Do You Need to Worry About Thyroid Nodules?

Thyroid nodules are very common. An otolaryngologist explains when to be concerned.

Your thyroid is a small, butterfly-shaped gland in the front of your neck. Its main job is to produce thyroid hormones, which help regulate your body’s metabolism and control your heart rate, body temperature, growth and development. A thyroid nodule is a small bump or growth that develops on this gland. Thyroid nodules can cause a range of symptoms — or none at all.

“Thyroid hormones are involved in nearly every body function,” says Liyang Tang, MD, an otolaryngologist with the USC Head and Neck Center, part of the USC Caruso Department of Otolaryngology – Head and Neck Surgery and Keck Medicine of USC. “It regulates metabolism, affects brain development and promotes cell growth both in terms of development and protein synthesis. You need thyroid hormones because without them, your body would slow down, you become fatigued and could eventually die.”

Because of the thyroid’s multiple responsibilities throughout the body, thyroid nodules can produce a wide range of symptoms. Some can cause cancer or problems due to their size or how they affect your thyroid’s hormone production; however, most nodules are benign, meaning they don’t cause symptoms and don’t usually need treatment.

“Thyroid nodules are common,” Dr. Tang says. “People become concerned about them, but if you were to scan everyone, a good majority of people would come back with some sort of little nodules that aren’t causing any harm.”

How to tell if you have a thyroid nodule

If a doctor finds any unusual bumps or characteristics during a physical examination of your neck and thyroid during your annual preventative checkup, they usually will do an ultrasound to detect nodules.

“The ultrasound basically tells us if there are any high-risk features of the nodule. If there are, then we will perform a biopsy to determine future treatment. But most of the time, these are not malignant/cancerous,” Dr. Tang says.

Are thyroid nodules cancerous?

Some thyroid nodules are cancerous, Dr. Tang explains. But that doesn’t necessarily mean you need to worry.

“People are always alarmed to hear the word ‘cancer,’ but papillary thyroid cancer is a very curable type of cancer,” she says.

There are four types of thyroid cancer:

1. Papillary: The most common type (about 80% of all cases) and the least aggressive. This type of cancer has a greater than 95% survival rate for patients after five years, Dr. Tang says.
2. Follicular: Makes up about 10%-15% of thyroid cancer cases.
3. Medullary: May be inherited and caused by a genetic mutation, making up about 2% of cases.
4. Anaplastic: Rarest and most aggressive form of thyroid cancer, making up about 2% of cases.

“With older patients who have papillary thyroid cancer, especially if the nodule is less than a centimeter, we offer surveillance of the cancer, where we don’t surgically remove the nodule. Instead, we just watch to see if it grows or not,” Dr. Tang says. “This can be beneficial for patients because then they don’t have to go through a surgery, and many times the cancer does not grow or spread.”

There are also many new treatments for thyroid cancer, Dr. Tang explains. While surgery is still the main treatment for thyroid nodules and cancers, new noninvasive therapies such as radiofrequency ablation are being offered at places such as Keck Medicine. Radiologists can treat thyroid nodules with radiofrequency by inserting a needle into a cell and using high-frequency radio waves to heat and destroy cells.

“Nowadays, patients are looking for alternatives to surgery. It’s exciting to work at Keck Medicine because we do offer new therapies such as radiofrequency ablation, and we can create a treatment plan that’s individualized to your thyroid nodule to help you feel good about your treatment plan,” Dr. Tang says. “But most of the time with thyroid nodules, there’s nothing to worry about.”

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