A thyroid nodule is a localized growth within the thyroid gland. Most nodules are benign, but some may be malignant. Symptoms can include neck swelling, difficulty swallowing, and voice changes, depending on size and location.
Diagnosis involves ultrasound imaging and fine-needle aspiration biopsy to determine nodule characteristics. Suspicious features on imaging guide further evaluation and treatment decisions.
Small, benign nodules may only require regular monitoring. In contrast, malignant or symptomatic nodules often necessitate surgical removal or radioactive iodine therapy, depending on type and stage.
Endocrinologists develop individualized treatment plans for patients. Continuous monitoring ensures early detection of changes, preventing unnecessary procedures while addressing potentially dangerous nodules promptly.
| Disease Name | Thyroid Nodule |
| Definition | Nodules that form in the thyroid gland, usually benign; they may be fluid-filled (cystic) or solid. Some nodules may produce hormones while others do not. |
| Symptoms | Usually asymptomatic; large nodules can cause swelling in the neck, difficulty swallowing or breathing, and hoarseness. |
| Causes | Iodine deficiency, genetic factors, thyroid inflammations, autoimmune thyroid diseases (Hashimoto’s disease), exposure to radiation. |
| Risk Factors | Advanced age, female gender, family history of thyroid nodules, iodine deficiency, radiation exposure, history of autoimmune disease. |
| Diagnostic Methods | Physical examination, thyroid ultrasound, blood tests (T3, T4, TSH), fine-needle aspiration biopsy (the nodule structure is examined by biopsy), thyroid scintigraphy. |
| Types of Nodules | Simple nodule (non-hormone producing), toxic nodule (excess hormone producing), hot nodule (active, hormone producing), cold nodule (non-hormone producing and requires investigation). |
| Treatment Methods | Observation is generally recommended for benign and small nodules; for hormone-producing nodules, medication, radioactive iodine therapy, or surgical intervention. For suspicious or large nodules, surgical removal (thyroidectomy) may be required. New generation treatments: Thyroid RF or microwave ablation, the nodule is reduced by 80%, the normal thyroid is preserved. |
| Complications | Large nodules may compress the airway or esophagus, causing difficulty in breathing and swallowing; although the cancer risk is low, some nodules may be malignant. |
| Surgical Requirement | Surgical intervention is required if there is suspicion of cancer, a large nodule, hormone-producing nodules unresponsive to medication, or symptoms due to pressure. |
| Prevention Methods | Regular thyroid examination, adequate iodine intake, regular ultrasound and blood tests for those with a family history of nodules. |
Prof. Dr. Özgür KILIÇKESMEZ Prof. Dr. Kılıçkesmez holds the Turkish Radiology Competency Certificate, the Turkish Interventional Radiology Competency Certificate, Stroke Treatment Certification, and the European Board of Interventional Radiology (EBIR). In his academic career, he won the Siemens Radiology First Prize in 2008.
Interventional Radiology / Interventional Neuroradiology
What Is a Thyroid Nodule?
A thyroid nodule is defined as an abnormal growth or lump in the thyroid gland. These nodules can be solid or fluid-filled and are often discovered during imaging tests performed for other reasons. Most nodules are harmless, but a small portion may be malignant and lead to cancer. When a nodule is detected, ultrasound is used to evaluate its size and structure. Fine-needle aspiration biopsy may also be performed to determine if the nodule contains cancerous cells. Nodules found to be benign after diagnosis are usually monitored. However, different treatment options are considered if the nodule is suspicious.
What Are the Causes of Thyroid Nodules?
Multiple factors may play a role in the formation of thyroid nodules, and some causes contribute more to this condition. While these growths are generally benign, sometimes they can contain malignant cells. The development of nodules varies depending on underlying conditions.
Main causes include:
- Thyroid Adenomas: Adenomas, which are benign tumors, are overgrowths of thyroid tissue. Although the exact cause is unknown, these adenomas generally do not create serious health issues.
- Thyroid Cysts: Cysts are fluid-filled structures that are usually benign. However, in some cases, cancer cells may be found in cysts.
- Chronic Inflammation: Autoimmune diseases such as Hashimoto’s thyroiditis may lead to chronic inflammation of the thyroid, causing nodule formation.
