By Tomer Davidov, M.D.
Thyroid nodules, or abnormal growths on the thyroid gland, are a common condition, especially among older adults and women.
While most nodules are benign, it is important to have them evaluated, as about 10% are cancerous, according to the American Cancer Society. Most patients with thyroid nodules and thyroid cancer have no symptoms and have normal thyroid function.
When detected early, thyroid cancer can usually be successfully treated with surgery to remove the gland and any affected lymph nodes.
Women at Greater Risk
The thyroid gland is a butterfly-shaped gland in the front part of the neck below the Adam’s apple. The gland creates hormones that regulate body metabolism. A thyroid nodule is characterized by an abnormal growth of thyroid cells that forms a lump within the thyroid gland.
By age 60, about one-half of all people have a thyroid nodule, according to the American Thyroid Association. The vast majority of thyroid nodules are benign and do not cause cancer.
The American Cancer Society reports that thyroid cancer has increased in the United States, tripling in the past three decades, with 52,070 new cases of thyroid cancer diagnosed in the United States this year and more than 2,000 cancer-related deaths. Most of the increase is attributed to the increased use of thyroid ultrasound, which can detect small thyroid nodules that might not have otherwise been found in the past.
For reasons that are unknown, nearly three out of four cases of thyroid cancer are found in women, and though the disease can occur at any age the risk peaks earlier for women than men. Women are most often in their 40s or 50s when diagnosed while men are usually in their 60s or 70s.
Other risk factors include a family history of thyroid cancer and radiation exposure to the head and neck.
See Your Doctor
If you feel lumps in your neck or have thyroid nodules incidentally found on a CT scan or MRI performed for other health problems, you should see your doctor who can schedule a neck ultrasound and thyroid nodule biopsy.
Thyroid nodules are evaluated using a needle biopsy with ultrasound guidance to ensure the nodule is accurately located.
When the thyroid gland is enlarged, but is benign on biopsy it is called a goiter. Most patients do not need surgery for a goiter unless it causes compression symptoms such as neck pain, neck pressure, choking, or difficulty swallowing. If a thyroid nodule biopsy is suspicious for cancer, surgery is usually required.
In its early stages, thyroid cancer may not cause any symptoms. However, as the disease advances it may cause symptoms such as a palpable lump in the neck, neck pressure, enlarged lymph nodes in the neck, or a hoarse voice.
Thyroidectomy, which is the surgical removal of either part or all of the thyroid gland, is the most common surgery for thyroid cancer. Surgery is performed through a small incision about two inches long across the front of the neck. The procedure typically takes about two hours, and most patients can return home from the hospital within a day. Though thyroid surgery is safe and effective, potential complications can include:
- Damage to the delicate nerves controlling the vocal cords, causing temporary or permanent hoarseness or weak voice.
- Damage to the parathyroid gland, which can cause calcium levels to fall, resulting in numbness, tingling or muscle spasm.
- Bleeding and infection.
At Penn Medicine Princeton Medical Center, patients with thyroid cancer have access to comprehensive care provided by a multidisciplinary team that includes an experienced endocrine surgeon, multiple endocrinologists, a pathologist that specializes in thyroid pathology, radiologists and medical oncologists. The team meets regularly to discuss patient cases to ensure each patient’s treatment is tailored in a way that leads to the best possible outcome.
Surgeons at PMC routinely offer specialized nerve monitoring in the operating room to closely follow and preserve the delicate nerves that control voice function.
In many cases, thyroid cancer can be cured through surgery alone. In some instances though, radioactive iodine therapy may be recommended to destroy any cancer cells not removed during surgery.
Patients who have had most or all of thyroid gland removed will also need to take a daily thyroid hormone replacement pill.
Discovering a thyroid nodule can be unnerving, but it is important to remember that most are benign. However, a thorough evaluation is necessary to rule out cancer or identify it early when it can be effectively treated.
To find a physician affiliated with Princeton Health, call 888.742.7496 or visit www.princetonhcs.org.
Tomer Davidov, M.D., F.A.C.S., specializes in general and endocrine surgery and is a member of the Penn Medicine Princeton Health medical staff.