What are thyroid nodules and swellings?
A swelling in the neck due to an enlarged thyroid gland is called a goitre. Nodules are lumps in the thyroid gland. Most are harmless but you should arrange an appointment with your doctor as soon as you find a lump or swelling.
What are the main causes of enlargement of the thyroid gland?
The main cause is unknown, but thyroid nodules and thyroid enlargement are more common in women than men and increase in frequency with age.
Women often develop thyroid enlargement during pregnancy and the menopause.
If you have a nodule or swelling in your neck you should see your doctor with a minimum of delay. Your doctor will assess the swelling and refer you to a specialist clinic if necessary. Most nodules and swellings are harmless, but it is always best to have them checked promptly in case they are among the few that are cancerous.
What are the main types of thyroid nodules and swellings?
The most common types are as follows:
- Single thyroid nodule (solitary nodule)
Solitary nodules are most commonly benign and very often can be left untreated. If a cancer cannot be excluded by investigations, surgery is usually recommended. If the nodule is ‘hot’ (i.e. it produces too much thyroid hormone) then it can be treated either by drug therapy, radioactive iodine treatment or sometimes surgery.
- Multiple thyroid nodules (multinodular goitre)
A multinodular goitre is common and usually does not need an operation unless you have problems with swallowing and/or breathing or if the goitre is unsightly. It is rare to find cancer in a multinodular goitre, but if the thyroid gland is growing rapidly or one or more of nodules raises concern following investigation, then surgery may also be recommended.
- Diffuse goitre
This is often caused by autoimmune thyroid conditions such as Hashimoto’s thyroiditis and Graves’ disease and can be associated with an over- or an under-active thyroid.
- Retrosternal goitre
Sometimes a multinodular thyroid grows down behind the breastbone. It can constrict or squash the windpipe (trachea) and the large veins in the neck and/or the gullet (oesophagus) because it is in a fixed bony space. In this situation, surgery may be considered. Most retrosternal goitres grow slowly over many years.
The following are types of thyroid nodules:
- Colloid and Hyperplastic nodules
These are benign lumps which can be solitary or found in a multinodular goitre. They can usually be observed without the need for surgery.
- Thyroid adenoma
This is also benign lump, but is harder to distinguish from a cancer by scans and biopsy. It is, therefore, usually removed surgically so that its benign nature can be confirmed by close examination under the microscope.
- Thyroid cyst
This is a swelling that contains fluid, which is treated by removing the fluid through a needle (fine needle aspiration). If this fails, then surgery may be advised.
- Thyroid cancer
Thyroid cancer is rare and has a high cure rate. The treatment for thyroid cancer is surgery to remove most or all of the thyroid gland, followed by radioactive iodine in some cases. You may need to take levothyroxine (synthetic thyroid hormone) in a slightly higher than normal dose to replace your body’s thyroid hormone production and to stop the cancer from recurring.
What are the usual tests performed to investigate thyroid lumps and swellings?
There are various tests that can be carried out to find the cause of your thyroid problem. These include:
- Blood tests – this is usually the first test performed and is done to ensure that your thyroid is not over- or under-active.
- Ultrasound scan - this is painless and uses sound waves from a probe to examine the structure of the thyroid gland. It can establish the number and size of nodules in the thyroid and can give important information on the likelihood that a nodule is benign or a cancer.
- Fine needle aspiration cytology (FNAC) - removes cells from the thyroid for examination under a microscope. There may be some discomfort, but most people describe it as similar to having blood drawn.
- X-rays - a CT scan (a special form of X-ray) may be performed to check the position of a retrosternal goitre in relation to the windpipe (trachea) and gullet (oesophagus).
- Nuclear medicine scan - this checks the size, shape, and position of the thyroid and detects areas that are over-active (‘hot’) or under-active (‘cold’).
What is the treatment?
If all the investigations are reassuring and the thyroid lump or swelling is not causing any problems, then no treatment may be required. Sometimes, the size of the lump may be monitored by follow-up scans. In some situations, the doctor may recommend one or several of the following treatments:
- Surgery – see: Your Guide to Thyroid Surgery
- Radioactive iodine – see: Your Guide to Treatment of an Over-Active or Enlarged Thyroid Gland with Radioactive Iodine
- Antithyroid drugs – see: Your Guide to Antithyroid Drug Therapy to Treat Hyperthyroidism
- Levothyroxine tablets - see: Your Guide to Hypothyroidism
You may also find helpful: Your Guide to Thyroid Function Tests.
Some important points….
- Any nodule or swelling you find should be investigated straightaway
- Most nodules and swellings are not cancerous
- Most thyroid cancers are curable
- Treatment for any of the above conditions may involve one or several of the following: surgery, radioactive iodine, antithyroid drug therapy or levothyroxine tablets
- Check with your doctor whether your prescription is exempt from charges
It is well recognised that thyroid problems often run in families and if family members are unwell they should be encouraged to discuss with their own GP whether thyroid testing is warranted.
If you have questions or concerns about your thyroid disorder, you should talk to your doctor or specialist as they will be best placed to advise you. You may also contact the British Thyroid Foundation for further information and support, or if you have any comments about the information contained in this leaflet.
The British Thyroid Foundation
The British Thyroid Foundation is a registered charity: England and Wales No 1006391, Scotland SC046037
The British Thyroid Association - medical professionals encouraging the highest standards in patient care and research
The British Association of Endocrine and Thyroid Surgeons - the representative body of British surgeons who have a specialist interest in surgery of the endocrine glands (thyroid, parathyroid and adrenal)
First issued: 2008
Revised: 2011, 2015
Our literature is reviewed every two years and revised if necessary.
© 2015 BRITISH THYROID FOUNDATION