Lung-Sparing Surgery Is Effective for Some with Early-Stage Lung Cancer
What Are Thyroid Nodules?
Thyroid nodules are solid or fluid-filled lumps or bumps. They're found on your thyroid, a small gland in your neck. This gland makes thyroid hormone, which affects your metabolism (the internal process that turns your food into energy), heart rate, and many other systems in your body. Sometimes, cells in your thyroid can grow out of control and form a lump, called a thyroid nodule.
Thyroid nodules are often so small that you won't be able to feel one. (Photo Credit: SCIEPRO/Science Source)
Most often the answer is no. You usually can't feel thyroid nodules. Even though they happen from an overgrowth of cells, only about 1 in 10 thyroid nodules turn out to be cancer. Benign (noncancerous) thyroid nodules are common. Lots of people get them as they get older. If a thyroid nodule isn't cancerous, it may not need any treatment. Your doctor might just watch it to make sure it doesn't keep growing or start causing other problems.
There are several types of thyroid nodules. Most are not cancerous (benign) and are easily treatable. Some nodules are so small that you may not even notice them, while others can grow large enough to cause discomfort when swallowing, sleeping, or even wearing certain clothing.
Thyroid adenoma
These are noncancerous growths of normal thyroid tissue. You do not need treatment for these growths unless they lead to symptoms. Your doctor will monitor them with regular ultrasounds of your neck.
Toxic adenoma
These growths cause your thyroid to make extra hormones, a condition called hyperthyroidism. They are very rarely cancerous. Only 1%-8% of people with hyperthyroidism develop cancer from these growths.
Thyroid cysts
These growths are filled with fluid. They are almost never cancerous.
Goiter
Any swelling or rise in the size of your thyroid is called a goiter. They can be caused by problems with your autoimmune system or by too little iodine in your body. You won't need treatment unless you are having certain symptoms.
Multinodular goiter
Your doctor might use this term when your thyroid is swollen and has multiple growths. Most often, these growths are benign. You will only need treatment if you have certain symptoms or if any of the growths test positive for cancer.
Thyroid cancer
Cancer can form when the cells in your thyroid don't grow normally. Some types of thyroid cancer — papillary and follicular — grow more slowly than other types of the disease. Other kinds of thyroid cancer include:
The type of cancer you have will determine your treatment.
Thyroid nodules usually don't have symptoms. But in certain situations, you might experience symptoms.
Large thyroid nodule symptoms
These large nodules can cause:
Hot thyroid nodule symptoms
When a nodule causes the thyroid to make too much hormone, this is sometimes called a "hot nodule." It may cause:
Hypothyroidism symptoms
Sometimes, people with thyroid nodules make too little thyroid hormone. This can cause symptoms of hypothyroidism:
It's not always clear why you get thyroid nodules. Several medical conditions can cause them to form. They include:
Thyroiditis
This is chronic inflammation of the thyroid. One type of thyroiditis is called Hashimoto's disease. It's associated with low thyroid activity (hypothyroidism).
Iodine deficiency
Iodine is an essential mineral. A diet low in iodine can cause thyroid nodules. This is uncommon in the U.S. Because iodine is added to many foods.
Thyroid adenoma
This is an unexplained overgrowth of thyroid tissue. Most adenomas are harmless, but some produce thyroid hormone. This leads to an overactive thyroid (hyperthyroidism).
Hashimoto's disease
This is an autoimmune disease that causes damage to your thyroid gland.
Thyroid cancer
In some cases, nodules can be caused by thyroid cancer.
Thyroid nodules are quite common. By the age of 60, half of all people have them.
Several things can raise your risk of a thyroid nodule. They include:
You may be able to identify one just by looking in the mirror. Face the mirror with your chin raised a little. Swallow and look for a bump on either side of your windpipe near your Adam's apple. Put your fingers gently on your neck in that spot and feel for a bump. If you find one, ask your doctor about it.
If you notice one, have your doctor check it. For problems with your thyroid, you may want to see a specialist called an endocrinologist. Endocrinologists specialize in health problems related to the glands that make hormones, including the thyroid. They will do a physical exam and might order one of the following tests to find out if it's cancer or not:
Sonogram of thyroid nodules
Your doctor, or a physician who specializes in thyroid disease, may perform a sonogram of your neck. This procedure, sometimes called an ultrasound, is painless. It uses high-frequency radio waves to create a picture of your neck. This helps your doctor to better diagnose the size, shape, and number of nodules, whether they might be cysts or something more serious. A sonogram can also help your doctor perform a biopsy.
