Thyroid Nodule Treatment Long Island
Thyroid nodules are very common and most are benign. At any given time, about a third of the US population harbors a thyroid nodule and the chances of having a nodule are about equal to the patient’s age in decades. In other words, a person in their 50s (sixth decade of life) has about a 60% chance of having a thyroid nodule. Some of these nodules will be discovered on physical examination, while many are found incidentally on imaging studies of the head and neck for unrelated conditions. Once a thyroid nodule has been identified, the next step is to determine if it is overproducing thyroid hormone or whether it may be cancerous.
Symptoms of Thyroid Nodules
Most thyroid nodules do not produce any symptoms at all. When a nodule over-produces thyroid hormone, it may cause symptoms of hyperthyroidism. Very large nodules may also cause compressive symptoms – when the nodules that press against the esophagus they may cause difficulty with swallowing, while those that press against the trachea may cause difficulty breathing. Finally, some nodules can cause voice changes.
Evaluation of Thyroid Nodules
The work up of a thyroid nodule begins with a thorough medical history and physical examination. Your doctor will ask about symptoms of hyperthyroidism, risk factors for thyroid cancer, and the presence of compressive symptoms. A physical exam will reveal the size and texture of the nodule and whether it is soft and mobile or hard and fixed. Blood work will be sent off to determine if the thyroid function is normal and whether there are antibodies to the thyroid circulating in the blood. Almost always an ultrasound of the neck will then be performed. This allows your physician to accurately measure the size of each nodule (many people have more than one), map the location within the thyroid and evaluate the characteristics of the nodule (solid versus cystic, presence or absence of calcifications, regularity of the borders) which is helpful is evaluating for the possible presence of cancer. Physical examination and ultrasound can also identify enlarged lymph nodes in the neck that may be related to the thyroid.
Thyroid Nodule Biopsy
Nodules that are greater than 1 cm or have worrisome ultrasound characteristics should be biopsied by fine needle aspiration. In this procedure, under ultrasound guidance, you physician will place a needle into the nodule and aspirate some cells. The needle is smaller than the one typically used to draw blood. Slides are made of the aspirate and then interpreted by the cytopathologist who use the Bethesda classification system to categorize each nodule.