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Thyroid Lump


Presentation

  • Presentation Symptoms Thyroid lumps are often asymptomatic and are noticed by family members or seen in the mirror. They may sometimes cause pain and rarely present with features of compression of the trachea. Ask about previous radiation.[patient.info]
  • Immediate FNA cytology assessment by a pathologist, who is present in the clinic and studies the tissue under a microscope to make a diagnosis. A biopsy is the only sure way to tell whether a person has cancer.[ahns.co.nz]
  • Frequently the lumps are not single but multiple and part of an innocent, non-cancerous condition called multinodular goitre, which just means that several swellings are present.[familydoctor.co.nz]
  • Clinical features Patients may present having become aware of a lump in the neck – thyroid nodules will be felt quite low down in the anterior neck, and will rise on swallowing.[entsho.com]
  • If the surgery confirms that no cancer is present, no additional surgery to “complete” the thyroidectomy is necessary.[thyroid.org]
Cervical Lymphadenopathy
  • Palpable cervical lymphadenopathy. Other potential red flags: [ 1, 10 ] Family history of thyroid cancer or endocrine tumour. History of previous irradiation or exposure to high environmental radiation.[patient.info]
  • lymphadenopathy, and hoarseness due to recurrent laryngeal nerve paralysis.[merckmanuals.com]
  • lymphadenopathy Needle aspiration biopsy is the most accurate method of investigation.[bmj.com]
  • lymphadenopathy. 2 Nodules also should be biopsied if the patient has a history of head and neck irradiation, thyroid cancer, or MEN type 2 in a first-degree relative. 2 Hyperfunctioning nodules do not need to be biopsied. 2 Larger nodules may be biopsied[aafp.org]
Goiter
  • Multinodular Goiter A multi-nodular goiter is an enlarged thyroid gland with a goiter comprised of multiple thyroid nodules.[endocrine.surgery.ucsf.edu]
  • A goiter can be smooth and uniformly enlarged, called diffuse goiter, or it can be caused by one or more nodules within the gland, called nodular goiter. Nodules may be solid, filled with fluid, or partly fluid and partly solid.[ucsfhealth.org]
  • Singer – Board Certified Otolaryngologist Thyroid & Parathyroid Conditions css id: Goiter Goiter refers to an enlarged thyroid gland. A goiter can develop in one or both sides of the thyroid gland.[entnet.org]
  • There is no clear distinction between a multinodular thyroid and a multinodular goiter, but the term goiter implies that the thyroid gland is enlarged.[massgeneral.org]
Thyroid Lump
  • Most thyroid nodules are benign, but some may produce excess thyroid hormone and other thyroid lumps may be cancerous.[thyroid.com.au]
  • Sudden onset of pain within a thyroid lump. (Likely cause is a bleed into a thyroid cyst.) Differential diagnosis [ 10 ] Thyroid lumps and swellings Non-toxic (simple) goitre - non-functioning nodules. TFTs are normal.[patient.info]
  • In other cases, increased exercise and acupuncture have helped with thyroid lumps, but results have not been proven for all patients. It is best to consult your physician first before starting any program to reduce thyroid lumps.[healthyliving.azcentral.com]
  • Red flags Thyroid lumps (nodules) may occasionally represent a primary thyroid malignancy, although most are benign. Very large thyroid lumps may rarely lead to tracheal compression and airway symptoms.[entsho.com]
  • Diagnosis If you have been referred for diagnosis of a thyroid lump, after an initial examination by a specialist, you may be assessed by one or more of the following methods. 1.[familydoctor.co.nz]
Falling
  • Between 1,000 and 1,500 fine-needle aspirations are performed on thyroid nodules at NUH each year, and about 6 per cent fall into this "indeterminate" category.[straitstimes.com]
  • Malignant thyroid tumours are mostly adeno carcinomas , most of which fall into four categories: Papillary carcinoma (65%): the most common thyroid malignancy. Has an excellent prognosis if diagnosed early, especially in young females.[entsho.com]
  • If these are injured the calcium levels in your blood can fall. Calcium is important for nerve and muscle function and you may need to take calcium tablets if this happens.[familydoctor.co.nz]
  • While most thyroid nodules do not fall into this category, it is an important determination to make for all thyroid nodules. Please see the section on Hyperthyroidism and Graves Disease for more information about overactive thyroid nodules.[montefiore.org]
