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.
Thyroid cancer incidence: what actually happened
For three decades, thyroid cancer was the fastest-growing cancer diagnosis in the United States. That is no longer the case — and understanding why matters if you have just been diagnosed.
- New U.S. cases peaked around 2014–2015 and have declined or held steady since. The American Cancer Society now describes thyroid cancer as having grown faster than any other U.S. cancer only until recently.
- For 2026, the ACS estimates about 45,240 new cases (32,000 in women, 13,240 in men) and about 2,320 deaths.
- Thyroid cancer is still almost three times more common in women than men, and is often diagnosed younger than most adult cancers — the average age at diagnosis is 51.
- Most of the earlier rise was overdiagnosis, not more disease. Increasingly sensitive ultrasound found small, slow-growing papillary cancers that in many cases would never have caused symptoms or harm. One analysis of SEER registry data from 2000–2019 attributed roughly 85% of early-stage papillary thyroid cancer in women to overdiagnosis.
- Death rates stayed low and flat the entire time. The current U.S. thyroid cancer death rate is about 0.5 per 100,000 people per year — one of the lowest of any cancer.
- The decline is credited largely to updated clinical guidelines, including 2015 recommendations that discouraged biopsy of very small nodules.
Why this matters for you: if you have been diagnosed with a small papillary thyroid cancer, you are in exactly the group the medical community has spent the last decade rethinking. That reassessment is a major reason active surveillance and nonsurgical treatment options are discussed far more openly today than they were ten years ago. A diagnosis is not automatically an argument for aggressive treatment — it is a reason to ask careful questions about what your specific nodule requires.
Steps to Diagnosis
There are three main steps in this process:
- Current guidelines from the American Thyroid Association
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.
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.
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.
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.
Preventing unnecessary thyroid surgeries and preserving quality of life, through education
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Copyright 2024 By – SYT