- Multinodular Goiter: This condition, in which the enlarged thyroid contains multiple nodules, may be linked to iodine deficiency and other thyroid problems.
- Thyroid Cancer: The vast majority of nodules are benign, but some may rarely be cancerous.
- Iodine Deficiency: This common global condition can cause goiter and nodule formation due to iodine deficiency.
- Genetic Factors: People with a family history of thyroid disorders have a higher risk of developing nodules.
- Environmental Factors: Radiation exposure, especially during childhood, increases the risk of nodule formation and cancer.
- Age and Gender: More common in women and prevalence increases with age.
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How Common Are Thyroid Nodules?
Thyroid nodules are lesions commonly seen in different populations and regions. The prevalence of nodules varies depending on detection methods and demographic features. In the general population, the incidence of thyroid nodules can vary between 2% and 67% depending on the detection method used. For example, ultrasound examinations in some communities report prevalence rates between 24% and 34%.
Demographic factors significantly affect the prevalence of thyroid nodules. The incidence of these lesions is higher in women than in men, and the risk increases with age. For instance, in a study with over 121,000 participants, the prevalence in women was recorded as 40.6%, while in men it was 29.8%.
Various factors increase the risk of developing thyroid nodules. These include:
- Gender: Due to hormonal factors, thyroid nodules are more likely to develop in women.
- Age: The frequency of thyroid nodules increases with advancing age.
- Obesity: High body mass index and metabolic issues are associated with thyroid nodules.
- Iodine deficiency: The prevalence of thyroid nodules is higher in regions with iodine deficiency.
Finally, the widespread use of advanced imaging techniques has increased the incidental detection of nodules. This has led to the identification of nodules in asymptomatic individuals in various regions. Diagnosis rates may vary between countries, which is also a factor influencing treatment methods.
What Is the Formation Process of Thyroid Nodules?
The formation of thyroid nodules is a complex process developed by the effects of both molecular and environmental factors. At the cellular level, clonal expansion seen in thyroid follicular cells is one of the main causes of nodule formation. Mutations in genes such as the TSH receptor can lead to uncontrolled cell proliferation. These genetic changes may be triggered by environmental factors like iodine deficiency and can affect cellular growth processes.
Environmental factors also play a significant role in the development of thyroid nodules. Iodine deficiency is one of the main reasons that increases nodule formation, especially in populations with insufficient iodine intake. Additionally, demographic factors such as age, gender, and hormonal changes affect the frequency of thyroid nodules. Women and elderly individuals are more susceptible to this condition.
Pathophysiological processes such as inflammation or fibrosis in the thyroid gland can also trigger nodule development. For example, autoimmune diseases such as Hashimoto’s thyroiditis increase the risk of nodule formation by causing chronic inflammation in the gland.
Advanced imaging techniques are crucial in the diagnosis of thyroid nodules. Especially ultrasonography is used to evaluate the size and structure of nodules. New techniques such as elastography aim to increase diagnostic accuracy.
Molecular research on thyroid nodules also continues. Genetic markers can be used to determine whether a nodule is malignant. In this way, more personalized treatment approaches are being developed.
What Are the Symptoms of Thyroid Nodules?
The symptoms of thyroid nodules may vary depending on the size, location, and pressure on surrounding structures. Most small nodules do not cause symptoms and are usually detected incidentally. However, some nodules may lead to various symptoms. As the nodule grows, the feeling of discomfort in the neck may increase, causing visible swelling. In this case, individuals may notice a sense of fullness or a lump in the neck. Also, the growth of the nodule may exert pressure on surrounding structures, resulting in more pronounced symptoms.
Pressure symptoms include:
- Difficulty swallowing
- Feeling of fullness in the neck
- Hoarseness or voice changes
- Difficulty breathing
- Persistent dry cough
Some nodules may affect thyroid hormone balance and lead to thyroid dysfunction. Especially toxic nodules can cause hyperthyroidism symptoms due to excess hormone production. Hyperthyroidism accelerates metabolism and may cause various symptoms.
