Thyroid nodules: 8 questions, answered

The thyroid is a butterfly-shaped gland in your lower neck that produces hormones which control your metabolism, heart rate and body temperature. 

Sometimes, a nodule forms in the thyroid gland. You may be able to be feel it or see it as a lump in your neck. However, many nodules are found during imaging tests done for other reasons. While discovering a lump can be concerning, thyroid nodules usually aren’t cancerous. 

Oncologic endocrinologist Steven Weitzman, M.D., leads UT MD Anderson’s Thyroid Nodule Clinic. Here, he’ll answer eight common questions about thyroid nodules.

What is a thyroid nodule? 

A thyroid nodule is a growth in your thyroid gland. These growths are very common, especially as people age. 

Most nodules don't cause symptoms. They’re often found accidentally during imaging tests for another condition or during a routine physical exam.

When thyroid nodules do cause symptoms, you may notice hoarseness, difficulty swallowing, pressure in your neck, or a visible lump or enlargement of your thyroid gland.

What causes thyroid nodules? 

While the exact cause of most thyroid nodules is not known, several factors increase your risk of developing thyroid nodules. These include:

• Increasing age: The risk of developing thyroid nodules steadily increases as you age. And they’re three times more common in people in their 60s compared to younger people.
• Being female
• Family history of thyroid disease 
• Iodine deficiency
• Prior radiation exposure to the head or neck
• Certain inherited conditions, such as familial adenomatous polyposis (FAP), multiple endocrine neoplasia type 2 (MEN2), Carney complex, DICER1 syndrome, and PTEN hamartoma tumor syndromes, including Cowden syndrome  

How are thyroid nodules diagnosed?

Once a nodule is found, it’s important to have it evaluated to determine if you need further testing or treatment. 

An ultrasound is the best test for evaluating a thyroid nodule. 

“Ultrasound is an excellent tool, but it is operator-dependent,” explains Weitzman. “In UT MD Anderson’s Thyroid Nodule Clinic, our dedicated head and neck ultrasonographers evaluate the thyroid and surrounding lymph nodes every day. They make sure we thoroughly examine the thyroid and the surrounding lymph nodes.” 

Are thyroid nodules cancerous?

Only about 5% of thyroid nodules are cancerous. 

“The goal is to identify which nodules need additional evaluation or treatment while avoiding unnecessary procedures for people who are unlikely to have cancer,” says Weitzman.

Specialists look at several features on ultrasound, including the nodule’s size, shape, appearance and borders. Based on these features, the nodule receives a risk score that helps determine whether a biopsy is needed.  

No single feature alone determines whether a nodule is cancerous. “If a nodule scores above a certain threshold, we recommend a biopsy,” says Weitzman. “If it's below that threshold, we can often monitor it with follow-up imaging.”

Depending on the nodule, another ultrasound may be recommended within six to 12 months to check for any changes.

“The longer a nodule remains stable, the more confident we become that it's benign,” he says. “In some cases, we can eventually stop monitoring nodules that clearly don't pose a risk.”

Do nodules affect thyroid function? 

The role of your thyroid gland is to produce thyroid hormone. If your body produces too much thyroid hormone, this is called hyperthyroidism. It can make you feel shaky, have a fast heartbeat, or experience unintentional weight loss. If you have too little thyroid hormone, it’s called hypothyroidism. This can make you feel tired, have a puffy face or gain weight.

Most people with thyroid nodules have normal thyroid hormone levels. Sometimes, a nodule can produce extra thyroid hormone on its own. These overactive thyroid nodules are called ‘hot nodules.’ The overactive nodules are usually not cancerous and often can be treated without a biopsy or surgery.

“Thyroid nodules that make too much thyroid hormone are almost never cancer,” says Weitzman. “Because of that, a needle biopsy is usually not needed. Sometimes, though, a biopsy may still be done if the nodule looks concerning on an ultrasound. If a biopsy is needed, doctors take extra care because an overactive nodule can release more thyroid hormone.”  

Do thyroid nodules require treatment? 

Most thyroid nodules never require surgery, and many don’t even need a biopsy. 

If a biopsy is needed, doctors perform a fine needle aspiration to collect cells from the nodule. The procedure is guided by ultrasound and often takes less than 30 minutes.

If treatment is needed, there are a few options. Surgery may involve removing all or part of the thyroid gland, depending on the location and size of the nodule. If the thyroid is overactive, treatment may also include daily medicine or radioactive iodine to treat the overactive nodule.  

What is active surveillance?

Active surveillance means watching the nodule closely with regular ultrasounds and follow-up visits instead of treating it right away. 

Given their expertise in monitoring thyroid nodules, UT MD Anderson's specialists carefully select patients for whom this can be a safe and effective option. 

“Some thyroid cancers start as small nodules and grow very slowly,” explains Weitzman. “For carefully selected patients, it can be safe to monitor the nodule rather than treat it right away. If the nodule shows signs of growth or change, treatment can still be effective when started later. Many small thyroid cancers never spread or affect how long a person lives.”

What makes UT MD Anderson’s Thyroid Nodule Clinic different?

UT MD Anderson’s Thyroid Nodule Clinic sees both new and current patients. Weitzman says the clinic is unique because the team takes a comprehensive approach to evaluating thyroid nodules and guides patients through their treatment and monitoring options. 

“The right care is not always the most aggressive care. Sometimes, it’s best not to remove the nodule,” he says. “Our team is excellent at making this distinction.” 

The multidisciplinary team of specialists works together to evaluate thyroid nodules and recommend the right treatment, if treatment is needed. Using the latest evidence and national guidelines, the goal is to identify nodules that need attention while helping patients avoid unnecessary procedures. 

Request an appointment at UT MD Anderson online or by calling 1-877-632-6789.