Are thyroid nodules serious?

Written by Hu Jian Zhuo
Nephrology and Endocrinology
Updated on September 29, 2024
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The severity of thyroid nodules needs to be assessed based on their nature, size, function, and location. Generally, they can be classified into benign and malignant, with malignant nodules being thyroid cancer, which requires timely treatment. Surgical treatment is the main method for treating thyroid cancer, whereas most benign nodules do not require special handling. Regarding the size of the thyroid nodules, if the nodules are too large and compress surrounding tissues such as the trachea, esophagus, and nerves, surgical treatment is recommended. For common benign nodules, regular observation is sufficient. Functionally, some thyroid nodules may affect thyroid function, such as in Hashimoto's thyroiditis, which can present with diffuse multiple nodules, leading to either hyperthyroidism or hypothyroidism. In such cases, appropriate medication treatment is needed. From a positional perspective, ectopic growth of thyroid nodules, if located at areas like the base of the ear, pharynx, neck, esophagus, or thoracic cavity, is a rare congenital developmental anomaly. If such a nodule significantly enlarges and compresses surrounding tissues, surgical treatment is advised.

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Written by Guo Min
Endocrinology
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What are the symptoms of thyroid nodules?

Thyroid nodules are formed due to the proliferation of thyroid tissue into masses, and clinically, these nodules are categorized as either benign or malignant, and as cystic or solid. Generally, cystic nodules are benign. However, a portion of solid nodules are malignant. Therefore, in the early stages, a patient with thyroid nodules might not exhibit any symptoms because the nodules are relatively small. As the thyroid nodules progressively enlarge, for instance, when they grow larger than two or three centimeters, the patient may start feeling discomfort in the neck. Some patients with nodules that grow inward can experience compression of the trachea, leading to difficulties in swallowing and breathing obstruction. Thus, when feeling discomfort in the neck, it is crucial to go to the hospital for an ultrasound to confirm whether thyroid nodules are present.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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What should I eat for thyroid nodules to dissipate?

Traditional Chinese Medicine (TCM) believes that thyroid nodules are mainly caused by emotional distress, dietary imbalances, and environmental maladjustment. Long-term emotions such as anger and depression can lead to stagnation of qi (vital energy), resulting in liver qi dysfunction and the formation of phlegm. Qi stagnation and phlegm accumulation in the front of the neck lead to the formation of this goiter. Therefore, the treatment for this condition often involves the use of foods or medications that soften hardness, disperse nodules, reduce swelling, and resolve stasis. For example, purslane, loofah, plums, and dried figs are some of the foods that can clear heat, facilitate diuresis, reduce swelling, and disperse nodules. Appropriate consumption of these foods can be beneficial in slowing the progression of the disease. However, it is generally difficult to dissolve nodules through diet alone, and active treatment is still necessary.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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Probability of thyroid nodules becoming cancerous

The malignant manifestation of thyroid nodules is thyroid cancer. Thus, thyroid nodules are divided into two major categories: benign and malignant. Benign nodules generally make up the vast majority, with malignancies accounting for less than 5%. Malignant thyroid nodules are cancerous. Some benign thyroid nodules may also become malignant over time. Generally, small nodules do not show obvious clinical symptoms during the cancerous transformation, but their nature changes. When a nodule compresses surrounding tissues and causes certain symptoms, such as hoarseness, tracheal compression, and difficulty swallowing, it often indicates that the tumor is in the middle or late stage. Overall, the chances of benign nodules becoming cancerous are very small. The malignancy rate of benign nodular goiter is about 5%, and the possibility of adenomas turning malignant is around 10%. As the diameter increases, the possibility of adenomas becoming malignant gradually increases. There are several high-risk factors for the malignant transformation of thyroid nodules: for instance, having a history of radiation exposure to the head and neck area during childhood or adolescence, patients who are younger than 14 or older than 70; the rate of malignant transformation of thyroid nodules significantly increases; and the rate of malignant transformation in male nodules is significantly higher than in females. Also, patients whose nodules significantly increase in size in a short period during regular check-ups are also considered high-risk for malignancy.

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Written by Yuan Qing
Pulmonology
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Which is more serious, pulmonary nodules or thyroid nodules?

It is impossible to compare the severity between thyroid nodules and lung nodules. Firstly, thyroid nodules and lung nodules occur in different organs. Lung nodules are mostly caused by inhalation of dust, pollutants, or smoke. Thyroid nodules, on the other hand, often result from genetic factors, or issues with the patient’s own constitution leading to the formation of these nodules. Most lung nodules can be classified as benign or malignant through diagnostic tests, whereas it is often difficult to assess the nature of thyroid nodules with standard tests. Additional auxiliary examinations, such as PET-CT or SPECT, and biopsy pathology are needed to determine the nature of thyroid nodules. Therefore, the approaches to observing and handling these two types of nodules are entirely different, and they cannot be compared.

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Written by Hu Jian Zhuo
Nephrology and Endocrinology
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Does thyroid nodule puncture hurt?

Fine needle aspiration is an invasive examination, but it is currently an important and most efficient method for assessing benign and malignant conditions, generally conducted under ultrasound guidance. Thyroid nodule aspiration does not cause much pain, similar to that of an injection. Anesthetics are used during the procedure, so the pain is not very noticeable. However, as the effect of the anesthetic wears off, there may still be some pain at the puncture site, but the patients do not need to carry a heavy psychological burden.