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Struma nodosa
Thyroid nodules are common and almost always benign — what matters is the one-time assessment.
Also known as: goiter · thyroid nodule
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Thyroid nodules are decidedly common — ultrasound finds them in a large share of adults, and the proportion rises with age. The great majority are benign and stay that way. They still cause regular alarm, because the word nodule sounds different from what it usually is: a district built a little differently from the neighbouring tissue, often filled with fluid. Placing them takes two separate questions. The first is function: is the gland working normally, too little or too much? TSH answers that, and it decides whether the nodule makes hormone at all. The second is texture: how does the nodule look on ultrasound, how big is it, is it growing? From those two answers follows whether it is only watched, whether a fine-needle sample makes sense, or whether more is needed. Size alone says little; a large soft nodule can be more harmless than a small one with a suspicious pattern. A goitre without nodules is in turn usually the answer to years of scarce iodine. And one thing almost always holds: watching is an active decision, not a fallback.
A low TSH points to a producing nodule, and such nodules are almost never malignant. The order therefore saves examinations that would otherwise follow.
Ultrasound judges edges, internal structure, calcifications and shape. Whether a sample makes sense follows from that — not from the diameter alone.
For unremarkable nodules a planned follow-up is the approach with the best balance of benefit and harm. Every further examination also finds more that would never have caused trouble.
It picks up a rare, different form and is not measured routinely for every nodule. With a family history or before an operation it makes sense.
The four parathyroid glands lie right against the thyroid. Tingling around the mouth and in the fingertips after the procedure belongs reported at once.
For a goitre from iodine shortage a normal supply makes sense. With autonomous nodules a sudden large amount of iodine can instead trigger overactivity — so no self-experiments with seaweed or iodine cures.
Levothyroxine barely shrinks a nodule and can, given long term, burden bone and heart — it was long usual and is today no longer regarded as standard. Iodine helps only if iodine shortage is the cause. Radioiodine shrinks a hot nodule by about half over three to six months. Radiofrequency ablation is a newer route for benign nodules. A cold nodule is sampled, not treated — the first question is what it is.
In about one in two adults, ultrasound finds nodules; the great majority are benign, and about one in twenty sampled nodules is malignant. Sampling is done from about a centimetre, and below that with a suspicious appearance. A hot nodule is practically never malignant. The thyroid grows over years with iodine shortage; a goitre partly recedes on iodine in young people, and hardly at all in older people with nodular change.
It moves up with swallowing — which separates thyroid tissue from a lymph node. It is usually found by chance, while shaving or at another examination.
Most nodules do nothing. Their discovery is therefore often an incidental finding and no reason to hurry.
With larger glands. Shortness of breath lying down or with the arms raised is the sign that this is no longer only cosmetic.
Palpitations, restlessness, weight loss — one district keeps producing on its own account. It develops slowly and is often put down to age.
New, persistent hoarseness without a cold needs examining, because the nerve to the vocal cords runs close to the gland.
This combination, especially together with enlarged neck lymph nodes, is the reason not to wait for the next check. It is rare — and that is exactly why it is worth knowing.
The first step with any nodule: a low TSH speaks for a nodule that makes hormone itself — it is clarified by a scan and is practically never malignant.
Shows together with the TSH whether the thyroid delivers too much or too little overall. The size of the nodule says nothing about that.
A special value for a rare form of thyroid cancer. It is not measured with every nodule, but with a family history and before an operation.
A goitre classically arises from iodine deficiency — now rare in Switzerland thanks to iodised salt. With existing hot nodules, however, a lot of iodine can trigger overactivity. Hence: assessment first, iodine after.