Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The thyroid gland is found in the neck just below the "Adam's apple." This gland is responsible for producing thyroid hormone, which is an important hormone that stimulates the metabolism of the body. Between 4% and 7% of people in the United States have lumps (or nodules) in their thyroid gland that can be felt on examination. Like many things, the thyroid gland gets "lumpier" as we get older and the frequency of these nodules increases with age. In fact, many are found incidentally during routine examinations or radiology testing. Thyroid nodules are also more common in women than in men. In fact, ultrasound studies have found that up to one in every three women has at least one thyroid nodule that may be too small to notice. (Usually, a nodule needs to be greater than one centimeter in diameter for it to be felt.). Interestingly, because women have so many more nodules than men, the incidence of detected cancer is higher in women then in men by virtue of absolute numbers. However, each individual nodule is more likely to be cancerous if found in a man.
Doctors always hold a degree of concern whenever a new growth is
detected on the body, regardless of the tissue involved. The concern
is whether or not the growth or nodule is cancer (malignant).
Fortunately, fewer than 10% of thyroid nodules are malignant. The
majority of thyroid nodules are harmless growths, known as adenomas,
and are contained within a capsule. Even though cancerous nodules are
uncommon, the doctor will take the necessary measures to be certain.
What is the initial assessment of a thyroid nodule?
All patients with a thyroid nodule should undergo a complete medical
history and physical examination. Specific questions regarding the
onset of the nodule, related pain or discomfort, symptoms of thyroid
disease, and family history are addressed. In addition, the doctor
will take into account the patient's age and sex when evaluating the
possibility of malignancy. Patients with a history of head and neck
radiation (which was commonly used in the 1950's as an acne) are at a
higher risk. Cancerous nodules are also more frequent in men as
compared to women. The doctor will also look for general symptoms of
thyroid disease in addition to other illnesses. The size and
characteristics of the nodule are assessed. Is it soft or firm? Does
it move with swallowing, or is it fixed? Is there more than one
nodule? Are there other nodes involved? Does it hurt when the nodule
is touched? The answers to these questions will help the doctor
evaluate what further investigations, if any, are necessary.
The following is a list of factors that increase the suspicion of
malignancy:
Age: Patients less than 30 years of age and greater than 60
years of age have a higher risk of cancer in a thyroid nodule as do children;
Associated symptoms such as difficulty swallowing or
hoarseness;
Nodules are less concerning to a physician if it is one of many present in the gland, and also if the nodule is hyperfunctioning (or "hot") using nuclear thyroid imaging.
After the initial evaluation, the doctor may choose to order thyroid blood tests or imaging scans to determine the functional activity of a thyroid nodule and it's anatomy. The cornerstone in the assessment of a solitary thyroid nodule is a procedure known as fine needle aspiration biopsy ("FNAB") of the thyroid gland.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
There are four major types of thyroid cancer: papillary, follicular, medullary, and anaplastic thyroid cancer. Tumors on the thyroid are referred to as thyroid nodules. Symptoms of thyroid cancer include swollen lymph nodes, pain in the throat, difficulty swallowing, hoarseness, and a lump near the Adam's apple. Treatment usually involves chemotherapy, surgery, radioactive iodine, hormone treatment or external radiation and depends upon the type of thyroid cancer, the patient's age, the tumor size, and whether the cancer has metastasized.
Cysts are saclike structures that can occur throughout the body and usually contain a semisolid, liquid, or gaseous substance. Infections, tumors, genetic conditions, chronic inflammatory conditions, and wear and tear can cause cysts. Though some cysts may be palpable, others may not produce any symptoms. Treatment depends upon the location and cause of the cyst.
Thyroid nodules are the most common endocrine problem in the United States. The term "thyroid nodule" refers to any abnormal growth that forms a lump in the thyroid gland. The vast majority of thyroid nodules are benign.
There are many types of thyroid disease. Some occur due to the function of the thyroid itself such as hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, etc. Some causes of thyroid disease occur due to problems with the structure of the thyroid gland such as goiters, thyroid nodules, and thyroid cancer. Treatment of thyroid disease depends on the cause of the disease.
The thyroid gland produces hormones that are essential for normal body metabolism.
Blood testing is now commonly available to determine the adequacy of the levels of
thyroid hormones. These blood tests can define whether the thyroid gland's hormone production is normal, overactive, or
underactive.
What are thyroid hormones?
Thyroid hormones are produced by the thyroid gland. This gland is located in the lower
part of the neck, below the Adam's apple. The gland wraps around the windpipe
(trachea) and has a shape that is similar to a butterfly - formed by two wings (lobes) and attached by a middle part (isthmus).
The thyroid gland uses iodine (mostly available from the
diet in foods such as seafood, bread, and salt) to produce thyroid hormones. The two most important
thyroid hormones are thyroxine (T4)
and triiodothyronine (T3), which account
for 99.9% and 0.1% of thyroid hormones pre...
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