Thyroid nodules (lumps) are very common.
Approximately 50% of people will have a thyroid lump if the thyroid is scanned with an ultrasound machine
In the UK the only lumps that need to be assessed are:
1. Visible thyroid swellings
2. Palpable thyroid swellings
3. Thyroid nodules seen on scans >1cm in size
Thyroid nodules under 1cm in size do not require any action
In my view thyroid ultrasound is over used particularly outside hospitals and I generally recommend that patients should first see someone in a one-stop thyroid clinic where biopsies are undertaken after clinical assessment.
The only way to determine whether a thyroid nodule is benign or malignant is to perform a fine needle aspiration of some cells which are then assessed under a microscope by a cytology specialist.
The Fine Needle Aspiration (FNA) can either be done by the consultant in clinic - quick and straightforward using a blood test needle - or done by a radiology specialist with the aid of ultrasound.
The results from FNA are classified:
THY 1 Not enough cells to give a clear diagnosis - the test must be repeated to acheive a diagnosis
THY 2 Benign - repeated at 2-3 months as a second double check and if still benign
THY 3 Indeterminate - this should be reviewed in a thyroid multi-disciplinary team meeting
THY 4 Suspicious result which may represent a thyroid cancer
THY 5 Definite thyroid cancer according to cytology
The action following the biopsy is outlined below:
THY 1 Repeat to establish diagnosis if possible - if no clear answer needs surgery to remove
THY 2 Benign and can therefore safely leave alone or offer patient choice re excision
THY 3 Remove to acheive definite diagnosis as 20% plus are cancerous
THY 4 Repeat to acheive definite diagnosis if possible or remove with on-table frozen section
THY 5 Needs surgery - usually a total thyroidectomy
Benign nodules are still removed. The reasons for removing these are:
1. Symptoms - often uncomfortable in the neck, difficulty swallowing, choking feeling etc
2. Cosmetic issues
3. Cancer concerns
4. Family history of thyroid cancer
5. Radiation exposure - particularly as a child (increase cancer risk)
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Thyroid Surgery by a UK specialist surgeon