Thyroid Nodules

Thyroid nodules — small lumps on the thyroid gland at the base of the neck — are very common and usually don’t cause symptoms or require treatment.

However, if you do need treatment, you’ll find the full range of options at Rush. In addition to offering standard therapies like medication and surgery, we’re the first in Chicago to use radiofrequency ablation to shrink problematic thyroid nodules.

Symptoms of Thyroid Nodules

Most thyroid nodules cause no symptoms, but a small percentage may be cause for concern. Some nodules may become big enough to create discomfort or difficulty when you breathe or swallow. Some may produce too much thyroid hormone, leading to hyperthyroidism. About 5% are cancerous; fortunately, most cases of thyroid cancer can be cured.

Symptoms include the following:

• A lump you can feel under the skin of your neck, just above your collar bones
• Dysphagia (difficulty swallowing)
• Pain or swelling in your neck
• Voice changes, including discomfort or difficulty when speaking

Diagnosis and Treatment of Thyroid Nodules at Rush

If you have any of these symptoms that don’t go away after a few days, see your primary care provider. If your provider thinks you may have a thyroid nodule, you may be referred to an endocrinologist, otolaryngologist or endocrine surgeon for further testing.

If you have a thyroid nodule, your endocrinologist will want to make sure it’s not cancerous. To determine whether it's benign (noncancerous) or malignant (cancerous), you may need one or more of the following tests:

• Test of thyroid-stimulating hormone: This blood test measures the level of thyroid-stimulating hormone (TSH) in your blood. If you have a high level, your body may not be producing enough thyroid hormone (hypothyroidism) because of Hashimoto’s disease or another condition. If you have low levels of TSH, your body may be producing too much thyroid hormone (hyperthyroidism) and you may need a thyroid scan.
• Thyroid scan: If you have a low level of TSH, your doctor will likely perform a thyroid scan before performing a fine-needle aspiration biopsy. You will be given a small dose of radioactive iodine via a pill or injection. If the nodule absorbs the substance, it is a “hot” nodule that is not cancerous but produces too much thyroid hormone. If it does not absorb the substance, it is a “cold” nodule and has a 5% chance of being cancerous.
• Fine-needle aspiration biopsy: In this procedure, which typically takes less than five minutes, your doctor uses a hollow needle to extract a small amount of tissue from the nodule. A pathologist then examines the tissue under a microscope to determine whether it is cancerous. In the vast majority of cases, it is not cancerous. Rush providers are often able to provide an in-office ultrasound and biopsy as soon as your first appointment.
• Molecular genetic testing: Some thyroid nodules have features that look “indeterminate” (borderline for cancer) under a standard microscope. In these cases, Rush providers offer innovative molecular biopsies that help determine which nodules are cancerous. This helps our patients avoid potentially unnecessary surgery.
• Ultrasound exam: If your level of TSH is normal or high, your provider may recommend an ultrasound to create a picture of the inside of your body. This helps pinpoint the precise location of the nodule and allows the doctor to see other characteristics – such as size, shape and whether it is filled with fluid or solid tissue – that may help with a diagnosis.

If your nodule is benign, your doctor may recommend one or more of the following options:

• Watchful waiting: If your benign nodule is not causing pain or discomfort — and you don’t have compressive symptoms such as trouble swallowing, throat pressure, trouble breathing or voice changes — you may not need any treatment. Your doctor may recommend periodic exams to make sure it is not growing or interfering with your thyroid function.
• Medications: If your nodule is producing too much thyroid hormone, you may need medication for hyperthyroidism, such as radioactive iodine and antithyroid medication. If your nodule is caused by hypothyroidism, you will be treated for this condition.
• Radiofrequency ablation: This minimally invasive procedure shrinks thyroid nodules that are large enough to cause symptoms. A tiny needle inserted into the nodule delivers waves of heat energy. This heat destroys the tissue that makes up the nodule.
• Surgery: Most people do not need surgery for benign thyroid nodules, but your doctor may recommend this option if your nodule is large enough to cause discomfort or difficulty in breathing or swallowing or if it causes hyperthyroidism that does not respond to medication.

If thyroid cancer is diagnosed, you can receive treatment from our dedicated thyroid cancer team at Rush.
 

Rush Excellence in Thyroid Nodule Care

• Nationally recognized thyroid experts: Rush endocrinologists helped write the American Thyroid Association guidelines for the care of hypothyroidism. Also, U.S. News & World Report ranked Rush University Medical Center among the best in the nation for endocrinology and otolaryngology.
• A safe, effective alternative to surgery: Because Rush offers thyroid radiofrequency ablation, you now have a less invasive treatment option for large or overactive thyroid nodules. Instead of removing problem nodules, your provider uses heat to damage (and shrink) the tissue inside. This means you can avoid anesthesia, an overnight hospital stay and a visible surgical scar. In most cases, thyroid radiofrequency ablation takes 30-60 minutes; afterward, you can immediately resume your normal activities.
• In-office diagnostics: Rush endocrinologists and endocrine surgeons offer in-office diagnostic testing, minimizing the need to travel between offices during your visit.
• Ultrasounds during surgery: Rush surgeons perform ultrasounds during thyroid nodule surgery to visualize the thyroid. The high-resolution images help guide the procedure, which can lead to better outcomes for patients.
• Experienced thyroid surgeons: Rush surgeons who perform thyroid surgery are considered high-volume experts, meaning they perform many procedures every year. Research has shown that choosing a high-volume surgeon leads to better surgical outcomes. Our surgeons use advanced surgical technology, including intraoperative nerve monitoring, to make surgery as safe as possible.