  • One in five biopsies fall into this group, in which adequate tissue has been obtained, but the features of the cells seen just are not characteristic enough of a benign or malignant nodule to be sure.[endocrine.surgery.ucsf.edu]
Lymphadenopathy
  • Check for regional lymphadenopathy.[patient.info]
  • […] or irregular outline and microcalcification papillary carcinoma solid hypoechoic with a lobulated or irregular outline and globular calcification medullary carcinoma intranodular vascularity taller than wide axially (AP ML) characteristic associated lymphadenopathy[radiopaedia.org]
  • […] solitary nodule Dysphagia Dysphonia Increasing size (particularly rapid growth or growth while receiving thyroid suppression treatment) Signs that suggest thyroid cancer include stony, hard consistency or fixation to surrounding structures, cervical lymphadenopathy[merckmanuals.com]
  • 5% are malignant The risk of malignancy is similar for solitary nodules and multinodular goitres Urgent referral to secondary care is necessary only if the nodule is growing rapidly (over few weeks) or associated with stridor, hoarseness, or cervical lymphadenopathy[bmj.com]
  • 25] Surgery [ edit ] Surgery ( thyroidectomy ) may be indicated in the following instances: Reaccumulation of the nodule despite 3–4 repeated FNACs Size in excess of 4 cm in some cases Compressive symptoms Signs of malignancy (vocal cord dysfunction, lymphadenopathy[en.wikipedia.org]
Euthyroid
  • However a majority of patients will be euthyroid. Differential diagnosis Most thyroid nodules are adenomas . These are benign, and are extremely common, especially with advancing age.[entsho.com]
  • The evaluation of thyroid nodules in euthyroid and hypothyroid pregnant women is the same as in other adults. Thyroid nodules are uncommon in children, but the malignancy rate is much higher than in adults.[aafp.org]
  • The vast majority of patients will have normal thyroid function (euthyroid). Ultrasound The next diagnostic study performed is ultrasonography.[ent.uci.edu]
  • Precise control of how many proteins are made from these genetic blueprints maintains the normal or euthyroid thyroid state.[endocrine.surgery.ucsf.edu]
Cough
  • Rarely, a large lump may cause cough, shortness of breath or stridor due to compression of the underlying trachea. In some cases of malignancy, direct involvement of the recurrent laryngeal nerve may cause hoarseness.[entsho.com]
  • This can result in shortness of breath, voice change, cough, increased pressure sensation in the neck and sometimes difficulty swallowing. Surgery to remove the thyroid gland is usually necessary to treat large goitres that are causing symptoms.[familydoctor.co.nz]
  • Surgery to remove an enlarged thyroid can relieve compression of nearby structures and improve symptoms in patients with related difficulty swallowing, cough, or shortness of breath.[endocrine.surgery.ucsf.edu]
  • You have a new cough that does not improve. You begin choking or have new or increased trouble swallowing. Your voice becomes hoarse. You are losing weight without trying. You have questions or concerns about your condition or care.[drugs.com]
  • Other symptoms that may appear are: Pain in the neck, sometimes reaching the ears Difficulty swallowing Trouble breathing or wheezing Persistent cough Diagnosis will also vary depending on the condition.[northshore.org]
Stridor
  • Rarely, a large lump may cause cough, shortness of breath or stridor due to compression of the underlying trachea. In some cases of malignancy, direct involvement of the recurrent laryngeal nerve may cause hoarseness.[entsho.com]
  • Side view of a goitre A goitre A multinodular goitre A large multinodular goitre Red flag features [ 9 ] Prompting same day referral Stridor associated with a thyroid mass Prompting urgent (two-week rule) referral Child with a thyroid nodule.[patient.info]
  • […] disease if the thyroid lump is associated with voice change,rapid enlargement, cervical lymphanopathy or persistent pain The UK guidelines expect such a patient to be seen by a specialist within two weeks of seeing their primary physcian.Any patient with stridor[endocrinesurgeon.co.uk]
  • […] nodules are common, but only about 5% are malignant The risk of malignancy is similar for solitary nodules and multinodular goitres Urgent referral to secondary care is necessary only if the nodule is growing rapidly (over few weeks) or associated with stridor[bmj.com]
Stridor
