Thyroid nodules, abnormal growths or lumps in the thyroid gland, are more common among women. The incidence of thyroid cancer is 8.7 per 100000 people per year, though this seems to be increasing over the years. They often require careful attention due to their potential impact on thyroid function and health risks. Detecting them early and understanding the treatment options available are crucial for managing thyroid health.

What Are Thyroid Nodules?

Thyroid nodules are localized swellings or lumps that form within the thyroid gland, a butterfly-shaped organ situated in the front of the neck, below the Adam's apple. These nodules can be singular or multiple, and they may differ in size, shape, and texture. Most thyroid nodules are benign and do not cause any noticeable symptoms. However, in some cases, they can grow large enough to cause discomfort, difficulty swallowing, or a visible swelling in the neck.

Causes and Symptoms

Several factors can contribute to the development of thyroid nodules. These include iodine deficiency, thyroid inflammation (thyroiditis), genetic predisposition, or previous radiation exposure. Most nodules are asymptomatic and discovered incidentally during a physical examination or imaging studies. Certain characteristics raise suspicion of a malignant thyroid swelling. These indicators include a family history of thyroid cancer or thyroid cancer syndrome, rapid nodule growth, a very firm or hard nodule, signs suggesting fixation to surrounding structures, hoarseness of voice due to vocal cord paralysis, enlargement of regional lymph nodes, or the presence of other lesions like a lung mass, indicating distant metastases.

However, it's important to note that while these features are considered classical indicators, many patients do not present with these typical signs. Therefore, additional factors in conjunction with the presence of a thyroid nodule should prompt further investigations. These additional factors include a history of radiation exposure, being male, extreme ages (<20 or >70 years), previous neck irradiation, nodules larger than 4 cm, or the presence of any pressure symptoms.

Diagnosis

Accurate diagnosis of thyroid nodules is crucial for determining appropriate treatment. Surgeons use various diagnostic tools to evaluate nodules. Ultrasound imaging is commonly employed to assess the size, characteristics, and number of nodules. Blood tests measuring thyroid hormones (freeT3, freeT4, and TSH); Anti-TPO antibodies can provide valuable information about thyroid function and inflammation. Additionally, fine-needle aspiration cytology (FNAC) is often performed in a fluid sample from the nodule, allowing for microscopic examination to determine if it's benign or malignant.

Treatment Options

The approach to treating thyroid nodules depends on several factors, including nodule size, characteristics, symptoms, and the patient's overall health. For small, asymptomatic nodules that are confirmed to be benign, a "watchful waiting" approach may be recommended. This involves regular monitoring through imaging studies and physical examinations to observe any changes in size or symptoms or ultrasound character of the nodules.

However, if nodules cause symptoms such as difficulty breathing or swallowing, or if they're suspected to be cancerous, Surgery, known as thyroidectomy, might be necessary to remove the diseased gland.

Radioactive Iodine Therapy

Radioactive iodine therapy involves the administration of radioactive iodine orally. This treatment is primarily used for nodules that are overactive (producing excess thyroid hormones) or following total thyroidectomy for thyroid cancer for ablation of microscopic remnants. Radioactive iodine is absorbed by the thyroid tissue, targeting and destroying abnormal cells while minimizing damage to surrounding healthy tissue.

Follow-Up and Conclusion

In conclusion, understanding thyroid nodules and their treatment options is crucial for maintaining thyroid health. Early detection through proper diagnosis methods like ultrasound and FNAC is key. Treatment strategies range from watchful waiting for benign nodules to surgery, or radioactive iodine therapy for symptomatic or malignant nodules. Tailored treatment plans, regular monitoring, and open communication with doctors are vital for managing thyroid nodules effectively.

Regular follow-up appointments and monitoring are often recommended to track any changes in nodules and adjust treatment plans accordingly. Individuals with thyroid nodules need to work closely with their doctor to develop a personalized treatment plan that addresses their specific conditions and concerns.

Dr. Ferdinant J
Consultant
Department of Thyroid, Breast Cancer & Endocrine Surgery
Apollo Adlux Hospital, Angamaly