Thyroid nodules
Lumps within the thyroid gland — extremely common and, in the great majority, benign. The evaluation focuses on two questions: is the nodule overactive (making too much hormone), and is there any feature suggesting the small chance of cancer.
What it is
A thyroid nodule is a discrete lump within the thyroid gland. They are very common — found by touch in a small percentage of adults but on ultrasound in a large proportion, increasingly with age — and the overwhelming majority are benign: colloid nodules, cysts, or benign growths. Only a small minority (roughly 5–10%) are cancerous, and most thyroid cancers found this way are highly treatable. Nodules usually cause no symptoms and are found incidentally, on examination or on a scan done for another reason. The evaluation answers two practical questions: first, is the nodule producing excess thyroid hormone (a 'hot', usually benign, nodule causing hyperthyroidism), which the TSH screens for; and second, does it have any features — on ultrasound or by risk factors — that warrant a needle biopsy to check for cancer.
Key lab markers
- TSH — the first test; a low TSH suggests an overactive ('hot') nodule, which is very rarely cancer.
- Free T4 (and T3) — to characterise an overactive nodule.
- Thyroid ultrasound — the key test; describes size and features that estimate cancer risk and guide biopsy.
- Fine-needle aspiration biopsy — for nodules with suspicious features or above a size threshold.
- Thyroglobulin — not for diagnosis, but used in follow-up if a nodule proves cancerous and is treated.
- Anti-TPO — if coexisting autoimmune thyroid disease is suspected.
Symptoms
- Usually none — most nodules are found incidentally
- A visible or palpable lump in the neck
- Rarely, if large: difficulty swallowing, a sensation of tightness, or a change in voice
- Symptoms of an overactive thyroid, if the nodule makes excess hormone — palpitations, weight loss, heat intolerance, tremor
- Pain is uncommon and usually from bleeding into a nodule or thyroiditis
Related symptoms
Related lab panels
When to discuss with a doctor
A thyroid lump, or a nodule found on a scan, is worth assessing — but reassuringly, most are benign. The standard first steps are a TSH blood test and a thyroid ultrasound; based on the ultrasound features and size, a fine-needle biopsy may be advised to check for cancer, or simple monitoring may be enough. A rapidly growing nodule, a hard fixed lump, hoarseness, difficulty swallowing or breathing, or a nodule with enlarged neck lymph nodes should be evaluated promptly. An overactive nodule causing hyperthyroid symptoms is treated on its own terms. Mediora.AI can flag the TSH pattern that suggests an overactive nodule; the ultrasound assessment and any biopsy belong with endocrinology.