Thyroid Nodules (cont.)
What is the treatment for thyroid nodules?
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.
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