By Cheryl D. Almirante, MD, FACE, ECNU, CCD:
Thyroid nodules are extremely common. In fact, by age 60 about half of all people have a thyroid nodule that can be found either through palpation or with imaging. Although the condition is predominately benign, it is important to facilitate necessary assessment of each patient in order to rule out thyroid cancer. Treatment of patients with thyroid nodules can be complex in nature. In such cases, evaluation by an endocrinologist is important to ensure appropriate work-up, treatment, and monitoring.
People with thyroid nodules are at greater risk for developing thyroid cancer if they have a history of high radiation dose exposure, are older than 40 years of age, and/or have a family history of thyroid cancer.
Patients with thyroid nodules are mostly asymptomatic. Nodules are commonly detected on routine physical examination or incidentally discovered on radiological procedures such as MRI or CAT scan. In other instances, patients present with a sensation of a lump in their necks and complain of persistent neck pain, problems with swallowing, and hoarseness.
A primary care physician can determine if there is hyperfunctioning or hypofunctioning of the thyroid gland. The initial laboratory test performed may include the thyroid-stimulating hormone (TSH). The most common condition is Hashimoto’s thyroiditis, which is a cause of hypothyroidism and increases the risk of development of thyroid nodules. Additionally, iodine deficiency, although currently rare in the United States, is known to cause thyroid nodules.
When a nodule is found, specialized testing such as thyroid ultrasonography and fine needle aspiration biopsy is necessary for a comprehensive diagnosis to determine malignancy. This can be performed by an endocrinologist with an Endocrine Certification in Neck Ultrasound (ECNU). This designation signifies a commitment to clinical excellence and quality evaluations for patients with thyroid and parathyroid conditions, through both diagnostic ultrasound and biopsies. The endocrinologist conducts real-time imaging of the patient’s thyroid gland and surrounding neck structures and, if necessary, performs a fine needle aspiration biopsy under ultrasound. If needed, biopsies can be performed at the same appointment.
Caring for patients with thyroid nodules requires a close collaboration between primary care physicians and endocrinologists. Together, they can improve patient outcomes, longevity, and overall quality of life.
Dr. Almirante is a Board certified, fellowship trained endocrinologist at TPMG Newport News Endocrinology. She has extensive experience with treatment of thyroid nodules, hyperthyroidism, hypothyroidism, diabetes, and osteoporosis. mytpmg.com