Thyroid Nodule Treatment
In a patient with a known thyroid nodule, the initial step is to determine the risk for cancer. High-risk features include:
- Being male under the age of 40
- A history of radiation therapy to the head or neck
- Big lymph nodes in the neck
- Problems swallowing
- Problems speaking
- A family history of thyroid cancer
The next step is an ultrasound of the thyroid to determine the size of the nodule(s) and if it has certain characteristics that increase the possibility of its being cancer. A fine needle aspiration biopsy to obtain tissue from the thyroid nodule is then performed to determine whether the nodule is benign or malignant.
The specimen obtained from the fine needle aspiration is examined by a pathologist, who will most times be able to make a diagnosis between a benign or malignant lesion. If the lesion is benign, the patient is monitored for the growth of the nodule(s) 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 Center surgeons for removal of the thyroid.
Usually, the entire thyroid is removed (thyroidectomy), although in selected instances, only a part of the gland may be removed. At surgery, lymph nodes also may be removed to determine any possible spread of the tumor beyond the thyroid gland. Subsequent therapy depends upon the findings at the time of surgery. Some patients may merely 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 show progression. Most of the time, residual tumor can be treated with additional surgery or radioactive iodine. For resistant tumor external beam radiation may be prescribed, or the patient may be entered into a clinical trial with newer therapies or receive some existing targeted chemotherapies.