Symptoms of hyperthyroidism include:
- Weight loss
- Rapid heartbeat
- Nervousness
- Intolerance to heat
More rarely, some nodules may cause hypothyroidism, reducing the body’s energy levels and resulting in issues such as fatigue and weight gain. Additionally, in cases of thyroid cancer, nodules can spread to lymph nodes, leading to prominent lumps in the neck. Given the diversity of thyroid nodules, imaging methods such as ultrasound and biopsy play an important role in the evaluation process.
How Are Thyroid Nodules Diagnosed?
The diagnosis of thyroid nodules is a multi-step process that uses different assessment methods at each stage. The first step is to take a detailed medical history and perform a physical examination. Factors such as previous radiation exposure, family history of thyroid cancer, or rapid growth of the nodule increase the risk of malignant tumors. Additionally, if the patient has symptoms such as difficulty swallowing or breathing, these findings guide the evaluation process.
Thyroid ultrasonography is the most important method for evaluating the size and characteristics of a nodule. Ultrasound examines the structural features of the nodule and identifies suspicious situations. For example, irregular borders, microcalcifications, or increased vascularity may suggest malignancy. This assessment is performed using classification systems such as the Thyroid Imaging Reporting and Data System (TI-RADS).
For nodules that appear suspicious, fine-needle aspiration (FNA) biopsy is performed. This biopsy method evaluates the cellular structure of the nodule and usually provides reliable results. The Bethesda system is used to determine if the nodule is malignant.
If biopsy results are unclear, molecular tests may be applied. These tests evaluate possible mutations in the genetic structure of the nodule. If a malignant mutation is found, surgical intervention is recommended.
How Are Thyroid Nodules Treated?
Different methods are preferred in the treatment of thyroid nodules depending on the patient’s symptoms and the structure of the nodule. Non-surgical options for the treatment of benign nodules are becoming increasingly important. Interventional radiology methods are especially preferred due to their minimally invasive nature and lower risk. These treatment methods aim to shrink the size of the nodule and often help preserve thyroid function.
Main treatment methods include:
- Radiofrequency ablation (RFA): High-frequency electrical currents are used to heat and shrink nodule tissue. It is a highly effective method for solid or semi-solid nodules.
- Microwave ablation (MWA): Uses microwaves to heat and destroy nodule tissue. It is generally preferred for larger nodules and may create a wider ablation area than RFA.
- Ethanol ablation (EA): Involves injecting ethanol into the nodule to destroy the tissue. It is used especially for cystic nodules and is cost-effective.
- Laser ablation (LA): Uses laser energy to thermally destroy nodule tissue. It is highly effective for small nodules.
What Are the Risk Factors for Thyroid Nodules?
Multiple risk factors play a role in the development of thyroid nodules, with both environmental and genetic effects contributing to this process. Especially certain conditions and exposures can increase the likelihood of developing thyroid nodules.
- Age and Gender: Thyroid nodules are usually more common in women and become more prevalent with age. Especially women over 40 are at greater risk than men.
- Radiation Exposure: Ionizing radiation treatments applied to the head and neck during childhood are a significant risk factor for the development of thyroid nodules.
- Iodine Intake: Both iodine deficiency and excessive iodine intake can trigger thyroid nodule development. Nodules are more common in regions with iodine deficiency, but high iodine intake can also increase risk.
- Genetic Predisposition: A family history of thyroid nodules or cancer increases an individual’s risk of developing nodules. Some genetic mutations also increase malignancy risk.
- Thyroid Diseases: Conditions such as Hashimoto’s thyroiditis, multinodular goiter, and hyperthyroidism are factors that increase the risk of thyroid nodules.
- Hormonal Changes: Hormonal changes seen in women, such as pregnancy or menopause, may also affect the development of thyroid nodules.
- Obesity and Metabolic Syndrome: Obesity, insulin resistance, and metabolic syndrome may cause thyroid nodules to occur more frequently.
When Can Thyroid Nodule Treatment Be Performed?
Treatment of thyroid nodules is planned based on certain clinical findings and the patient’s complaints. First, treatment is considered when thyroid nodules cause symptoms or cosmetic issues. These symptoms include difficulty swallowing, difficulty breathing, and noticeable swelling in the neck. Especially nodules larger than 2 cm or with a volume exceeding 20 mL can be treated with interventional radiology methods.
