What to do about thyroid lumps (nodules)

An unexplained lump anywhere on the body can be a source of worry. In the case of thyroid lumps, it’s quite common to have them. However, thyroid lumps aren’t always benign, so it’s vital to get them checked to rule out more serious, potentially cancerous, causes.

Learn about thyroid lumps, symptoms and treatment from Mr Jonathan Hughes, a specialist in the diagnosis and treatment of thyroid lumps.

What is a thyroid lump (nodule)?

Your thyroid is a hormone-producing gland at the centre of the bottom half of the neck; on either side of the windpipe. It’s very common to get nodules in the thyroid gland and, thankfully, only a small proportion of these are cancerous. However, if you’ve got a new lump in your thyroid gland that hasn’t been checked before or has changed, it needs urgent attention to rule out the small possibility of cancer.

Are there types?

Solitary thyroid lumps are the most worrying, as they are the most likely to be cancerous. Multinodular goitre is when there are lots of nodules in the thyroid gland. These are most commonly completely benign. Benign nodules don’t become cancerous, but if there’s a change or you see a new lump, that needs to be evaluated urgently.

What are the symptoms?

Thyroid lumps are generally painless. In some cases, a large thyroid lump or multiple lumps can affect the ability to swallow (dysphagia) and the ability to breathe. This is because of the thyroid gland’s proximity to the windpipe and oesophagus.

A change in voice is a more worrying symptom, and might suggest a cancerous thyroid lump has infiltrated into the nerve that moves the vocal cords.

Furthermore, thyroid cancer can spread to the lymph glands in the neck, causing lumps away from the thyroid gland at the side of the neck.

How is it treated?

All thyroid lumps need investigating.

The essential tests are a blood test to look at the levels of hormones that stimulate and are produced by the thyroid gland; so-called thyroid function tests.

Another key investigation is an ultrasound scan of the thyroid gland and the surrounding lymph glands. An experienced specialist radiologist is able to determine which thyroid lumps are benign or cancerous.

Often, the radiologists perform a needle test at the same time as the scan and sample some of the cells from the lump; these cells are then analysed to give more information about the likelihood that the lump is malignant.

In many situations of benign thyroid lumps, patients can be reassured by a specialist that a lump is benign, no further action is needed, and it can be left alone, particularly if it’s not causing symptoms.

If a lump is causing breathing and swallowing problems, then the entire thyroid or half of it could be removed with an operation.

There are two surgical approaches to the removal of the thyroid gland:

• A hemithyroidectomy is the removal of half the thyroid
• A total thyroidectomy is the removal of the entire thyroid

While this can seem worrying, it’s possible to live normally after the removal of the thyroid gland. If the whole gland is removed, patients will need to take thyroxine (the hormone produced by the thyroid) in the long-term. If half the gland is removed, it’s unlikely that replacement therapy is needed.

If the specialist isn’t completely sure if a thyroid lump is benign, often the recommendation is for a diagnostic hemithyroidectomy surgery, where half the thyroid is removed and analysed. If part of the gland is cancerous, the other half might also need to be removed.

Diagnosed thyroid cancers most often require surgical removal of the whole thyroid gland. If the surrounding lymph glands are involved, these will also need removing with a neck dissection operation.

All cancers are discussed in Multi-Disciplinary Team (MDT) meetings, with specialist surgeons, oncologists, pathologist, radiologists, and support nurses. Careful assessment of the benefits of an extra radiation treatment is made. If this is required, it is delivered in a single tablet but it does need you to stay in the hospital for three days.

Can lumps come back after treatment?

Yes, thyroid cancer can come back, and patients are monitored very carefully after completing treatment with scans and blood tests.

Click here to begin looking after your health with Mr Hughes, a leading specialist with a wealth of experience in all aspects of ear, nose and throat conditions.