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Thyroid Nodules

    What Is The Thyroid Gland?

    The thyroid is a small butterfly-shaped organ that sits in the neck in front of your windpipe. This gland produces a hormone called “thyroid hormone” that is responsible for many of the bodies regulatory activities. It controls your body’s metabolism, heart rate, breathing, and energy levels.

    What Is A Thyroid Nodule?

    Thyroid nodules are common growths within the substance of the thyroid gland. A large portion of the population has asymptomatic nodules that are often discovered incidentally during tests for other reasons. The majority of thyroid nodules are not cancerous but may require testing to ensure that there are no cancerous cells contained within the nodule. Some thyroid nodules may transform and change into cancer over time so they may need to be observed. If you have been diagnosed with a thyroid nodule, you need to be seen and evaluated by a thyroid specialist.

    What Causes Thyroid Nodules?

    Thyroid nodules are very common and can occur for a variety of reasons. They may be caused by low iodine in your diet. They may be caused by underlying diseases within the body that cause inflammation of the thyroid gland, such as Hashimoto’s Thyroiditis. Sometimes the little growths may contain fluid that causes cysts in the thyroid gland. More serious causes of nodules include thyroid cancer. Often times however, thyroid nodules are simply normal tissue within the thyroid gland that are of little to no consequence.

    What Are The Symptoms Of Thyroid Nodules?

    Most often thyroid nodules are asymptomatic and are usually found during workup and testing for other reasons. You may have gotten an MRI of the spine for neck pain and the radiologist finds a nodule “incidentally” in the thyroid gland. Other symptoms may be related to the nodule size. If the nodule is large or is part of a large thyroid gland, it may cause swallowing problems, hoarseness, or sometimes even difficulty breathing. Other types of nodules that produce thyroid hormone may cause anxiety, nervousness, sleeplessness, weight loss, or an irregular heartbeat.

    What Are The Risk Factors For Thyroid Nodules?

    Risk factors for developing thyroid nodules include:

    • Family history
    • Age
    • Gender
    • Radiation exposure

    What Do I Do If I Was Told I Have A Thyroid Nodule?

    The first thing to do is to remain calm. Thyroid nodules are very common and usually are not dangerous. However, they do need to be worked up by a qualified physician. By seeing a head and neck surgeon and an endocrinologist, the appropriate plan of action can be made to manage your thyroid nodule.

    How Is A Thyroid Nodule “Worked Up”?

    The goal of evaluating thyroid nodules is to find out which are the “good ones” (i.e. not cancer), and which ones are “bad ones” (i.e. possibly cancer). By seeing a qualified physician like Dr. Mourad, certain tests can be done to help distinguish different types of nodules, and allow for an appropriate plan of action.

    • Ultrasound – An ultrasound is usually one of the first tests that are used to evaluate a nodule. Similar to baby ultrasounds, it is a painless procedure in which a probe is applied to the thyroid gland in the neck that takes different pictures of the thyroid nodule. Based on how the nodule appears in the ultrasound, it can help distinguish good nodules from bad nodules. If the nodule is larger than 1 cm, calcified, has a large blood supply, or is irregularly shaped then you may need further work-up.
    • Blood work – Your physician may also draw blood to determine if your thyroid hormone levels are within a normal range. “Hot” nodules produce excess thyroid hormone and are usually non-cancerous.
    • Fine Needle Aspiration – Also known as an FNA, this is an outpatient procedure in which a small needle is inserted into the nodule and used to extract cells. These cells are then evaluated under a microscope allowing the physician to determine the probability of having cancer. The cells will help determine: No cancer, low probability of cancer, a high probability of cancer, or the presence of actual cancer cells. Depending on what this test shows you may need surgery.

    What Do I Do If My Nodule FNA Shows “No Cancer”?

    Most often FNA will show no cancer, and these nodules are referred to as benign. Depending on the appearance of the nodule under ultrasound these can be watched over time. This would usually involve yearly ultrasound. Ultrasound testing will be used to determine any suspicious changes such as changes in size or blood flow that may indicate a cancerous change in the nodule. If there are no changes, then you can continue to be followed without intervention. However, if there are changes found in your yearly ultrasound, you may need to repeat the FNA.

    What Do I Do If My Nodule Shows “Low To High” Probability Of Cancer?

    These types of nodules are more difficult to manage and there are a variety of options that exist. One option is to repeat the FNA and see if a second sample produces a more accurate result. Other times, genetic testing can help determine which nodules are truly cancer and which ones are benign. However, the best intervention to know for sure if there is cancer, is to remove the nodule entirely, and evaluate the whole nodule and gland under the microscope.

    What If My Nodule Appears To Be Cancerous?

    Again, the first thing is to remain calm. Thyroid cancers are more than 95% curable if caught at an early enough stage. Depending on the characteristics of the cancer, it will need to be removed with surgery. The extent of surgery will usually involve removing at least one lobe of the thyroid gland in a procedure called a “hemithyroidectomy”. Sometimes, very small cancers, that do not appear aggressive do not need anything more than a hemithyroidectomy. However, usually both lobes of the thyroid gland need to be removed in a procedure called a “total thyroidectomy”. Total thyroidectomies are performed when there is a high likelihood of cancer being involved in the non-nodule side of the thyroid gland.

    What Does Surgery Of The Thyroid Gland Involve?

    There are two sides of the thyroid gland. Surgery of the thyroid lobe usually involves removing one or both sides of the thyroid lobe. This is highly dependent on the size and type of thyroid cancer you have. Surgery is usually performed in a hospital, and depending on the type of surgery, you may be able to go home the same day. Other times, you may have to spend 1-2 days in the hospital for observation. The intent of surgery is for a cure, and to remove all cancer.

    Why Should I See Dr. Mourad For My Thyroid Surgery?

    Dr. Mourad is a highly dedicated and skilled thyroid surgeon. He is one of New York City’s highest volume surgeons performing more than 50 thyroid surgeries annually. He is also a dedicated researcher who studies and uses artificial intelligence in managing and predicting thyroid cancer behavior. He has presented his original research at the International Federation of Head and Neck Surgery (IFHNOS) 6th World Congress in Argentina. He also has published extensively about thyroid cancer and continues to be a leader in the field.

    Meet Dr. Moustafa Mourad

    Meet Dr. Moustafa Mourad

    Head and Neck Surgeon

    Moustafa Mourad, MD, is board-certified in head and neck surgery and highly-trained in cosmetic plastic surgery and facial reconstruction. He treats many conditions, both cosmetic and complex, that affect the head, neck and entire facial area. Learn More »

    Thyroid Research and Publications

    Moustafa Mourad MD Masoud Saman MD Raja Sawhney MD Yadranko Ducic MD. Management Of The Thyroid Gland During Total Laryngectomy In Patients With Laryngeal Squamous Cell Carcinoma. Laryngoscope. 2015 Aug; 125:1835–1838. Link to Article.

    Mourad M, Kadakia S, Jateganokar A, Gordin E, and Ducic Y. Intraoperative Nerve Monitoring During Parathyroid Surgery: The Fort Worth Experience. Head & Neck. 2017 Aug;39(8): 1662-1664. Link to Article.

    Kadakia S, Mourad M, Hu S, Brown R, Lee T, and Ducic Y. Utility of intraoperative nerve monitoring in thyroid surgery: 20-year experience with 1418 cases. Oral Maxillofac Surg. 2017 Sep;21(3):335-339. Link to Article.

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