Evaluation of a Thyroid Nodule
Medically reviewed by Dr. C.H. Weaver M.D. 4/2022
According to the American Cancer Society there will be about 65,000 individuals diagnosed with thyroid cancer this year and women will make up approximately three times as many of these cases as men (about 49,000 cases in women versus about 15,000 in men). 1
The process generally starts when a small abnormal growth on the thyroid gland. This growth is called a nodule, and it’s often the first noticeable sign of thyroid cancer.
The thyroid gland is located in the front of the neck and is attached to the lower part of the voice box (larynx) and to the upper part of the windpipe (trachea). It has two sides, or lobes, that are connected by a narrow neck. The thyroid gland produces thyroid hormones, which regulate metabolism, growth, and development and are essential for life.
Most of these thyroid nodules are not cancerous, but to be safe, your doctor will recommend testing to check for cancer. The American Thyroid Association (ATA) publishes guidelines for evaluating nodules and the key points are summarized below. 2
Room for Improvement in Evaluating Thyroid Nodules
In the past, testing nodules for cancer could be tricky due to a risk that a growth would not test clearly positive or negative (malignant or benign). When results weren’t obvious, doctors would often recommend that nodules were tested with a needle biopsy each year to check for thyroid cancer. This ongoing screening would cost the patient money, as well as ongoing worry about having cancer.
This process of checking nodules for cancer could get even more troublesome when needle biopsy results continued to give an unclear result. Many of these patients went on to have their thyroid partially or completely removed (thyroidectomy) to make a final diagnosis. In addition to the cost and impact of surgery, these patients were left without a thyroid or an incomplete thyroid and would often have to take thyroid medication for the rest of their lives. Most of these patients did not have thyroid cancer, so surgery—and lifelong hormone therapy—wasn’t necessary.
Today’s More Accurate Testing
These days, however, the outlook for patients with thyroid nodules is much improved. Thanks to significant advances in how doctors evaluate nodules and the technology they use, we have a better—and earlier—understanding of what types of nodules are likely to be cancerous and what types are not. As a result, more patients without cancer, or without cancer likely to grow and cause problems, can avoid surgery and therapy.
For example, doctors now understand that the most common type of thyroid cancer (papillary) tends to not be very dangerous when it hasn’t spread to the lymph nodes. This means that these patients can often safely avoid aggressive treatment. Doctors try to only use aggressive treatment in patients most likely to benefit (those with more aggressive disease).
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Advances in technology are also helping doctors find the most appropriate treatment for thyroid nodules. Specialists in reading biopsy samples for thyroid disorders specifically (thyroid-specialist cytopathologists) are able to more accurately find cancer or rule it out. And when these specialists can’t make a clear diagnosis, there are now two types of additional tests: one to confirm the presence of cancer, and another to confirm that there are no signs of cancer. The test to confirm thyroid cancer will also help doctors determine the extent of surgery needed (partial or complete thryroidectomy), while the test to confirm that there is no cancer will help them avoid unnecessary surgery.
What This Means if You Have a Thyroid Nodule
For patients with thyroid nodules, these advances have the potential to significantly improve care. Namely, patients with inconclusive early testing can have more confidence in avoiding surgery and lifelong thyroid therapy when it’s likely unnecessary.
Thyroid Nodule Ultrasound
When a thyroid nodule has been detected the cause of the nodule must be determined. The majority of thyroid nodules are benign, so the focus is on determining which ones are cancer.
Ultrasound uses sound waves to image the thyroid by passing a small hand-held transducer over the thyroid. The test is quick, accurate, painless, and completely safe, and the results are available immediately. Not all nodules need this test, but it is almost routine.
This test can help determine if the nodule has characteristics of a cancerous nodule and should require further evaluation. Ultrasound alone cannot make the diagnosis of cancer.
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Fine Needle Biopsy of Thyroid Nodules
The only way to determine if a nodule is cancerous is to perform a biopsy. Doctors can stick a very thin needle into a nodule and remove cells for microscopic examination. This is called a fine needle aspiration biopsy (FNA). Fine needle biopsy is a safe, effective, and easy way to determine if a nodule is cancerous. The needle is placed into the nodule several times and cells are aspirated into a syringe. The cells are examined by a pathologist and the nodule is then classified as non-diagnostic, benign, suspicious, or malignant.
References:
- Thyroid Cancer Overview. The American Cancer Society. Available at: Accessed March 15, 2015.
- Kloos, RT. Providing Optimal Care for Patients With Thyroid Nodules. Endocrinology Advisor. Available at . Accessed March 15, 2015.
