Diagnosis

The thyroid is a small, butterfly shaped gland in the neck.

It is a vital organ. It impacts all aspects of life.

Incidence of Thyroid Nodules

Five to ten percent of thyroid nodules are palpable (can be felt).
With ultrasound imaging, detection increases to about 60%.
The risk of developing nodules increases with age.

Types of Thyroid Nodules

Cysts (fluid filled)
Solid
Combination of cystic and solid components

Benign or Cancerous Thyroid Nodule?

Most thyroid nodules are benign: 90-95%

4.0-6.5% are malignant (cancerous)

Most malignancies are papillary thyroid cancer (PTC), the least aggressive type: 80%

Other thyroid cancers (follicular, medullary, anaplastic) which are rare can be more aggressive.

“The incidence of thyroid cancer has increased dramatically during the past three decades and it is now the fastest growing cancer in women. Almost all of this increase is in papillary thyroid cancer (PTC).” –American Thyroid Association

Steps to Diagnosis

There are three main steps in this process:

Current guidelines from the American Thyroid Association

Measure thyroid stimulating hormone (TSH) level

If the level is below normal:

A radionuclide thyroid (thyroid uptake) scan will be performed.
This will determine if thyroid nodules are “hot” (secreting excess thyroid hormone) or “cold” (non-functioning).

If the level is normal or elevated:

Ultrasound and/or fine needle aspiration biopsy will be performed.

Perform ultrasound imaging

This is a painless test that takes only a few minutes.

It allows your doctor to “see” the visible characteristics of your nodules and take measurements.

Your nodule will be given a TI-RADS score: 1 – 5.

This scoring system assigns points for each visible characteristic to classify a thyroid nodule’s risk of malignancy.

These findings will determine if there is need for biopsy.

Perform fine needle aspiration biopsy (FNA)

This test is performed by inserting a very small needle into the nodule to collect a sample of cells.

This sample is evaluated under a microscope by a pathologist.

Biopsy results are classified using the Bethesda System, I – VI:

I: Non-Diagnostic or Unsatisfactory (repeat the biopsy)

II: Benign – risk of malignancy is low (0-3%)

III: Atypia of Undetermined Significance (AUS) (repeat the biopsy; perform molecular testing

IV: Follicular Neoplasm – perform molecular testing)

V: Suspicious for Malignancy

VI: Malignant

Could you be a candidate for a nonsurgical treatment option?

Nonsurgical treatment options are now available for appropriate candidates.
However, not everyone is a good candidate. Some patients truly need surgery.
To determine if you are a candidate for any of these procedures, you must be evaluated by a physician who has been trained in nonsurgical modalities.

Click to FIND A PHYSICIAN.

Who might be a candidate for nonsurgical treatment?

Patients with benign thyroid cysts or nodules which cause compression symptoms (difficulty swallowing or breathing) or are cosmetically concerning
Patients with “hot” toxic thyroid nodules causing hyperthyroidism (overactive thyroid)
Patients with a solitary papillary thyroid cancer (PTC), less than 2 cm, without thyroidal extension and not close to any critical structures in the neck, and no lymph node involvement
Patients who have already undergone thyroidectomy (full thyroid removal) who have a solitary papillary thyroid cancer (PTC) lymph node recurrence and do not wish to undergo further surgery
Patients who are not good surgical candidates
Patients with inoperable thyroid cancer (this is not curative and is only palliative until other treatment options can be pursued)

Who is not a candidate for nonsurgical treatment?

Patients with follicular, medullary, or anaplastic thyroid cancer
Patients with papillary thyroid cancer that is larger than 2 cm and/or has metastasized
Patients with papillary thyroid cancer that extends outisde the thyroid capsule
Patients with nodules that are too close to vital structures in the neck (arteries, nerves, esophagus, trachea)

Which procedure is right for you?

To date, radiofrequency ablation (RFA) of thyroid nodules is the most exhaustively researched and proven therapy in terms of safety and clinical efficacy.
However, new technologies are developing rapidly and several other nonsurgical treatment options are now available.
Some procedures are better suited to different types of thyroid nodules.

Click to learn more about PROCEDURES.

Click here to read the publication, Choice in Ablative Therapies for Thyroid Nodules (Hu & Kuo, 2023), which describes several available procedures and provides guidance for their application.

Disclaimer: None of the statements made here should be considered medical advice. We are patients, not doctors. You must seek the guidance of a physician who has been specifically trained in these procedures. Additionally, it is beneficial to get the opinions of multiple doctors when making decisions that can impact the rest of your life. Educate yourself on the risks and benefits so you can make informed decisions about your healthcare.