Thyroid nodules and general surgery
Thyroid nodules are very common and most are not cancer, but they need to be checked with ultrasound and sometimes a biopsy. This page explains what a thyroid nodule means, when surgery is considered, what to expect afterwards and when it is urgent.
What is this problem?
A thyroid nodule is a lump or small mass formed by overgrowth of cells in the thyroid gland. MedlinePlus writes that a nodule may be benign, cancerous or a fluid-filled cyst, single or multiple, and ‘hot’ (makes hormone) or ‘cold’ (does not). Nodules are common, are seen more often in women and become more common with age. They often cause no symptoms and are found on an examination or on imaging done for another reason.
When a nodule is large it can press on structures in the neck: a visible swelling of the neck (goitre), a change in voice, neck pain, difficulty breathing, especially lying down, or trouble swallowing. A nodule that makes hormone gives signs of an overactive thyroid, such as a racing heart, sweating, anxiety, trembling and weight loss.
About thyroid cancer, the NHS writes that the main symptom is a lump at the front and lower part of the neck, usually firm, growing slowly and painless. Hoarseness, trouble swallowing or breathing, and pain or a feeling of pressure at the front of the neck are possible too. The same source stresses that these symptoms are very common, have many causes, and having them does not necessarily mean cancer.
When does someone come to a surgeon?
- A nodule that a fine-needle biopsy has shown to be cancer, or whose result is unclear (MedlinePlus).
- A nodule that has grown and presses on breathing or swallowing.
- A nodule that makes too much hormone when no other treatment is suitable.
- A goitre or a change in the neck that another doctor has referred.
Referral to a surgeon does not mean an operation is certain. MedlinePlus says that for a non-cancerous nodule with no symptoms and no growth, follow-up with examination and ultrasound may be the most suitable approach.
How is it investigated?
MedlinePlus names these tests:
- thyroid blood tests, including TSH
- thyroid ultrasound
- a thyroid scan (nuclear medicine)
- fine-needle biopsy (FNA) of one or more nodules, sometimes together with genetic testing of the tissue
For a non-cancerous nodule that is not growing, the doctor may repeat the biopsy 6 to 12 months later, especially if the nodule has become bigger (MedlinePlus). When cancer is suspected, the NHS says the doctor examines the neck and may ask for blood tests and send the patient for further tests.
How is it treated in general?
- Follow-up. For a nodule with no symptoms that is not cancerous, MedlinePlus counts regular examination and ultrasound as perhaps the most suitable approach.
- Radioactive iodine for a nodule that makes too much hormone, which reduces its size and activity. It is not given in pregnancy or breastfeeding (MedlinePlus).
- Surgery on all or part of the thyroid, when the nodule is cancerous, presses on breathing or swallowing, the biopsy result is unclear, or it makes too much hormone (MedlinePlus). For thyroid cancer the NHS names two forms: removing the whole thyroid and removing part of it (lobectomy). Sometimes lymph nodes in the neck are removed too. Which suits you is for your doctor to decide.
- Thyroid hormone tablets. Usually needed after the whole gland is removed, and in some patients after part is removed too (NHS). MedlinePlus stresses that both surgery and radioactive iodine can cause permanent underactivity of the thyroid, which is treated with a daily tablet.
After the operation, according to MedlinePlus you can usually go home the same day or after one night in hospital. You may have a drain with a small bulb. Neck pain and tenderness, especially when swallowing, are common, and your voice may stay hoarse for about a week. See the care at home guide for details.
What can you do?
- Bring the ultrasound report, the biopsy result and hormone tests.
- Tell the doctor if you have had radiation to the head or neck in the past, or if thyroid cancer runs in your family. MedlinePlus counts both as important.
- Write down any change in voice, trouble swallowing or breathing, and when it started.
- Carry your medicine list. Do not stop thyroid hormone tablets or any other medicine yourself.
- After surgery, watch for the signs MedlinePlus lists for calling the surgeon: fever, redness or swelling of the wound, bleeding, a weak voice, trouble eating, a repeated cough, and numbness or tingling of the face and lips.
When to get urgent help
- Difficulty breathing. If breathing has become very hard, you cannot say a sentence or your lips have turned blue, call 115, Iran’s emergency number (NHS). If you have not had surgery and are only more short of breath than usual, the NHS advises urgent medical help; contact your doctor the same day.
- After thyroid surgery: neck swelling with difficulty breathing, or any new difficulty breathing. Call 115, Iran’s emergency number, and do not wait for the office to reply.
- After thyroid surgery: bleeding from the wound, or numbness and tingling of the face, lips or fingers. Tell the surgeon the same day, and if they cannot be reached, go to the emergency department. MedlinePlus counts numbness of the face and lips and bleeding from the wound among the reasons to call the surgeon.
Do not drive yourself. See the full list in the guide When should I call urgently?
About ‘general surgery’
The doctor’s specialty title is ‘Thoracic Surgery Subspecialist and General Surgeon’. From the general surgery side, this page explains only the thyroid. Other operations will be listed once the doctor confirms them.
Frequently asked questions
Does a thyroid nodule mean cancer?
Not necessarily. MedlinePlus writes that only a small number of thyroid nodules are due to cancer, and non-cancerous nodules are not life-threatening. The same source says that for the most common types of thyroid cancer the outlook after treatment is very good. Even so, every nodule has to be checked to find out which type it is.
What makes a nodule more suspicious?
MedlinePlus names these: a hard nodule, a nodule stuck to the tissue around it, a family history of thyroid cancer, a change in voice, age under 20 or over 70, earlier radiation to the head and neck, and being male. Having any of these does not mean cancer; it only means a closer look is needed.
Do I definitely need surgery?
Not always. MedlinePlus says that for a non-cancerous nodule that causes no symptoms and is not growing, follow-up with examination and ultrasound may be the most suitable approach. Surgery on all or part of the thyroid is suggested when the nodule is cancerous, causes trouble breathing or swallowing, the biopsy result is unclear, or it makes too much hormone.
Will I need to take tablets after the thyroid is removed?
MedlinePlus writes that if the whole thyroid is removed, thyroid hormone tablets may be needed for life, but if only part is removed they may not be. The NHS also says tablets are sometimes needed after part is removed. With regular blood tests the doctor adjusts the dose. Do not stop or change the medicine yourself.
What does 'general surgery' mean on this site?
This page is only about the thyroid. The doctor's general surgery work will be added to the site once he confirms it.