Is thyroid nodules cancerous? When should I worry about thyroid nodules?

Thyroid Nodule

The thyroid gland is in the neck, below the Adam's apple. It is firmly seated on the windpipe like a saddle on a horse. The gland is under the control of the pituitary gland at the base of the brain and is one of the regulators of body metabolism. Its secretion is one of the important regulators of heart rate, body weight, and the speed at which one functions. If the gland functions at above or below the normal rate, the imbalance can be controlled by medication.

The surgeon is concerned primarily with the diagnosis and treatment of lumps or irregularities of this gland. The patient can live a completely normal adult life even if the entire thyroid gland is removed, since the functions of the gland can be substituted for by medication.

How does the doctor know whether there is a lump on the thyroid? 

The lump can actually be felt in the patient's neck on one side of the windpipe. It becomes especially obvious when you swallow. If you look in the mirror, you can often see it for yourself.

How long has it been there? It is impossible to tell. What can it be? 

A lump ordinarily represents one of three changes in the thyroid gland. It may be an encapsulated fluid collection, which is a cyst. Inflammation may also be present as a mass. More significantly, this focal enlargement may be an innocent tumor or a cancer.

Can you tell what it is by feeling it? 

Usually not. Palpation simply reveals that something is there. The method of examination, of itself, is not accurate enough to determine which of the three changes is present. A thyroid scan is of help in the differential diagnosis.

What is a thyroid scan? 

This is a diagnostic procedure. A radioactive (atomic) material is taken by mouth in a very small dose, which has no harmful effect. The iodine in this material is retained by the thyroid. A Geiger counter that monitors radioactivity is placed over the neck to scan (map out) the gland. If there is an area of no activity, it means that a change has taken place there. The area is dubbed "cold." A "cold" area or "cold nodule" is one that is not functioning.

Why does the scan help? 

The scan tells how much of the gland is altered and in what areas. Sometimes it reveals a small or hidden "cold" area of disease that cannot be discerned by palpation. The pattern of radioactivity often suggests the diagnosis.

What are the other tests for? Do you do a breathing metabolism test? 

Blood tests, which tell at what rate the gland is functioning and how its iodine components are distributed, are a more accurate measurement of thyroid function than the breathing metabolism test. The latter examination is rarely done nowadays.

If you don't know what it is, why do you want to operate? 

The nodule should be removed just because the doctor doesn't know what it is. The operation will reveal the diagnosis while at the same time offer the opportunity for instituting proper treatment. So that if it turns out to be a cyst, the operation will have been unnecessary. In a sense that is true, but it is the only way of knowing that it is a cyst and not a tumor. What you mean is that you are advising an operation because this lump could be a cancer. That is correct. We do this because it is not possible to be sure otherwise.

Suppose it is not a cancer. What is done? 

Part or all of the diseased area will be removed so that there is no chance of the cyst's squeezing the windpipe.

Suppose it is a cancer. What is done? 

All or most of the gland is taken out, along with any lymph glands that are involved.

Will I be cured then? 

I feel perfectly OK now. A complete cure is possible for the vast majority of patients with cancer in this area who are seen in the early stage.

Will the scar be visible? 

The scar is placed in the skin folds of the neck. After the incision heals completely, the scar is quite inconspicuous.

What Is A Thyroid Nodule?

Will my voice be normal after the operation? 

The nerves that allow the vocal cords to function are positioned on each side of the thyroid gland. If the nerve is involved in a tumor or inflammatory process, it will result in interference with vocal cord mobility and cause voice changes. These changes can be recognized preoperative by larnygoscopic examination.

The laryngeal nerves may be manipulated in the course of a thyroid operation; the extent and duration of any voice changes are dependent on the extent to which this has taken place. In most instances there are no permanent voice changes.

How soon do I have to make a decision about the operation? Can we just observe it to see what happens? 

Once the diagnosis of a "cold" nonfunctioning area is made, the surgeon cannot determine its cause except by surgery. This is not an emergency, but there is nothing to be gained by waiting. You should have the operation at a time convenient to your family arrangements.

My grandmother had such a lump in the old country for twenty years and she never did anything about it and was OK until age ninety two.

It may not have been the same kind of lump. How is one to be sure that you will also be so fortunate? 

The two situations are not necessarily comparable.

How long is the hospital stay for such a thyroid operation? 

You are usually in and out within a week.


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