Thyroid nodules are abnormal growths or Lumps that develop within the thyroid gland, which is located in the neck. While most thyroid nodules are (benign), some may require further evaluation to rule out malignancy.
Multinodular goitre
- Most common - esp in older patients
- Usually euthyroid but may be hyper- or borderline with suppressed TSH levels but normal T4 and T3
- Can cause tracheal and/or oesophageal compression and laryngeal nerve palsy
- May extend retrosternally
- Diffusely enlarged with multiple small nodules in glands
Solitary nodular goitre
- Difficult to diagnose as differentiating the small minority of malignant nodules is important and require surgery
- Rapid enlargement with lymph node changes and pain may suggest an aggressive malignancy - but most thyroid cancers are slow growing and painless
- May just be the largest nodule of a multinodular goitre
- Solitary toxic nodules are quite uncommon and may be associated with T3 toxicosis
Fibrotic goitre (Riedel’s thyroiditis)
- Rare condition usually producing a “woody” gland.
- Associated with other midline fibrosis and often difficult to distinguish from carcinoma being irregular and hard.
- Clinical clues include systemic inflammatory markers being raised
Causes/Factors
- Iodine Deficiency: In regions with low dietary iodine, nodules may form.
- Inflammation: Chronic inflammation of the thyroid (thyroiditis) can contribute.
- Genetic Factors: Family history may increase the risk of nodular development.
Symptoms
- Palpable Lump: A noticeable lump or swelling in the front of the neck.
- Difficulty Swallowing: Large nodules may cause difficulty swallowing.
- Hoarseness: Nodules pressing on the vocal cords may lead to hoarseness.
- Thyroid Function Changes: Some nodules can alter thyroid hormone levels.
Diagnostic Tests
- Thyroid Ultrasound: Imaging study to visualize the size and characteristics of nodules.
- Fine Needle Aspiration (FNA) Biopsy: Removal of a small tissue sample for examination.
- Thyroid Function Tests: Assessing thyroid hormone levels to evaluate overall thyroid function.
Management
- Observation: Small, non-cancerous nodules may be monitored without immediate intervention.
- Thyroid Hormone Replacement: For nodules affecting thyroid function, hormone replacement may be prescribed.
- Surgery: Larger or suspicious nodules may be removed surgically, especially if cancer is suspected.