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Benign thyroid nodules
These nodules usually develop due to overgrowth of normal thyroid tissue. The exact molecular mechanisms that cause nodules are not fully understood. Surgery is not usually recommended for the benign nodules because they can be monitored over time with ultrasound testing. If the thyroid nodule grows, a repeat FNA or thyroid surgery may be recommended, especially if the nodule causes symptoms or has grown more than 30-50%.
Suppression treatment with thyroid hormone:
If a thyroid nodule is known not to be, but the nodule is large, some clinicians will suggest a trial of levothyroxine to shrink the nodule by artificially creating mild hyperthyroidism in the patient. Thyroid hormone levels should be monitored carefully during suppressive treatment and the patient is put at increased risk of cardiac and bone diseases. Dr. Jogi and Elhaj do not advocate this type of treatment in most patients.
Indeterminate nodules:
Indeterminate thyroid nodules are not cancerous but they can look very similar to true thyroid cancers. Over time, they may invade surrounding tissues, at which point they are classified as thyroid cancer. Classically, the best way to evaluate these nodules is with a surgical specimen so that the nodules entire architecture is preserved for better visualization. Depending on a patient’s thyroid cancer risk factors and associated clinical symptoms, the treatment is either surgical removal of the lobe of the thyroid and has the nodule or monitoring the nodules with ultrasound over a period of time. At the time of surgery, about 1 – 20 percent of indeterminate thyroid nodules are classified as thyroid cancer.
Autonomous ('hot') thyroid nodules:
Some thyroid nodules, independent from the direction from the pituitary gland, produce excess thyroid hormone. These are called autonomous hyper-functioning “hot” thyroid nodules. These nodules are almost always benign, but they overproduce thyroid hormone and can lead to hyperthyroidism. Depending upon a patient’s particular situation, treatment for these types of nodules may be observation, surgery, or radioactive iodine therapy.
Cystic thyroid nodules:
These thyroid nodules are usually benign and are filled with fluid. These nodules may simply collapse when the fluid is removed. The fluid in these cysts usually return immediately after drainage, so unless a patient is symptomatic, observation may be appropriate.
Malignant thyroid nodules (thyroid cancer):
First, it is important to understand that only about 5-10% of all thyroid nodules are malignant. Most patients that have thyroid cancer will have a very good chance for cure and long term survival. Thyroid cancer treatment will depend on the type of cancer present. The three most common types of cancer found in the thyroid are papillary, follicular and medullary thyroid cancer.
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