  • Rarely, a large lump may cause cough, shortness of breath or stridor due to compression of the underlying trachea. In some cases of malignancy, direct involvement of the recurrent laryngeal nerve may cause hoarseness.[entsho.com]
  • Side view of a goitre A goitre A multinodular goitre A large multinodular goitre Red flag features [ 9 ] Prompting same day referral Stridor associated with a thyroid mass Prompting urgent (two-week rule) referral Child with a thyroid nodule.[patient.info]
  • […] disease if the thyroid lump is associated with voice change,rapid enlargement, cervical lymphanopathy or persistent pain The UK guidelines expect such a patient to be seen by a specialist within two weeks of seeing their primary physcian.Any patient with stridor[endocrinesurgeon.co.uk]
  • […] nodules are common, but only about 5% are malignant The risk of malignancy is similar for solitary nodules and multinodular goitres Urgent referral to secondary care is necessary only if the nodule is growing rapidly (over few weeks) or associated with stridor[bmj.com]
Muscle Weakness
  • Nodule causes hyperthyroidism If the nodule is hormonally active and secreting excess amounts of thyroid hormone, you may experience symptoms of hyperthyroidism : Rapid, irregular heartbeat Insomnia Unexplained weight loss Muscle weakness Nervousness[health.clevelandclinic.org]
  • Symptoms of Thyroid Nodules A solid, usually painless lump in the front of the neck, near the windpipe or Adam’s apple Feelings of nervousness, weight loss and heartbeat irregularity Having a feeling of fullness Muscle weakness/tremors A throaty harshness[healthcommunities.com]
  • If the cells in the nodule produce thyroid hormones, the nodule may produce symptoms of hyperthyroidism such as sudden, unexplained weight loss, nervousness, muscle weakness, increased appetite, trouble sleeping, and rapid or irregular heartbeat.[melbournethyroidcentre.com.au]
  • weakness difficulty sleeping nervousness In some cases, thyroid nodules develop in people with Hashimoto’s disease.[healthline.com]
  • Symptoms of hyperthyroidism include: Irritability/nervousness Muscle weakness/tremors Light or missed menstrual periods Weight loss Difficulty sleeping Enlarged thyroid gland Vision problems or eye irritation Heat sensitivity (trouble dealing with heat[my.clevelandclinic.org]
Neck Mass
  • Avoid the wait At the Swedish Cancer Institute (SCI), the Neck Mass and Thyroid Nodule Biopsy Clinic has a process that eliminates the wait for test results.[swedish.org]
  • Children with thyroid nodules are more likely to present with a palpable neck mass. 1 This is in contradistinction to adults, where a rising proportion of asymptomatic thyroid nodules are identified incidentally on neck or chest radiographs that are performed[med.uth.edu]
Neck Mass
  • Avoid the wait At the Swedish Cancer Institute (SCI), the Neck Mass and Thyroid Nodule Biopsy Clinic has a process that eliminates the wait for test results.[swedish.org]
  • Children with thyroid nodules are more likely to present with a palpable neck mass. 1 This is in contradistinction to adults, where a rising proportion of asymptomatic thyroid nodules are identified incidentally on neck or chest radiographs that are performed[med.uth.edu]
Neck Swelling
  • Symptoms such as neck swelling and pain often occur more rapidly than with other forms of thyroid cancer because the tumor grows quickly.[nyulangone.org]
Insomnia
  • Nodule causes hyperthyroidism If the nodule is hormonally active and secreting excess amounts of thyroid hormone, you may experience symptoms of hyperthyroidism : Rapid, irregular heartbeat Insomnia Unexplained weight loss Muscle weakness Nervousness[health.clevelandclinic.org]
  • If your gland is producing too much thyroid hormone (hyperthyroidism), you may experience: Weight loss Insomnia Anxiety Trembling hands Heat intolerance Signs that your thyroid is producing too little thyroid hormone (hypothyroidism) include: Weight gain[ucsfhealth.org]
  • […] persistent Coughing up blood Shortness of breath Symptoms of Possible Cancer Spread Bone pain in one spot without relief Weakness or numbness of an arm or leg that persists Hyperthyroid Symptoms Weight loss, heat intolerance, trembling hands, palpitations, insomnia[endocrine.surgery.ucsf.edu]
Lethargy
  • Other types of thyroiditis: De Quervain's thyroiditis - neck pain, fever and lethargy soon after an upper respiratory infection or a viral illness. Acute suppurative thyroiditis - results from bacterial or fungal infection causing abscess.[patient.info]