Thyroid nodule biopsy
Your doctor may test a very tiny sample of cells to see whether the growth is cancerous. They will use a sonogram to help insert a very delicate needle into a nodule, remove a small number of cells, then send them to a lab for closer examination under a microscope.
You may not need any treatment for thyroid nodules, especially if they are small and not causing any symptoms. The type of nodule, and whether or not it's cancerous, will help you and your doctor decide on the best approach.
You may not need any treatment for thyroid nodules, especially if they are small and not causing any symptoms. The type of nodule, and whether it's cancerous, will help you and your doctor decide on the best approach.
Common treatments include:
Draining. Fluid in cysts may be removed by your doctor or a specialist using a fine needle.
Ablation. Your doctor might use heat or an alcohol injection to break up nodules.
Surgery. Your doctor or a surgeon might remove nodules if they are large, cause symptoms, or are cancerous or if the cancer has spread. Part or all of your thyroid gland may also be removed if necessary. This is called a thyroidectomy. You may also be given radioactive iodine treatment after your operation to make sure any remaining cancer cells are destroyed. If your thyroid gland is removed, you will need to take medication for the rest of your life.
Thyroid nodules are common, especially if you are older than 60 years. Most nodules are noncancerous, but if you have trouble breathing or swallowing or experience other symptoms, like a hoarse voice that won't go away, it's wise to get checked by a doctor. Your doctor can conduct several tests to determine how serious the problem is and will discuss your treatment options, depending on the results. In some cases, you may need surgery, but many nodules can be treated without an operation.
Can thyroid nodules cause mucus in the throat?
Yes. Hoarseness that won't go away, frequent coughing, or feeling a need to to keep clearing your throat may be symptoms of a thyroid nodule.
What size thyroid nodules are worrisome?
You should get any size thyroid nodule evaluated by your doctor, who may decide to wait and see if it grows. Small nodules often don't need to be treated if they are not cancerous.
Do thyroid nodules need to be removed?
Small nodules often do not need to be removed, especially if they are not causing symptoms. Larger nodules or growths that cause you trouble swallowing, breathing, or discomfort should be evaluated for possible removal.
What should you avoid if you have thyroid nodules?
If you have thyroid problems, it's best to speak with your doctor about what foods to avoid or cut back on. Soy and soy-based products can interfere with hormone medication, for example. Other foods that may cause problems for people with thyroid issues include:
Do thyroid nodules cause weight gain?
Weight gain can be a sign of hypothyroidism. If diet, exercise, and lifestyle modifications are not addressing your weight issues, ask your doctor to check your thyroid levels.
Lung Nodules: When They May Cause Concern
Lung nodules are common and usually develop after an injury or infection. However, in a small number of cases, they may be a sign of lung cancer.
Lung nodules can vary in size and shape. They can appear as sharp or blurry areas in the results of a CT scan.
While lung nodules are not usually a cause for concern, doctors may want to repeat a person's CT scan or perform additional tests to rule out lung cancer.
Lung nodules are formations with a rounded or irregular shape that healthcare professionals may notice on the results of a radiological imaging test. They typically have a diameter of 3 centimeters (cm) or fewer.
These nodules may be a sign of an old lung injury or infection and are not usually a cause for concern.
However, healthcare professionals may recommend repeating the imaging test, such as a CT scan, after a few months or 1 year to check if the nodule is growing. Whether they make this recommendation depends on various factors related to the nodule, such as its:
In most cases, lung nodules that appear on CT scans are not cancerous. Usually, nodules result from previous infections and injuries that have caused scar tissue growth in the lungs.
However, healthcare professionals may still recommend a person with a nodule undergoes another CT scan after a few months to check if the nodule has grown to ensure it is not a tumor.
If the nodule has grown during the period between scans, doctors will perform more tests.
Only about 5% of lung nodule cases turn out to be cancerous.
It is common for lung nodules to appear during a CT scan that people undergo for reasons unrelated to cancer screening or the diagnosis of lung conditions.
Every year, healthcare professionals find lung nodules in about 30% of people who undergo CT scans of the chest.
Nodules can form due to the following factors:
Healthcare professionals refer to these lung nodules as "incidental pulmonary nodules." They are rarely related to cancer.
If a doctor has concerns about a lung nodule, they may recommend a person undergoes another chest CT scan after a set time. This allows the doctor to check whether the nodule has grown within this period.
