Thyroid Nodules

The thyroid is a small gland located at the base of the neck. It takes iodine from our diet and uses this to make thyroid hormone which controls how all our cells use energy for metabolism. It is very common for the thyroid to develop nodules which are due to overgrowth of some of the thyroid cells.

Most thyroid nodules don’t need any treatment. If they are diagnosed via an ultrasound the nodules can often be assessed by how they look on the ultrasound.

You should seek medical assessment of thyroid nodules if they:

  • are suspicious for a thyroid cancer (which can be predicted from an ultrasound)

  • are large - especially if larger than 4cm

  • are causing symptoms such as difficulty swallowing, difficulty breathing and/or pressure in the neck

  • if you develop hoarseness of your voice

  • if they are producing too much thyroid hormone

  • if you have a risk factor for thyroid cancer such as prior radiation treatment or a family history

Treatment for thyroid nodules include observation, biopsy for diagnosis and thyroid surgery.

More information about thyroid nodules can be found here at this Conversation article written by A/Prof Glover and his colleagues - https://theconversation.com/my-scan-shows-i-have-thyroid-nodules-should-i-be-worried-203245

Thyroid Biopsies and

Molecular Testing

As part of an assessment of a thyroid nodule, you may have a thyroid biopsy which is usually performed by a radiologist using an ultrasound to guide the biopsy. From this biopsy, the cells of the nodule are analysed by a pathologist under the microscope.

A biopsy is generally preformed to tell whether a nodule is likely to benign (or not a cancer) or if it could be a thyroid cancer.

From these biopsies a diagnosis can be given, which could include:

  • Benign - meaning there is less than 5% chance of the nodule being a thyroid cancer and that the nodules can likely be safely monitored.

  • Atypical - meaning there is less than 10% chance of the nodule being a thyroid cancer. For this diagnosis, it may be possible to repeat the biopsy, perform further analysis with molecular testing, observe the nodule or have the nodule removed with surgery for a definitive diagnosis.

  • Indeterminate - meaning there is an approximate 30% chance of the nodule being a thyroid cancer. For this diagnosis, the traditional treatment has been to remove the nodule for diagnosis with surgery which is called a diagnostic hemithyroidectomy. Another recent treatment option is to perform molecular testing on the biopsy sample which can give a better prediction of whether the nodule is a cancer or if it is benign.

  • Cancer - meaning the nodule is more than 90% likely to be a thyroid cancer. Treatment for thyroid cancer can take a number of forms depending on the size, type and what your treatment preferences are. Recently molecular testing has also been used to help predict how aggressive a cancer is likely to be.

A/Prof Glover through this training and experience is an expert in the molecular biology of thyroid nodules and thyroid cancer and aims to provide this experience to his patients when they are deciding on their treatment options.

Thyroid Cancer

Thyroid cancer is one of the most commonly diagnosed cancers in Australia. Traditionally treatment for thyroid cancer involved removing the whole thyroid (called a total thyroidectomy) followed by treatment with radioactive iodine tablets (called RAI). It is now understood that this treatment over-treats many people with thyroid cancer and there can be a number of options for treatment.

For small thyroid cancers it may be possible to observe the cancer with regular ultrasounds. This is as most thyroid small cancers do not grow - which is called active surveillance.

For most larger cancers, treatment may include surgery with removal of half (hemithyroidectomy) or the whole thyroid (total thyroidectomy) and possible removal of the lymph nodes in the neck.

It is important to understand the options when you are deciding on treatment. A/Prof Glover through this training and experience is an expert in thyroid cancer management and seeks to personalise treatment to avoid over-treatment.