Questions and Answer of Thyroid Nodule

1. What are the most important complications of thyroid surgery?

Surgery to remove the thyroid gland is well tolerated and has low complication rates
when performed by an experienced thyroid surgeon. Complications unique to thyroid
surgery include bleeding within the neck causing difficulty breathing, seroma (simple
fluid) formation under the incision, and infection of the incision. Infrequent but serious
complications associated with thyroid surgery also include temporary or permanent
voice changes and temporary or permanent low blood calcium levels.

2. What is the difference between a thyroid nodule and a goiter?

A thyroid nodule is a growth within the thyroid gland. Thyroid nodules are extremely
common, and nodules large enough to be felt can be seen in 5 to 10% of women and
1 to 5% of men. A goiter is an enlargement of the thyroid gland and may be due to
general enlargement of the gland or enlargement due to the presence of multiple
nodules.

3. Does a goiter always require surgery?

The natural history of a benign goiter is usually slow enlargement or growth of its
nodules. Therefore, observation can be safe. A goiter is treated if there is a suspicion
of the nodules harboring cancer, if the goiter is growing quickly or hormonally
overactive, or if the goiter's large size is causing compressive symptoms, such as
hoarseness, difficulty swallowing, or difficulty breathing.

4. How are thyroid nodules diagnosed?

Thyroid nodules are most commonly discovered by chance during imaging studies,
such as CT or MRI scans or ultrasounds that are performed for other reasons.
Thyroid nodules may be discovered by the patient or a physician during a physical
examination.

5. What are the treatment options for thyroid nodules that are shown to be non-
cancerous (benign) on FNA biopsy?

For patients with normal thyroid function and thyroid nodules, observation with
periodic physical examinations and ultrasounds are necessary to be certain that the
nodule is not changing. Repeat biopsies may become necessary if the nodule size or
ultrasound characteristics change. Although a benign biopsy is very reassuring, such
biopsies will be correct 98 or 99% of the time, not 100%. Therefore, continued
surveillance is necessary.

For some patients with normal thyroid function and thyroid nodules, thyroid hormone
is prescribed to prevent further growth or to possibly decrease the size of the nodule.
When thyroid nodules cause local symptoms, exhibit continued growth or are a
source of anxiety, surgery is often the appropriate treatment option.

When thyroid function is high (hyperthyroidism) in a patient with thyroid nodules,

radioactive iodine or surgery are both excellent alternatives. In some patients,
medication alone is used to control the thyroid over-activity.

6. What are the risk factors for thyroid nodule?

Some common risk factors for goiters include:

 A lack of dietary iodine. People living in areas where iodine is in short supply
and who don't have access to iodine supplements are at high risk of goiters.

 Being female. Because women are more prone to thyroid disorders, they're
also more likely to develop goiters.

 age. Goiters are more common after age 40.

 Medical history. A personal or family history of autoimmune disease increases

your risk.

 Pregnancy and menopause. For reasons that aren't entirely clear, thyroid
problems are more likely to occur during pregnancy and menopause.

 Certain medications. Some medical treatments, including the heart drug

amiodarone (Cordarone, Pacerone, others) and the psychiatric drug lithium
(Lithobid, others), increase your risk.

 Radiation exposure. Your risk increases if you've had radiation treatments to

your neck or chest area or you've been exposed to radiation in a nuclear
facility, test or accident.
7. What are the most important complication of thyroid nodules?

Small goiters that don't cause physical or cosmetic problems aren't a concern. But
large goiters can make it hard to breathe or swallow and can cause a cough and
hoarseness.

Goiters that result from other conditions, such as hypothyroidism or hyperthyroidism,

can be associated with a number of symptoms, ranging from fatigue and weight gain
to unintended weight loss, irritability and trouble sleeping.

8. When is a CT Scan ordered?

When physical examination and or ultrasound cannot completely determine how far
the goiter actually goes, then a CT scan should be ordered. The CT scan will show
areas that the thyroid goiter extends and prepare the expert thyroid surgeon their
safe and effective approach to remove all of the goiter gland and spare all other
structures.

9. what is the prognosis of thyroid nodule?

Benign goiters have a good prognosis. However, all goiters should be monitored by
examination and biopsy for possible malignant transformation, which may be
signaled by a sudden change in size, pain, or consistency. Fortunately, the risk of
this is low. In patients exposed to low levels of radiation the risk rises.

10. What should be included in patient education about thyroid nodule?

Educate a patient about potential etiologies, eg, adequate dietary iodine intake,
avoidance of goitrogens, regular personal neck examination, and physician
examination.
For patients on medical therapy, reinforce the need to take medications on a regular
basis.