Many people have masses in their thyroid gland known as nodules. Most thyroid nodules are benign. Nodules are more common in women than men and are usually discovered on the 4th and 5th decade of life. Some are noted during a routine physical exam, many are detected with a screening ultrasound.
Depending on the size of the lesion and whether or not it is associated with multiple nodules or is just a single nodule determines how much of an evaluation is needed. Most nodules do not affect the function of the thyroid gland. Some doctors will test thyroid hormone levels when a nodule is detected, while others will not.
Between 5 to 15% of solitary thyroid nodules are malignant. Because of this risk most nodules over 1 cm in size need to be biopsied to determine if they are malignant. Risk factors associated with a nodule being cancer include: a hard nodule, a painful nodule, a rapidly enlarging nodule, age over 50 years, known radiation exposure and a family history of thyroid cancer.
Detecting malignant thyroid nodules and determining the need for thyroid surgery
The most common way to detect if a nodule is malignant is with an ultrasound guided needle biopsy of the nodule. A skilled physician can anesthetize the neck over the nodule and with the direction of the ultrasound can guide a needle into the nodule and sample the cells.
The sampled tissue is then examined by a cytopathologist skilled in the evaluation of thyroid disease. Most times the pathologist can provide a diagnosis of what type of tumor is present. This includes if is benign or malignant, and if malignant what type of malignancy of the thyroid it is.
If there is diagnosis of malignancy then thyroid surgery is recommended for most patients. Thyroid surgery will entail removal of the entire thyroid gland and usually the associated lymph nodes that drain from the thyroid gland. Sometimes if the needle biopsy is equivocal then most thyroid surgeons will recommend just removing the half of the thyroid gland that the nodule is in. This is called a thyroid lobectomy.
Choose the right surgeon for your thyroid surgery
When choosing a thyroid surgeon a patient with a thyroid nodule should find a thyroid surgeon skilled in all types of surgery of the neck. A patient should want a thyroid surgeon who has performed thyroid surgery hundreds if not thousands of times. Most ear, nose, and throat (ENT) surgeons are skilled in all types of neck surgery, including thyroid surgery. Some ENT doctors are further trained in a subspecialty known as Head & Neck Surgery which is a 1 or 2 year fellowship level training after residency.