“Is it cancer?” Patients often ask this question when they find out they have a thyroid nodule. For many, thyroid nodules are discovered incidentally during routine physical examinations, imaging tests like CT scans, or neck ultrasounds for completely unrelated reasons. Patients are referred to otolaryngologists, or ear-nose-throat doctors, who answer the nerve-racking question with a simple “I do not know.” Further testing is required to definitively diagnose the symptoms.
Before we dive into this, you may be wondering what the thyroid is. The thyroid is a butterfly-shaped gland located in the front of the neck. As part of the endocrine system, the thyroid’s main function is to produce thyroid hormones, which help the body use energy, stay warm, and keep the organs working as they should. The term “thyroid nodule” refers to an abnormal growth of cells that form a lump within the thyroid gland. Although the vast majority of thyroid nodules are benign (noncancerous), a small proportion of thyroid nodules may be thyroid cancer.
Image Source: Science Photo Library – SCIEPRO
Once a nodule is discovered, your primary care doctor will try to determine the overall health and condition of your entire thyroid. Your physician will feel the thyroid to see whether the entire gland is enlarged and whether a single nodule is present or multiple nodules are present. Blood tests may be ordered to measure thyroid hormone (thyroxine, or T4) and thyroid-stimulating hormone (TSH) levels, indicators that can determine whether the thyroid is functioning normally.
Since it is usually not possible to determine whether a thyroid nodule is cancerous by physical examination and blood tests alone, thyroid nodules are evaluated using specialized tests such as fine needle biopsy done by an otolaryngologist. A fine needle biopsy may sound frightening, but the needle used is quite minute; furthermore, local anesthetic may not even be necessary. This simple procedure is often done in an outpatient setting, such as in an otolaryngology office. Patients typically return home or to work after the biopsy without even needing a bandage! For a fine needle biopsy, a very thin needle is used to withdraw cells from the thyroid nodule and plate them on slides. The cells are then examined under a microscope by a pathologist who will determine if the sample is benign, malignant, or non-diagnostic. For non-diagnostic findings, a repeat biopsy or nuclear medicine testing may be necessary.
In summary, the following are important points to remember:
- Thyroid nodules generally do not cause symptoms.
- Thyroid tests are most typically normal—even when cancer is present in a nodule.
- The best way to find a thyroid nodule is to make sure your doctor checks your neck!
Stay tuned for the next installment of ENT Weekly when we will go over thyroid cancer and its treatment.
Feature Image Source: Justin Chin
