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.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
The vast majority of thyroid nodules do not cause symptoms. However, if the
cells in the nodules are functioning and producing thyroid hormone on their
own, the nodule may produce signs and symptoms of too much thyroid hormone
(hyperthyroidism). A small number of patients
complain of pain at the site of the nodule that can travel to the ear or
jaw. If the
nodule is very large, it can compress the esophagus or trachea and cause
difficultly swallowing or shortness of breath. In rare instances, a patient
may complain of hoarseness or difficulty speaking because of compression of
the larynx (or voice box).
What are the types of thyroid nodules?
Thyroid nodules may be single or multiple. A thyroid gland that contains
multiple nodules is referred to as a multinodular goiter. If the nodule is
filled with fluid or
blood, it is called a thyroid cyst. If the nodule produces thyroid hormone
in an uncontrolled manner without regard to the body's needs, the nodule is
referred to as autonomous. This type of nodule may cause signs and symptoms
of too much thyroid hormone or hyperthyroidism, as mentioned above.
Occasionally, patients with a thyroid nodule may have too little thyroid
hormone or hypothyroidism. This is most
often seen when the hypothyroidism is due to
Hashimoto's thyroiditis, an
inflammatory, autoimmune disease of the thyroid gland.
The most common types of noncancerous, single thyroid nodules are colloid
nodules or follicular adenomas. Another type of benign nodule that may be
seen is called a Hurthle cell adenoma. Only a minority of nodules are
cancerous. Cancerous nodules are classified by the types of malignant
thyroid cells they contain. These cell types include papillary, follicular,
medullary, or poorly differentiated (anaplastic) cells. The prognosis for
the patient depends largely on the cell type and how far the cancer has
spread by the time it is discovered.
In addition to thyroid cancer of the cell types mentioned, thyroid nodules
may contain lymphoma, a cancer of the immune system. Cancer from other
sites, such as breast and kidney, also can spread (metastasize) to the
thyroid gland.
The cause of most thyroid nodules is not known. In certain cases, a lack of
iodine in the diet can cause the thyroid gland to develop nodules. There
also are certain genes that may be involved in the development of nodules in
some individuals.
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.
Hashimoto's thyroiditis is the most common cause of hypothyroidism in the US. This conditions is caused by inflammation of the thyroid gland. Symptoms may include: fatigue, weight gain, cold intolerance, excessive sleepiness, dry or coarse hair, difficulty swallowing, a lump in the front of the throat, and many more. Treatment is usually hypothyroid medication.
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.
Thyroiditis is the inflammation of the thyroid gland. The inflamed thyroid gland can release an excess of thyroid hormones into the blood stream, resulting in a temporary hyperthyroid state. Some forms of thyroiditis can be diagnosed based on tenderness and enlargement of the thyroid gland. A thyroid scan sometimes is used in making the diagnosis. Thyroiditis can also be diagnosed with a biopsy of the thyroid gland.
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