The doctor may also want to collect a sample of tissue from the nodule through a prodedure called a biopsy. This involves passing a thin tube with a light and a camera, called a bronchoscope, down the person's throat to reach the nodule and remove some tissue.
If the lump is on the outer side of the lung, the doctor may pass a thin needle through the chest wall to reach the nodule with the guidance of a CT scan.
If the doctor thinks there is a high chance the lung nodule is cancerous or if they cannot reach it with a bronchoscope or needle, a person may have to undergo surgery. A surgeon can remove the nodule, its surrounding tissue, and, if necessary, a larger section of the lung.
If a lung nodule is a tumor, a doctor will advise the individual about available treatment options based on the location, size, and stage of the cancer.
The specialist can also provide advice about the possible complications and side effects of each treatment to help a person consider which option is most appropriate for them.
What are the symptoms of a cancerous lung nodule?
People with cancerous lung nodules may develop symptoms of lung cancer, such as:
What makes a lung nodule suspicious?
What size of lung nodule is worrisome?
A lung nodule that has an irregular shape or is bigger than 3 cm may be a sign of cancer. However, a person will need to undergo additional tests to determine whether a lung nodule is cancerous or not.
How often do lung nodules turn into cancer?
About 95% of lung nodules are benign, having developed due to an injury or a previous infection. Only about 5 lung nodules out of 100 turn into cancer.
Lung nodules are a common finding in CT scans. In most cases, lung nodules are from an old injury or infection and not a cause for concern.
Only about 5% of lung nodules turn out to be cancerous. If a doctor suspects a person may have a tumor, they may recommend attending a lung cancer screening test and undergoing a PET or CT scan after a few months to check whether the lung nodule has grown.
Thyroid Nodules On CT Scan Generally Have Low Risk For Malignancy
Most thyroid incidentalomas on computed tomography (CT) are benign, according to findings from a systematic review and meta-analysis published in Thyroid.
Guidelines about thyroid incidentaloma surveillance from the American Thyroid Association and American College of Radiology are conflicting.
To clarify the risk for malignancy for CT-identified nodules, investigators from the University of Alabama at Birmingham in the United States searched publication databases through April 2024 for cohort studies and randomized controlled trials reporting incidence and follow-up of thyroid nodules among patients with no history of thyroid disease.
The analysis included a total of 49 articles, of which 47 were cohort and 2 were randomized controlled trial designs. Study authors identified incidentalomas through text extraction of previous CT reports (59.2%) or through radiologist reevaluation (40.8%). The studies used chest CT alone (44.9%), neck CT alone (26.5%), or both/unspecified. Contrast was used in 44.9% of studies.
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Thyroid incidentalomas are not uncommon findings on CT and generally have a relatively low risk of malignancy.
The pooled study population comprised 235,765 patients (mean [SD] age, 56 [12] years), of whom 54.9% were women. The patients were undergoing CT for miscellaneous reasons (40.8%), trauma (16.3%), lung cancer screening (10.2%), and COVID-19 screening (8.2%).
The pooled prevalence of thyroid incidentalomas was 8.3% (95% CI, 7.4%-9.3%; I2, 99.3%).
The prevalence of thyroid incidentalomas was higher for:
Among individuals with incidentalomas, the rate of multiple incidentalomas was 27.0% (95% CI, 12.9%-41.1%; I2, 96.1%). The rates of incidentalomas with a size of at least 1 cm and at least 1.5 cm were 46.3% (95% CI, 32.3%-60.3%; I2, 97.5%) and 28.6% (95% CI, 19.9%-37.3%; I2, 85.7%), respectively.
The proportion of patients with incidentalomas who underwent follow-up biopsy was 28.4% (95% CI, 19.9%-36.9%; I2, 95.9%) and thyroid surgery was 8.2% (95% CI, 2.1%-14.4%; I2, 87.1%).
The pooled malignancy rate was 3.9% (95% CI, 3.0%-4.9%; I2, 92.3%).
Malignancy rates were similar in studies using test extraction vs radiologist reevaluation (PP, 6.0% vs 4.2%), neck CT vs chest CT (PP, 6.5% vs 3.6%), and contrast vs no contrast (PP, 5.5% vs 3.6%).
The malignancy rates were higher for:
Study limitations include between-study heterogeneity.
The study authors concluded, "Thyroid incidentalomas are not uncommon findings on CT and generally have a relatively low risk of malignancy."
This article originally appeared on Endocrinology Advisor
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