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What are Thyroid Lumps?
The thyroid gland is a small gland, shaped like a butterfly or bow-tie that lies in the lower part of the neck around the windpipe and voice box. The thyroid gland makes hormone to keep up the body’s metabolism. Almost all thyroid glands contain microscopic nodules that are too small to feel.
Larger more noticeable nodules occur in up to 2/3rds of adults and are 5 times more common in women who undergo more hormonal change throughout their lives.
What are the symptoms of Thyroid Lumps?
The commonest presentation is a painless lump in the lower neck, just off centre. This can understandably cause distress, but following investigation, most nodules do not need any active treatment.
Symptoms that warrant urgent medical review to exclude cancer include: the rapid enlargement of a single nodule; enlarged neck lymph nodes; voice change, swallow or breathing difficulties; coughing up blood and any thyroid nodule in a child. Radiation exposure or a family history of thyroid cancer are also risk factors for thyroid cancer.
How are Thyroid Lumps diagnosed and assessed?
Blood tests including thyroid function, calcium, vitamin D levels and special thyroid autoantibodies are usually performed. If suspicion for cancer is high, then blood tests specific to some thyroid cancers and familial conditions predisposing to thyroid cancers, may be also requested.
The most important diagnostic test is an ultrasound scan performed by an experienced dedicated head, neck and thyroid radiologist and a needle biopsy of a suspicious nodule. For most patients, we perform a ”one-visit” diagnostic service where you will have these investigations and be told the results on the same day and often during the same clinic visit.
Is very important that a camera endoscopic examination of the voice box is performed before and after thyroid or parathyroid surgery to ensure the vocal cords and therefore the nerves that supply them are working.
CT or MRI scan will provide additional information, particularly if there is suspicion that a thyroid cancer might be invading the windpipe or voice box or if there is a very large thyroid gland that has grown behind the breastbone (a retrosternal goitre).
Additionally, a radioactive iodine-based scan may provide information as to whether any nodules are producing excess or little thyroid hormone. Occasionally the ultrasound and needle biopsy cannot distinguish between a benign or malignant lump and a ”diagnostic” thyroid lobe excision may be required to clarify.
Treatment and Management of Benign Thyroid Lumps
If there is under or over-production of thyroid hormone then treatment is with thyroid hormone replacement or antithyroid medication under the supervision of an endocrinologist. Radioactive iodine treatment, radiofrequency ablation of nodules or surgical removal are other alternatives.
For benign nodules, management will be dependent on whether they are causing compression of the breathing or swallowing apparatus or indeed if there is a large component of the gland that is behind the breastbone. In these situations, removing either half of or the whole thyroid gland may relieve symptoms. An alternative treatment option is radiofrequency ablation of some smaller nodules.
About 5% of solitary thyroid nodules turn out to be cancerous. The commonest type is called papillary thyroid cancer. This has the best prognosis and comprises 80% of all thyroid cancers.
Modern management of thyroid cancer favours thyroid gland preservation in certain situations. Multiple studies have demonstrated that many small cancers with favourable histological features, in a low risk patient are not likely to grow much throughout their lifetime. For larger tumours or if there is more than one suspicious area in the thyroid and for the more aggressive cancer types, surgery is likely to be recommended.
All diagnosed or possible thyroid cancers will be discussed in a thyroid cancer multidisciplinary meeting to ensure the best individualised and evidence-based treatment is offered. Depending on the properties of the cancer, following the removal of your thyroid gland, you may need radioactive iodine treatment which will be administered by an endocrinologist.
We are a team of ENT Head and Neck surgeons with significant experience in managing complex thyroid cancers and very large retrosternal goitres. Where necessary, because we regularly perform other types of head and neck cancer surgery, we are also skilled in performing neck lymph node clearances with preservation of important nerves and major vessels.
We routinely use nerve monitoring to help us identify and preserve the nerves to the voice box, as these are intimately related to the under-surface of the thyroid gland (the recurrent laryngeal nerve and external branch of the superior laryngeal nerve). In addition, it is also critically important to preserve the closely associated small glands (parathyroid glands) that regulate calcium levels in the body.
Get in touch
To speak with a specialist about Thyroid Lumps, contact our team today.
We are available from Monday to Friday: 8am – 8pm.