Thyroid Nodule: 4 Reasons a Lump in Your Neck Could Require Treatment

Most are harmless but some need to action

woman having thyroid ultrasound

Don’t be too concerned if your doctor says you have thyroid nodules. This lump in the butterfly-shaped gland in your neck is common and usually not cancerous.

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Thyroid nodules occur in about 50 percent of people over the age of 40 and often don’t lead to any serious problems,” says endocrinologist Christian Nasr, MD.

Most contain a variable amount of fluid, and those with a significant amount of fluid are cysts. Most nodules can’t even be felt via palpation of the neck and are only discovered on an imaging study, such as an ultrasound.

In certain cases, however, a nodule can cause a problem that will make your doctor take a closer look. Here are four cases where thyroid nodules cause problems that require further attention, according to Dr. Nasr.

1. Family or personal history of cancer

If you have a close family member who has had thyroid cancer, or if you have a personal history of cancer of any kind, your doctor may order a fine needle aspiration of the nodule.

Also, if you’ve ever had ionizing radiation treatments to your head or neck, you may have an increased risk of thyroid cancer. In the case of a malignant (cancerous) nodule, patients need surgery to remove the entire thyroid gland and, possibly, the surrounding lymph nodes.

2. Nodule causes an obstruction

“If the nodule is so large that it causes difficulty swallowing or breathing, or it causes you to choke or affects your voice, it’s definitely a problem, even if it’s benign,” says Dr. Nasr.

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In these cases, the nodule may need surgical removal.

3. 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

Typically, surgical removal of the affected lobe or radioactive iodine can eliminate the nodule.

4. Nodule appearance is cosmetically unacceptable

“Sometimes nodules don’t cause any serious problems but are visible in the lower neck area. This can bother patients from a cosmetic standpoint,” Dr. Nasr says.

In this case, if the nodule is cystic, the endocrinologist may drain fluid to reduce its size and visibility. This is not a permanent solution because fluid may eventually re-accumulate inside the nodule.

If your thyroid ultrasound reveals suspicious aspects of a nodule, or if your nodule has a diameter greater than one centimeter, your doctor may take a biopsy.

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Depending on your medical history, he or she may advise surgical removal of the lobe containing the nodule.

The big takeaway

The bottom line about thyroid nodules: Don’t panic if you’re diagnosed with one. Only about 5 percent of diagnosed nodules turn out as malignant.

If you have a thyroid nodule, your doctor will monitor your condition with periodic blood tests that check the levels of thyroid hormone and thyroid-stimulating hormone. He or she may also order annual thyroid ultrasounds as an additional check.

Nodules that begin as benign rarely become malignant later. However, your doctor may decide to perform periodic biopsies if there is a size increase just to make sure.

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