Ask a Doctor: Cancerous Thyroid Nodules

Introducing: Ask a Doctor

At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.

That’s why our department’s introducing Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.

Today, our pediatric team discusses cancerous thyroid nodules.
Prepared by: David Templeton, Third Year Medical Student (University of Tennessee Health Science Center-College of Medicine)
Reviewed by: Dr. Anthony Sheyn, Pediatric ENT specialist

First, what is the thyroid?

The thyroid is a small gland that is found along the front of the neck that produces thyroxine (T4), a hormone involved with regulating several bodily functions including temperature regulation, metabolism, and growth. Signs of excess thyroxine include weight loss, increased heart rate, and heat intolerance. Signs of low thyroxine inversely include weight gain, fatigue, and cold intolerance.

What are thyroid nodules?

Thyroid nodules are typically soft or hard masses that arise in the thyroid and can either be solid or filled with fluid. These nodules are often found incidentally during scan of the head and neck, but they can also be found during your doctor’s physical exam or even during home inspection.

While most nodules are asymptomatic, thyroid nodules can produce symptoms of excess thyroid hormone as mentioned above. The nodules can rarely become so large that they block your airway causing difficulty breathing.

How do you tell if a thyroid nodule is cancerous?

When looking at a thyroid nodule, the initial evaluation by your doctor will revolve around excluding that the nodule is cancerous. Only 4-6% of thyroid nodules are diagnosed as cancerous, but the chance of cancer does increase with age.

To see if a nodule is cancerous, your doctor may order lab work to test thyroid function and an ultrasound to better approximate size and makeup of the nodule.

What happens if the thyroid nodule looks suspicious for malignancy on ultrasound?

If the initial ultrasound shows that the thyroid mass could be cancer, the next step in your treatment is obtaining a fine-needle aspiration (FNA) biopsy. This test consists of your medical provider locating the nodule and inserting a small needle into the thyroid to obtain a sample of the tissue.

This tissue will be looked at under a microscope to analyze any abnormal cells that may be present and can help determine what type of thyroid cancer you have if appropriate.

What is the purpose of obtaining a thyroid function test?

The thyroid function test that will typically be obtained is a thyroid stimulating hormone (TSH) level. This test measures how much thyroid hormone your body is trying to make and is an accurate measurement in determining overall thyroid hormone level.

If the TSH level is high, it means that your body has low thyroxine and is trying to make more to maintain normal levels. Inversely, if your TSH level is low, it often is an indication of your body having high thyroxine levels and thus your body is trying to shut off thyroxine production to return to normal levels.

Cancerous thyroid nodules are classically non-hormone producing while benign nodules can produce high or low thyroid hormone levels so this test can be beneficial in easily assessing potential cancer.

Benign thyroid nodules

Benign nodules may be followed up with your doctor routinely to check for growth and any change in thyroid function, however surgery is typically not recommended. If your thyroid nodule is symptomatic, you may be treated with medication to regulate the level of thyroid hormone.

Cancerous thyroid nodules

If the thyroid biopsy is determined to be malignant, the next step is evaluation of cancer spread to nearby lymph nodes, nearby structures, and distant structures. Depending on the type of thyroid cancer that the biopsy shows, surgery may be recommended.

Common types of thyroid cancers that you may hear include medullary thyroid cancer, papillary thyroid cancer (most common), thyroid lymphoma, anaplastic cancer, and cancer that originated elsewhere but migrated to the thyroid. Most patients diagnosed with cancerous thyroid nodules have an excellent chance of survival.

If you’d like to learn more about thyroid nodule treatment, we recommend this article from our Head & Neck Cancer team.

When should I consult a doctor?

Talk to your doctor if you notice any growth or abnormal changes to a previously found thyroid nodule. Additionally, if you notice any signs of excess thyroid hormone (weight loss, heart racing, poor temperature control) consult your doctor to see if your thyroid needs to be examined further.

How can our Dream Team help?

Our pediatric specialist, Dr. Anthony Sheyn, has wide-ranging expertise in treating ear, nose, and throat issues. If you have concerns about your thyroid, please contact our office to schedule an evaluation: 901-287-7337