Radiology Services

Newspaper Column

Question: Should I be concerned about a “nodule” the doctor found in my neck during my last exam?

Answer: Anytime a physician finds something of note on a physical exam, it is natural to be at least a little concerned. The term nodule generally refers to a lump found in the thyroid, a gland in the neck just below the Adam’s apple. The thyroid is a gland that makes hormones that help regulate many bodily functions such as heart rate, hunger, bowel activity, and overall energy level. The good news about thyroid nodules is that they are nearly always benign. Notice I stated nearly always benign. Between 90-95% of all nodules are benign, noncancerous overgrowths of thyroid tissue. Only about 5% are cancerous. Because of the chance of a nodule being cancerous, all nodules should be fully evaluated. The causes of the benign nodules include a cyst (collection of fluid), thyroid tissue that is overactive (hyperactive nodule), or many growths in an enlarged thyroid gland (multinodular goiter).

Generally these nodules cause no symptoms and are only discovered during a clinical exam or incidentally by the patient. Sometimes the nodules are overactive and can cause symptoms such as fast heart rate, weight loss, feeling jittery or nervous, diarrhea, or tremor. Occasionally these nodules can be found in an under active gland and be associated with symptoms like slow heart rate, weight gain, constipation, depression and fatigue. If you are having these symptoms your doctor may do some lab work to help determine the functional status of your thyroid. This can aid in the diagnosis of the thyroid nodule.

If you find a nodule yourself, you should be seen by a physician. This may be your primary care physician or may be a specialist such as an endocrinologist, internal medicine physician, or a neck surgeon.

Many times your physician will order additional tests, specifically a radiology or nuclear exam, to further evaluate the nodule and the remainder of the thyroid. Often a thyroid ultrasound is performed. This exam involves no radiation and is performed with a machine that uses high frequency “sound” waves. These waves pass thorough the thyroid and are used to evaluate the internal structure of the gland. This study can help confirm the nodule is in the thyroid. It can see if there are other nodules in the thyroid. Also, it is useful to determine if the nodule is cystic (made of fluid) or solid. Almost all fluid nodules are benign; however, most solid nodules are as well.

Another common test is a thyroid uptake and scan. This is a nuclear medicine procedure performed by either a radiologist or a physician that has special training in nuclear medicine. This involves swallowing a capsule of a very small amount of radioactive iodine. This does involve some radiation, but this amount of radiation is about one quarter of the amount a person receives from the environment (i.e. sun exposure) in one year. This exam can help determine if the nodule is overactive (hyperfunctioning) or under active (hypofunctioning.). This study can also help determine if other nodules are present. Hyperfunctioning nodules are almost always benign (approximately 98%.) Hypofunctioning nodules are benign about 80% of the time. For instance, a fluid nodule on ultrasound will generally demonstrate little function.

The combination of the blood work, ultrasound, and/or nuclear medicine exam will help to determine if you need to have your nodule or nodules biopsied. Thyroid biopsies are performed by a variety of physicians. This involves placing a small needle into the nodule and aspirating (removing fluid) or obtaining a piece of tissue for a pathologist to examine. Based on the pathology, your physician can help determine if any treatment or possibly further surgery is indicated.

The main things to remember are that most thyroid nodules are benign. Also, the work-up of the nodules may involve several tests, which can all be performed locally. If you have further questions, please ask your primary care physician, specialist, or radiologist.

Dr. Stephen P. Penor is a board certified radiologist at HSC Medical Center. He is associated with Hot Springs Radiology Services, Ltd., which provides radiology coverage for HSCMC.