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.
Because of the difficulty in
distinguishing follicular adenomas from follicular cancers, patients with either
of these two types of nodules, other nodules that are highly suspicious for
cancerous, and, of course, with definite cancer, should undergo surgery if they
are healthy enough to withstand surgery. Most thyroid cancers
are curable and rarely cause life-threatening
problems. Any nodule not removed needs to be watched closely with an examination and
follow-up with the physician every 6-12 months. This follow-up may involve a
physical examination, ultrasound examination, or both. Occasionally, a physician may
attempt to shrink the nodule by using suppressive doses of thyroid hormone.
Some physicians believe that if a nodule shrinks on suppressive therapy, it
is more likely to be benign, and if the nodule continues to grow regardless
of suppressive therapy, surgery should be considered strongly. The value of
suppressive therapy, however, is controversial.
If a nodule is causing hyperthyroidism, it is usually benign. Treatment is aimed at preventing the signs and
symptoms of hyperthyroidism such as heart failure, osteoporosis, and rapid heart rate. Treatments include
destroying the gland using radioactive iodine (this time with the iodine isotope 131), blocking the production of thyroid
hormone with medications, or just following a patient if the hyperthyroidism is mild.
In cases where a nodule is hyperfunctioning and the TSH is minimally suppressed, but the level of thyroid hormones in
the blood is not elevated (these patients have "subclinical hyperthyroidism"), treatment is individualized based on the
patients' age, the presence of other medical
conditions, and patients' preferences.
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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