Health Talk: Thyroid nodules, thyroid cancer | Maryland Gazette (HometownGlenBurnie.com)

In the past, most nodules were identified by exam at a physician's office or noted as a lump in the throat by patients or one of their close associates. Today many nodules are identified when obtaining tests of various types for other medical reasons. These tests may include CT scan, MRI or ultrasound. Most nodules do not cause symptoms.

Occasionally symptoms are seen and these relate to pain, difficulty breathing (especially when laying down), a feeling of food being stuck in the throat, and finally, can cause voice changes in the rare patient.

The first thing to note about thyroid nodules is that greater than 95 percent of all nodules will be found to be benign and will not need further surgery. Many of these nodules are filled with cystic fluid and can be aspirated away. The nodules are usually evaluated with the use of ultrasound followed by needle aspirate of the nodules.

This test is highly reliable, very accurate and can be performed in the office. An endocrinologist or a surgeon can perform this test and assist in making the diagnosis. Occasionally, the needle aspirate may not be conclusive and may need to be repeated.

Thyroid nodules are generally removed if they are causing symptoms, causing excess function or if they are thought to be cancerous. There are approximately 20,000 new cases of thyroid cancer annually with the incidence increasing slightly. Thyroid cancers are more common in females, more common as we age and tend to be more aggressive with increasing age. Radiation exposure can increase the chances of developing thyroid cancer.

Thyroid cancers are generally of four types. The two most common types are papillary and follicular thyroid cancers and account for about 95 percent of all thyroid cancers. The other two forms of thyroid cancer are medullary and anaplastic cancers. Medullary and anaplastic thyroid cancers tend to be more aggressive varieties and are infrequent.

Once the diagnosis of cancer is made the treatment generally consists of surgery. Surgery usually consists of removal of the lobe of the thyroid involved with the cancer and generally full or near complete removal of the other lobe of the thyroid. There will be nodal tissue removed with the thyroid as well as part of the surgery for the cancer. Radioactive iodine is generally given after the surgery as an adjunct to the treatment of the cancer. For most forms of thyroid cancer the cure rates approach 95 percent, as these cancers tend to be slow growing and removed with the surgery.

In summary, thyroid nodules are very common and increase in frequency as we age. These nodules harbor cancer in less that 5 percent of patients but should be evaluated by a surgeon or endocrinologist.

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Dr. Gopal Kowdley is a general surgeon specializing in endocrine surgery at Baltimore Washington Medical Center. To contact Dr. Kowdley, please call the Joslin Diabetes Center at 410-787-4940.