Symptoms of Thyroid Lump/Nodule

Thyroid Lump, Enlarged thyroid glands, Thyroid Nodules

The thyroid gland is located in the front of the lower part of the neck. Thyroid lumps are very common and are usually noticed to one side (or to both sides) of the midline. Thyroid lumps may be single, or there may be multiple lumps. Often thyroid lumps are associated with a diffusely enlarged thyroid gland (called a goitre).

Most thyroid lumps are benign, but even benign lumps can be problematic if they grow to become large enough to affect breathing and/or swallowing. Tumours of the thyroid may be benign or malignant (cancer), and cancer of the thyroid can cause the lymph nodes of the neck to become enlarged.

How do we evaluate thyroid lumps?

People with thyroid lumps are evaluated by taking a thorough medical history and by performing an examination of the neck and the upper airway, including endoscopy. Standard endoscopy of the upper airwayis called laryngoscopy, in which an endoscope (a slim tube with a camera on the end) is passed through the noseusing local anaesthetic to examine the airway.

Blood tests to check the function of the thyroid gland (thyroid function tests) are an important part of the workup of thyroid lumps.

An ultrasound scan (USS) of the thyroid is undertaken to characterize the number, location, size and structure of the lumps/nodules.

On the basis of the USS findings, a biopsy of the nodule(s) may be required using USS guidance – this is called a fine needle aspirate (FNA), in which a fine bore needle is inserted into the lump to take a sample of cells for inspection by a pathologist. These cells are categorized according to the Bethesda classification system, and a treatment plan is made on the basis of this classification. Some nodule scan be observed, while others may require removal, which requires removal of half of the thyroid gland (thyroid lobectomy or hemithyroidectomy) or removal of the entire thyroid gland (total thyroidectomy).

Additional investigations such as CT scanning may be required to complete the evaluation if the thyroid gland is very enlarged and is compressing adjacent structure such as the trachea, or if the thyroid gland has grown downwards behind the breastbone (sternum) into the chest.

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