Additionally, autonomously functioning thyroid nodules that overproduce thyroid hormones and cause hyperthyroidism are a priority for treatment. These nodules can be treated with ablation methods as an alternative to surgery or radioactive iodine therapy. Ablation reduces hormone production and preserves thyroid function.
In some patients, recurrent thyroid nodules or small thyroid cancers may require treatment. In patients not suitable for surgery or those who wish to avoid surgery, ablation methods can be effective. These methods are preferred for cancer nodules that are not close to critical structures.
When Can’t Thyroid Nodule Treatment Be Performed?
Thyroid nodule treatment cannot be performed in some situations. These situations are important for patient safety and treatment effectiveness. First, the presence or suspicion of malignancy or confirmed thyroid cancer is an absolute contraindication. Treatment is usually only recommended for benign nodules. Treatment can also be risky for patients with coagulation disorders. Special precautions are required for such patients due to increased bleeding risk.
Additionally, infectious or inflammatory conditions are contraindications. Active infection or thyroiditis increases the risk of complications. Also, ablation should not be performed for nodules associated with critical structures. These structures include the trachea, esophagus, and major blood vessels. Finally, large or multifocal nodules are not considered suitable candidates for treatment.
Contraindications:
- Presence of malignancy (over 2 cm)
- Coagulation disorders
- Active infection or thyroiditis
- Nodules associated with critical structures
- Large or multifocal nodules
- Poor general health status
These situations should be considered during the treatment process. In this way, patient safety and treatment outcomes are optimized.
What Is the Recovery Process After Thyroid Nodule Treatment?
The recovery process after thyroid nodule treatment is generally rapid and offers advantages for patients. First, patients who undergo radiofrequency ablation (RFA) can often return to daily life within 24 hours. The minimally invasive nature of the procedure reduces discomfort. In addition, the absence of scarring after the procedure is a significant cosmetic advantage.
Another method, percutaneous ethanol injection (PEI), is similarly minimally invasive. Patients can also usually return to normal activities immediately after this procedure. However, mild pain or swelling may occur at the application site.
Procedures such as thyroid artery embolization, performed for larger nodules, may require an overnight hospital stay. Nevertheless, the recovery process is quite fast. These methods provide gradual improvement after treatment and alleviate patients’ symptoms.
In summary, interventional radiology techniques offer many advantages compared to traditional surgeries:
- There is a lower risk of complications.
- General anesthesia is not required.
- Recovery times are short.
- Less need for pain management.
For all these reasons, interventional radiology methods have started to be preferred in the treatment of benign thyroid nodules.
How Can Thyroid Nodules Be Prevented?
Preventing the formation of thyroid nodules is possible by adopting a healthy lifestyle. First, iodine intake should be adequate. Iodine deficiency can adversely affect thyroid health. Ensuring sufficient iodine intake reduces the risk of nodule development, but excessive iodine intake should also be avoided. Maintaining a healthy metabolic state is also very important. Obesity and insulin resistance may increase the frequency of thyroid nodules.
Therefore, regular physical activity is recommended. In addition, adopting healthy eating habits helps control blood sugar levels.
Avoiding exposure to radiation is another preventive strategy. Especially unnecessary radiation to the head and neck region can adversely affect thyroid health. Limiting the use of radiation-based imaging methods will be beneficial. Regular monitoring of hormonal balance is also very important. Especially TSH levels may affect nodule formation.
Finally, lifestyle factors should be taken into account. Smoking is associated with thyroid nodules. Therefore, quitting smoking is one of the preventive steps. These strategies are effective methods to prevent thyroid nodules.
Frequently Asked Questions
Is a thyroid nodule cancer?
Thyroid nodules are very common and occur in up to 68% of healthy individuals. However, the risk of these nodules being cancerous is generally low; it ranges from about 3.1% to 15%. This rate may vary depending on the features of the nodule and the patient’s demographic characteristics. About 90% to 95% of thyroid nodules are generally benign and harmless. Risk factors for cancer include exposure to ionizing radiation, rapid growth of the nodule, hoarseness, and a family history of thyroid cancer or cancer syndromes. Therefore, most thyroid nodules are not cancerous, but a small portion may be malignant; thus, proper evaluation and management are very important.
