroid gland. The thyroid gland is a butterfly-shaped gland located inside the front ...
- Due to thyroid cancer
- Causing symptoms such as swallowing or breathing problems
- If the fine needle biopsy is inconclusive, and your provider can't tell whether the nodule is a cancer
- Making too much thyroid hormone
People with nodules that are making too much thyroid hormone may be treated with radioiodine therapy. This reduces the size and activity of the nodule. Pregnant women are not given this treatment.
Both surgery to remove thyroid gland tissue and radioactive iodine treatment can cause lifelong hypothyroidism (underactive thyroid). This condition needs to be treated with thyroid hormone replacement.
For noncancerous nodules that do not cause symptoms and are not growing, the best treatment may be:
- Careful follow-up with a physical exam and ultrasound
- A thyroid biopsy repeated 6 to 12 months after diagnosis, especially if the nodule has grown
Another possible treatment is an ethanol (alcohol) injection into the nodule to shrink it.
Outlook (Prognosis)
Noncancerous thyroid nodules are not life-threatening. Many do not require treatment. Follow-up exams are enough.
The outlook for thyroid cancer depends on the type of cancer. For most common kinds of thyroid cancer, the outlook is very good after treatment.
When to Contact a Medical Professional
Call your health care provider if you feel or see a lump in your neck, or if you have any symptoms of a thyroid nodule.
If you have been exposed to radiation in the face or neck area, call your provider. A neck ultrasound can be done to look for thyroid nodules.
References
Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2010;16(suppl 1):1-43.
Kim M, Ladenson P. Thyroid. In: Goldman L, Schafer AI, eds. Goldman' s Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 226.
Schlumberger MJ, Filetti S, Alexander, EK, Hay ID. Nontoxic diffuse goiter, nodular thyroid disorders, and thyroid malignancies. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 14.
Review Date: 4/19/2016
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.