As an endocrinologist, one of the most common medical conditions that I look for during a physical examination is the presence of thyroid nodules.
These are solid or fluid-filled lumps that form within your thyroid, a small gland located at the base of your neck, just above your breastbone. They are quite common and fortunately, the large majority of thyroid nodules are non-cancerous (benign).
Most thyroid nodules have no signs or symptoms and are detected by a doctor during a physical examination of the neck area. Be sure to have your doctor do an examination if you have any unusual swelling in your neck, or have trouble breathing or swallowing. This could be a sign that an enlarged thyroid nodule is pressing against the trachea (shortness of breath) or esophagus (difficulty swallowing).
It’s also important to rule out the possibility of cancer, although only a small percentage of thyroid nodules are malignant (cancerous). You’re at a higher risk if you have a family history of thyroid and other endocrine cancers, are male, and have a history of radiation exposure, particularly to the head and neck.
Thyroid irregularity can be the result of cysts, chronic inflammation of the thyroid, or iodine deficiency in the diet, although this is uncommon in the United States. In fact, drastic diet changes to increase or decrease iodine intake can be more harmful than helpful.
Testing & Treatment
Often, thyroid nodules are discovered during a routine physical examination. The doctor will feel your neck area and examine your thyroid while you swallow.
If a thyroid nodule has been detected, you’ll be referred to an endocrinologist to perform advanced imaging and other tests to rule out the possibility of cancer and to determine if the thyroid is functioning properly.
Testing can include thyroid ultrasound and fine-needle aspiration biopsy, in which a very thin needle is used to remove sample cells that are sent to a lab for analysis. This outpatient procedure has few risks and takes about 20 minutes in a doctor’s office. Often, the doctor will use an ultrasound to help guide the placement of the needle and a numbing cream to help reduce any pain or discomfort.
Treatment depends on the type of thyroid nodule you have. For benign nodules, most doctors will recommend simply monitoring your condition through regularly scheduled physical exams and thyroid testing. If the nodule remains unchanged, you may never need treatment. However, surgery may be advised if a benign nodule grows so large that it makes breathing or swallowing difficult.
The usual treatment for a malignant thyroid nodule is surgical removal.
Dr. Yana Basis Garger MD is a board-certified endocrinologist who concentrates on thyroid ailments and other medical issues such as diabetes, obesity, metabolic and nutritional disorders, pituitary diseases, menstrual and sexual problems. She is a member of the American Academy of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. Dr. Garger has co-authored articles published in the American Journal of Cardiology, the Journal of Investigative Medicine High Impact Case Reports and the Journal of Nuclear Medicine, and co-authored a chapter of the medical textbook Secondary Causes of Diabetes Mellitus. Dr. Garger is licensed to practice medicine in New York and New Jersey and is fluent in both conversational and medical Russian.