Thyroid Nodules


Robert Leinbach, MD

by Robert Leinbach, MD, UNC Regional Physicians Ear Nose and Throat

The thyroid is an endocrine gland that is located in the lower neck just below the larynx (voice box) and rests on top of the trachea (windpipe). The thyroid is an important gland because it makes a hormone called thyroid hormone that has a strong influence on metabolism. The hormone can affect your weight, heart rate, body temperature and overall energy level.

As a head and neck surgeon, I am frequently asked to evaluate patients with thyroid nodules and thyroid enlargement (goiter). Many times the patient did not even know that they had a nodule. The nodule may have been picked up during their annual physical examination with their primary care provider or perhaps was an incidental finding on CT or MRI scan of the neck or chest region. Patients can be somewhat caught off guard when they are told that they have a nodule.

Thyroid nodules are abnormal growths of thyroid tissue found in the thyroid gland. The majority, more than 90 percent, of thyroid nodules are found to be benign. Thyroid nodules are more common in women and the incidence of nodules increases as a person gets older. They can be solid or cystic (fluid filled) and can vary in size and shape.

When a thyroid nodule is discovered, a thyroid ultrasound and a thyroid function blood test (called a TSH) are both performed. Using ultrasound the nodule is measured and features of the nodule are described more completely. For example, is the nodule large (greater than four centimeters), solid vs. cystic, irregular in shape or are there small calcifications within the nodule? The TSH blood test will determine if the nodule is making excess thyroid hormone.

When a patient is evaluated, several questions need to be asked. One question is whether the patient has a history of radiation exposure or radiation therapy. Radiation exposure is known to increase the risk for developing thyroid cancer. A family history of thyroid cancer is also important information, as certain types of thyroid cancers run in families. These include papillary and medullary thyroid cancer. Papillary thyroid cancer is by far the most common type of thyroid cancer and has a very good prognosis with proper treatment. Women are three times more likely to develop thyroid cancer than men and the risk peaks somewhere around 30 to 50 years old. If men develop cancer, they normally develop it at a later age.

The most pressing question that most people have concerning a thyroid nodule is whether the nodule is cancerous or not. The best test to help determine the answer is called a fine needle aspiration biopsy (FNA). This test can be easily and safely performed in an office setting usually with ultrasound guidance. An ultrasound transducer is placed on the neck and a fine needle is passed into the nodule and cells are aspirated for pathologic examination. If the FNA is benign, frequently the nodule can be followed for any changes over time. If the FNA report shows cancer, the patient will need surgery. Sometimes the FNA cannot determine whether the nodule is cancerous or not and further genetic and molecular tests can offer more information. If the FNA does not give the answer, the physician will counsel the patient on options for treatment including observation vs. surgery taking the entire clinical picture into account.

If you are concerned about your thyroid health, please take time to talk to your primary care provider or feel free to call our office at (336) 781-4050.