Surgery to remove the gland typically addresses the problem, and recurrences or spread of the cancer cells are both uncommon. People who undergo thyroid gland surgery may need to take thyroid hormone afterward to keep their body chemistry in balance.
Choosing an experienced specialist can mean more options to help personalize your treatment and achieve better results. Join endocrinologist Paul Ladenson, M. Health Home Conditions and Diseases. How common are thyroid nodules? Are thyroid nodules cancer? The Johns Hopkins Thyroid and Parathyroid Center Our thyroid experts in the head and neck endocrine surgery team diagnose and treat patients with a variety of thyroid and parathyroid conditions.
Learn about our center. Watch Now. This test provides information that no other test can offer short of surgery. A thyroid needle biopsy will provide sufficient information on which to base a treatment decision more than 85 percent of the time if an ultrasound is used. Use of fine needle biopsy has drastically reduced the number of patients who have undergone unnecessary operations for benign nodules.
However, about percent of biopsy specimens are interpreted as inconclusive or inadequate, that is, the pathologist cannot be certain whether the nodule is cancerous or benign. In such cases, a physician who is experienced with thyroid disease can use other criteria to make a decision about whether to operate. A thyroid scan is a picture of the thyroid gland taken after a small dose of a radioactive isotope normally concentrated by thyroid cells has been injected or swallowed.
The scan tells whether the nodule is hyperfunctioning a "hot" nodule. Because cancer is rarely found in hot nodules, a scan showing a hot nodule eliminates the need for fine needle biopsy. If a hot nodule causes hyperthyroidism, it can be treated with radioiodine or surgery. Neither a thyroid scan nor radioiodine treatment should ever be given to a pregnant woman. Small amounts of radioactive iodine will be excreted in breast milk. Since radioiodine could permanently damage the infant's thyroid, breast-feeding is not allowed for women undergoing radioiodine treatment.
In thyroid ultrasoundography, high-frequency sound waves pass through the skin and are reflected back to the machine to create detailed images of the thyroid. It can visualize nodules as small as millimeters. Ultrasound distinguishes thyroid cysts fluid-filled nodules from solid nodules. Recent advances in ultrasonography helps physicians identify nodules which are more likely to be cancerous.
Thyroid ultrasonography is also used for guidance of a fine needle for aspirating thyroid nodules. Ultrasound guidance enables physicians to biopsy the nodule to obtain an adequate amount of material for interpretation.
Even when a thyroid biopsy sample is reported as benign, the size of the nodule should be monitored. A thyroid ultrasound examination provides an objective and precise method for detection of a change in the size of the nodule. A nodule with a benign biopsy that is stable or decreasing in size is unlikely to be malignant or require surgical treatment.
Most patients who appear to have benign nodules require no specific treatment. Some physicians prescribe the hormone levothyroxine with hopes of preventing nodule growth or reducing the size of cold nodules.
Radioiodine may be used to treat hot nodules. If the lesion is benign, the patient is monitored via ultrasound for the growth of the nodule or development of new nodules.
If there is growth, another biopsy may be performed. If the lesion is malignant, the patient is referred to one of the Thyroid Cancer Program surgeons for removal of the thyroid. About 10 percent of the time, the pathologist is unable to provide a diagnosis due to lack of specimen from the aspiration. That suggests an increased risk for malignancy, which may require surgery or monitoring. In most surgeries, the entire thyroid is removed total thyroidectomy.
Lymph nodes also may be removed to determine if the tumor has spread beyond the thyroid gland. Subsequent therapy depends upon the findings at the time of surgery. Some patients may be placed on thyroid hormone and followed with blood tests and ultrasound examinations, while other will receive radioactive iodine to destroy the residual thyroid tissue and then be followed with blood tests and ultrasounds. Using this type of therapy, the majority of cancers will be either cured or controlled and less than 20 percent will recur.
In the case of aggressive disease, a patient may qualify for clinical trials with newer therapies such as targeted chemotherapies. Skip to content. This study brings focus back to the use of growth rate as an independent predictor of malignancy. It is considerably well powered, with analysis of nearly 1, nodules, but its main strength is the comparison of growth rates of malignant nodules with benign nodules, a feature lacking in many long-term growth studies, for obvious reasons.
Careful consideration was given to the possibility of selection bias for this pool of nodules, and the authors, in my mind, have satisfactorily addressed the low likelihood that a bias of this sort could be influencing the data. The results show that nodule growth, defined as greater than 2 mm per year, was indeed an independent predictor of malignancy and that faster growth rates increased the risk.
Furthermore, cancers with higher-risk subtype eg, medullary thyroid cancer, tall cell variant of papillary were even more likely to demonstrate growth over the follow-up period. As we are using more selective criteria to determine which nodules to biopsy, as well as the recent trend toward consideration of observing small known cancers, this study suggests that tracking nodule growth rate is a useful tool in determining appropriate care. Healio News Endocrinology Thyroid. Source: Angell TE, et al.
Read next. October 18, Receive an email when new articles are posted on. Please provide your email address to receive an email when new articles are posted on.
0コメント