The thyroid gland is a butterfly-shaped organ located at the front of the neck; it produces hormones that regulate the body’s energy balance, metabolism and many vital functions. Small, usually oval or round masses that form in this gland are known as ‘thyroid nodules’. With the increasing use of ultrasound today, thyroid nodules are frequently detected, particularly in individuals over the age of 30.
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The majority of thyroid nodules are benign and do not cause any symptoms. However, a small proportion—approximately 5%—may be malignant (thyroid cancer). For this reason, every nodule must be carefully assessed. Thyroid nodules generally do not cause symptoms in patients; however, in some individuals, symptoms such as a swelling in the neck, difficulty swallowing, hoarseness, or, if the nodule produces excessive hormones, palpitations, weight loss and irritability (toxic goitre) may occur.
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Nowadays, thyroid nodules are usually detected during a neck examination carried out for another reason, or during investigations of that area such as ultrasound or CT scans. If a nodule is suspected, blood tests should be carried out to check TSH levels and a detailed thyroid ultrasound should be performed. Ultrasound reveals the number, size, structure and risk characteristics of the nodule. In nodules larger than one centimetre or those showing suspicious findings, a fine-needle aspiration biopsy (FNAB) is performed to determine whether the nodule is benign or malignant.
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The treatment approach depends on the type of nodule. Benign and small nodules are generally monitored regularly. In cases where nodules secrete hormones or grow to the point of compressing surrounding tissues, treatment options such as medication, radioactive iodine therapy or surgery may be considered. In the case of malignant (cancerous) nodules, surgical removal of the thyroid gland is the primary treatment method.
Thyroid surgeries are performed under general anaesthesia. The most significant complication of a thyroidectomy is hoarseness. This is because the nerves (the recurrent laryngeal nerves) that control the movement of the vocal cords
run alongside the posterior surface of the thyroid gland. As the number of nodules in the thyroid gland increases, or in cancer patients where the tumour directly encases the nerve, the risk of nerve damage may rise. The surgeon’s experience is crucial in these operations to minimise this risk. Furthermore, the use of a nerve monitor during surgery assists the surgeon by identifying the nerve and monitoring its function throughout the procedure. Despite all these precautions, hoarseness may still occur in cases of unilateral paralysis, and shortness of breath may occur in cases of bilateral paralysis.
Taking all this into account, although most thyroid nodules are benign, their size and characteristics should be monitored via ultrasound during regular check-ups. The risk of nodules becoming cancerous increases with age. If you notice a swelling in your neck that does not go away, it is advisable to consult an ear, nose and throat specialist. This is because cancers in the head and neck region, including those of the thyroid, often present as painless swellings in the neck. For this reason, do not neglect your regular medical check-ups to maintain a healthy lifestyle.
