How common are
nodules in the thyroid?
It is estimated that about 50% of the population will develop a small, unnoticeable thyroid nodule at some time in their life, making them very common.
Most nodules are never detected and do not cause problems. In fact, they are only found by doing an ultrasound, a CT scan, or MRI for other reasons. This is called a thyroid nodule incidentaloma.
Only 4-7% of the population will have a nodule that is large enough to be found by a physician feeling for it. They are more common in women and the incidence of nodules increases with age.
About 4% of women aged 20 years have a palpable nodule whereas 9% of women over age 70 have a palpable nodule. Nodules are only found in about 1% of men.
How do I tell
if I have a nodule?
You can check your own thyroid by standing in front of a mirror. Look at the area of your neck just above the notch where the collarbone comes together and just below the Adam’s apple. This is where the thyroid gland is located.
If possible, have a light shine from the side to throw a shadow over the area. Then tilt your head back slightly and watch this area for any shadows while you swallow.
If you see any prominence or enlargement in this area, you may have a thyroid nodule or an enlarged thyroid gland (goiter). See your physician for a more complete evaluation, as this does not mean that you do or do not have a nodule, but it can be an indicator.
You should also have your thyroid gland area examined during a general physical examination by a medical care provider.
Certain forms of radiation have been associated with increased risk of cancerous nodules in the thyroid. The risk is small and you have to be exposed to very high amounts of radiation.
For example, radiation at Hiroshima, Chernobyl, and nuclear weapons testing sites in the United States in the 1940s to 1970s have all been associated with increased risk of thyroid nodules and cancer.
Regular X-rays, dental X-rays, and sun exposure are not known risk factors. However, if you had radiation treatments to your head, neck, tonsils, or thymus, you may be at a slightly increased risk of thyroid cancer. If you are concerned that you had exposure, see your doctor for an evaluation to determine whether you have thyroid nodules.
A detailed list of the
causes of thyroid nodules
Follicular Adenoma,Hurthle cell adenoma,
Thyroglossal duct cyst, Subacute viral thyroiditis,
Sporadic C cell hyperplasia
Hurthle cell, Anaplastic, C cell origin, Medullary Carcinoma,
Lymphoma, Metastatic to the thyroid, Kidney, Breast,
parathyroid adenoma, lymph node, Branchial cleft cyst,
Other epithelial cysts
Risk Factors for any given
nodule to harbor cancer
Familial polyposis,Cowden’s and MEA 2
Simple Goiter: Not so Simple if you’re not treated
Large biopsy proven Benign Nodular Simple Goiter ( Not due to Hashimotos, and with normal TSH,T4,T3, and negative thyroid antibodies ) is causing local symptoms, and is a cosmetic problem as well. Prior to interventional procedures( ethanol PEI, and radiofrequency RFA ablation done by clinical thyroidologists surgery was the only solution.
Simple Goiter is a common thyroid disorder that because the thyroid blood tests for TSH and T4 are normal, the physician does not consider referring to a thyroid specialist for evaluation for therapy until things start to go wrong. When the thyroid goiter enlarges and causes symptoms they rush you off the the surgeon to have it removed. When the goiter starts to grow nodules they send you to a radiologist for a biopsy. Even if the biopsy is benign there is still a strong possibility you will see a surgeon who will tell you it is better to remove it. If the goiter causes rapid growth with or without pain and the ultrasound shows a cyst, your physician will again send you to the surgeon. After years of following your goiter without therapy it now becomes a cosmetic problem for you, he sends you to the surgeon. As you can see an untreated goiter that has not been evaluated and treated with non-invasive methods available to a clinical thyroidologist will usually end up under the surgeon’s knife.
Alternative to eventual surgery for simple goiters
TG was first used to follow thyroid cancer patients, but all thyroid cells make it so it is a cancer marker after thyroidectomy only. Normal thyroid glands and goiters make TG. The larger the goiter the higher the TG.
Well your simple goiter is not so simple after all. That is why you must request a referral to a non-surgeon endocrine thyroidologist, sonologist who is certified in endocrine neck ultrasound ECNU by American College of Endocrinology. Check thyroid.org for one near you, or visit me for a overnight complete evaluation to see if you are a candidate for any of these therapy options instead of waiting for the eventual referral by your physician to have your goiter removed.
If you have a thyroid nodule, you should have it evaluated by a physician trained in the diagnosis and management of thyroid nodules. Endocrinologists and clinical thyroidologists are the right specialists to see for nodule evaluation.
At Thyroid Center of Santa Monica, Richard Guttler, MD will take a careful history for risk factors for thyroid disease (including radiation exposure), do a physical examination, and order blood tests to check the activity of the gland. Some of the ways we can treat thyroid nodules using interventional thyroidology include nuclear medicine, ultrasound-guided PEI, and radioactive iodine.
Dr.Guttler’s Patient Alert to Epidemic of small harmless thyroid cancers that should not be biopsied
New patients with small thyroid nodules read this before you allow a thyroid biopsy to be done
This is a wake up call for all patients who have small thyroid nodules!
Dr.Guttler’s Thyroid Patient Blog Post: Long-Term Efficacy of a Single Session of RFA for Benign Thyroid Nodules:
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DR.Guttler’s Patient Thyroid Blog Post #12 Patient satisfaction and quality of life in hypothyroidism:
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Dr.Guttler’s Patient Blog Post# 5 Do You Know Your Family is At Risk Because You Have Hypothyroid Hashimoto’s Thyroiditis?
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DR.Guttler’s Patients #4 blogpost: Don’t Let The Surgeon’s Use of the Word “CANCER” Scare You into Surgery When Surgery is Unnecessary.
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