Workup

  • Some reports suggest that as many as 10-20% of pediatric thyroid cancer patients will have evidence of distant metastases on initial workup.[med.uth.edu]
  • American College of Radiology recommends the following workup for thyroid nodules as incidental imaging findings on CT, MRI or PET-CT : [8] Features Workup High PET signal or Local invasiveness or Suspicious lymph nodes Very likely ultrasonography Multiple[en.wikipedia.org]
  • Although the risk of cancer is small, it is the main reason for workup of these lesions. Measurement of thyroid-stimulating hormone can identify conditions that may cause hyperfunctioning of the thyroid.[aafp.org]
  • Diagnosing Thyroid Nodules If you, or your physician, suspect a thyroid nodule, the workup usually involves performing a physical exam to check your thyroid gland to determine if it’s enlarged and whether a single or multiple thyroid nodules are present[hoag.org]
  • If you happened to be PREGNANT, the chance of being cancer is not higher than in non-pregnant people; and workup and treatment can be deferred till after delivery. Symptoms Most of the time, I feel nothing.[endomds.com]

Treatment

  • They will share all of the test results and discuss various treatments.[swedish.org]
  • The findings came from a study of 309 patients who sought treatment at NUH between 2008 and 2014. It is the first such local study to be published and one of the largest of its kind internationally, in terms of sample size.[straitstimes.com]
  • Those people who have received radiation treatment to the head and neck regions for conditions such as acne, thymus enlargement, recurrent tonsillitis, chronic ear infections and birthmarks are at a greater risk for thyroid nodules and thyroid cancer.[thyroid.com.au]
  • […] surgeons offer a ‘one-stop’ diagnostic neck lump clinic where you will have access to a surgeon, radiologist and pathologist at a single appointment with the objective of offering a complete thyroid nodule assessment concluding with a diagnosis and treatment[ahns.co.nz]
  • Also, if you’ve ever had ionizing radiation treatments to your head or neck, you may have an increased risk of thyroid cancer.[health.clevelandclinic.org]

Prognosis

  • Has an excellent prognosis if diagnosed early, especially in young females. Follicular carcinoma (30%): also associated with a good prognosis.[entsho.com]
  • […] microcalcification papillary carcinoma solid hypoechoic with a lobulated or irregular outline and globular calcification medullary carcinoma intranodular vascularity taller than wide axially (AP ML) characteristic associated lymphadenopathy Treatment and prognosis[radiopaedia.org]
  • Fortunately when treated even though the tumour has spread the prognosis is exellent. The British Medical Journal in 2009 contains an exellent article on the investigation of thyroid nodules.[endocrinesurgeon.co.uk]
  • It has the same good outlook (prognosis) as the standard type of papillary cancer when found early, and they are treated the same way.[cancer.org]
  • However, prognosis for children with well-differentiated thyroid cancer remains very favorable and approaches nearly 100% 10-year survival 1 .The favorable survival of children with thyroid carcinoma reflects the finding that the most pediatric thyroid[med.uth.edu]

Epidemiology

  • Epidemiology [ 1, 4 ] Between 4-7% of adults have palpable thyroid lumps. Many more will be detectable on high-definition ultrasonography.[patient.info]
  • "Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup". European Thyroid Journal. 3 (3): 154–63. doi : 10.1159/000365289. PMC 4224250. PMID 25538897. Jenny Hoang (2013-11-05).[en.wikipedia.org]
  • Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22(6):901–911. 6. Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Ann Intern Med. 2005;142(11):926–931. 7.[aafp.org]
  • These epidemiological studies determined that nuclear tests would likely increase the number of thyroid cancers seen in Americans over future decades. However, the risks are greatest for those patients living near test sites for many years.[endocrineweb.com]
Sex distribution
Age distribution

Prevention

  • Surgery If natural remedies do not work, there are surgical procedures, including radiological or laser procedures that can help reduce the size of the lump, but overall the idea is to prevent the lump or nodule from increasing in size.[healthyliving.azcentral.com]
  • […] of Thyroid Nodules There is no known way to prevent thyroid nodules.[healthcommunities.com]
  • Prevention There’s no way to prevent the development of a thyroid nodule. If you’re diagnosed with a thyroid nodule, your endocrinologist will take steps to remove or destroy it or simply monitor it on an ongoing basis.[healthline.com]
  • Learn how to stay ENT healthy, prevent problems, and manage existing conditions to improve your, or a loved one’s, daily life.[entnet.org]
  • Prevention: The reason for most thyroid nodules is unknown. A diet with enough iodine will help prevent some nodules. Do You Have a Thyroid Nodule? Get a full thyroid nodule evaluation today at the UCLA Endocrine Center in Los Angeles, CA.[uclahealth.org]

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