Can a thyroid nodule go away on its own?
Yes, some thyroid nodules may shrink on their own. Especially cystic or largely cystic nodules may be reabsorbed or dry up over time. In addition, some solid nodules may shrink due to reasons such as internal bleeding or venous thrombosis. In one study, 17% of papillary thyroid microcarcinomas were observed to shrink during active surveillance. However, significant spontaneous shrinkage is not very common; therefore, it is important to regularly monitor changes in nodules.
What happens if a throat nodule is not removed?
If a throat nodule is not treated, it can lead to permanent hoarseness, vocal fatigue, and long-term damage to the vocal cords. Untreated nodules may continue to grow and harden, which further worsens voice problems and makes future treatments more difficult. Therefore, early intervention is very important; thus, more serious problems are prevented, and voice function can return to normal.
Can a nodule be detected in a blood test?
Blood tests cannot directly detect nodules; however, they can provide information about the cancer risk of existing nodules. For example, the Nodify Lung® test uses blood-based protein tests to evaluate whether lung nodules are cancerous. Similarly, in thyroid assessments, blood tests measure thyroid function and autoantibodies to provide information about thyroid health, but these tests do not directly detect nodules.
Are thyroid and nodules the same thing?
A thyroid nodule is a specific mass in the thyroid gland and can be benign or malignant. So, the presence of a nodule indicates an abnormality, but it does not necessarily mean a thyroid disease. Some nodules may affect thyroid function, leading to problems such as hyperthyroidism or hypothyroidism, which are considered thyroid diseases. Thus, a thyroid nodule may be related to thyroid disease, but they are not the same thing.
What kind of discomfort can a thyroid nodule cause?
Thyroid nodules usually do not cause symptoms, but when they grow or affect thyroid function, they can lead to certain complaints. Enlarged nodules can be felt or seen as swelling in the lower part of the neck. This can cause difficulty swallowing, difficulty breathing, or a sensation of pressure in the throat. If a nodule produces excessive thyroid hormone (hyperthyroidism), this can cause unexplained weight loss, excessive sweating, tremors, nervousness, and rapid or irregular heartbeat. On the other hand, nodules that produce less hormone (hypothyroidism) can cause problems such as fatigue, weight gain, dry skin, and sensitivity to cold.
Do nodules in the throat cause weight gain?
Laryngeal nodules, especially those on the vocal cords, do not cause weight gain. These benign growths usually occur as a result of excessive or improper use of the voice and affect voice quality, causing symptoms such as hoarseness. However, thyroid nodules may affect weight. If a thyroid nodule causes hypothyroidism, meaning the thyroid gland does not function properly, this slows metabolism and leads to weight gain. So, nodules on the vocal cords do not affect weight, but thyroid nodules can cause such a condition.
What should people with thyroid nodules pay attention to?
People with thyroid nodules should have regular medical check-ups, ultrasound monitoring, and thyroid function tests. These are necessary to evaluate the condition of the nodules and monitor changes. Adequate iodine intake is also important because iodine deficiency or excess can affect thyroid health. It is also important to avoid unnecessary radiation exposure to the head and neck region. If symptoms such as difficulty swallowing, breathing problems, or voice changes appear, a doctor should be consulted immediately. Following these measures can help manage thyroid nodules.
Girişimsel Radyoloji ve Nöroradyoloji Uzmanı Prof. Dr. Özgür Kılıçkesmez, 1997 yılında Cerrahpaşa Tıp Fakültesi’nden mezun oldu. Uzmanlık eğitimini İstanbul Eğitim ve Araştırma Hastanesi’nde tamamladı. Londra’da girişimsel radyoloji ve onkoloji alanında eğitim aldı. İstanbul Çam ve Sakura Şehir Hastanesi’nde girişimsel radyoloji bölümünü kurdu ve 2020 yılında profesör oldu. Çok sayıda uluslararası ödül ve sertifikaya sahip olan Kılıçkesmez’in 150’den fazla bilimsel yayını bulunmakta ve 1500’den fazla atıf almıştır. Halen Medicana Ataköy Hastanesi’nde görev yapmaktadır.
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