Thyroid Nodule Symptoms: Top Things to Know

What are Thyroid Nodules?

Thyroid nodules are organized, usually well-defined growths that occur in the thyroid gland forming a lump or bump within the otherwise smooth thyroid gland. Thyroid nodules are common, occurring in at least 40% of women and 30% of men during their lifetime. However, the overall prevalence of thyroid nodules in the general population has been estimated as high as 65-68% based on autopsy studies. Most thyroid nodules are benign, but some are cancerous and symptomatic. As best we know, thyroid cancer only accounts for approximately 5-10% of all thyroid nodules. Thyroid nodules that are benign or cancerous can cause symptoms as well. Below are the top things to know about thyroid nodule symptoms.

#1 Top Things to Know: What are the symptoms? 

Thyroid nodules are often found when a doctor examines a patient's neck. Nodules are also frequently discovered when a patient gets an x-ray, CT scan, MRI, or ultrasound the neck or chest for some other reason. Just like lumps, tumors, or growths elsewhere in the body, thyroid nodules can cause symptoms. The symptoms can be difficulty swallowing or breathing, a noticeable lump or mass in the neck, pressure/discomfort (particularly when lying down) to a feeling of a lump or something stuck in one’s throat. Additionally, as these nodules grow, they can extend into the chest cavity, or push on the windpipe (trachea) or swallowing tube (esophagus), or end up behind the voice box. As thyroid nodule size increases, so too does the likelihood of the symptoms. Finally, if a thyroid nodule reaches 4 cm, or your nodule is large enough to cause symptoms, then thyroid surgery for treatment is almost certainly necessary.

Expert evaluation of symptomatic thyroid nodules is paramount to obtaining the correct treatment plan. 

#2 Top Things to Know: Size matters

As thyroid nodule size increases, the likelihood of symptoms also increases. Intuitively, a nodule that is 1 cm in the largest dimension is much less likely to cause symptoms than a large nodule measuring 3.5 cm. Smaller nodules, however, can be symptomatic (more on that below) depending on their location. The natural course of most nodules, even benign ones, is slow growth or enlargement over time. Typically, the rate of growth is not rapid. Basically, thyroid nodule size has a fairly linear or consistent correlation with likelihood of symptoms. Importantly, thyroid nodule size, however, does not directly correlate with the nodules being malignant. Certainly, patients worry more about thyroid nodule size as these tumors grow, and the majority of large nodules will eventually require surgery. 

As thyroid nodule size increases, these masses crowd out/replace normal thyroid tissue. The larger the nodule, the more likely symptoms are present. The bottom line is thyroid nodule size matters.

For more information regarding thyroid nodules and evaluation, see our article Top 5 Worries About Thyroid Nodules.

Figure 1: Thyroid nodule size chart demonstrates relative size and the effects large nodules have on the thyroid gland. Enlarged thyroid lobe shown would lead to symptoms like difficulty breathing and swallowing and would require surgical treatment.

#3 Top Things to Know: Location is important

Similar to real estate, location of thyroid nodules is important, particularly as it relates to symptoms. Large nodules (measuring 3 cm or more) are likely to cause symptoms noted above regardless of their location. Nodules that are located in the isthmus (middle strip of thyroid tissue sitting on the windpipe) are almost always symptomatic and noticeable at a smaller size.  

Figure 2: Thyroid anatomy highlights the isthmus (the middle strip of thyroid tissue sitting on the windpipe) and a thyroid nodule. Nodules located in the isthmus are often symptomatic and noticeable at smaller sizes due to their proximity to the trachea, potentially causing breathing or swallowing difficulties.

Nodules that are anterior (near the surface of the thyroid lobe close to the skin) are also symptomatic at smaller sizes. Typically, these nodules are seen or felt/palpated sooner. Finally, nodules that are near the posterior (back) surface of the thyroid (closer to the spine) can cause symptoms due to pressing on the esophagus (swallowing tube) or windpipe (trachea).  

Figure 3: MRI image shows a nodule located near the posterior surface of the thyroid gland, close to the spine. Nodules in this location can cause symptoms by pressing on the esophagus (swallowing tube) or windpipe (trachea), leading to difficulty swallowing or breathing.

Large nodules in these aforementioned locations tend to be more symptomatic than they would elsewhere in the thyroid gland.

To have a world-class evaluation of your thyroid nodule, become our patient at https://www.thyroidcancer.com/become-a-patient

#4 Top Things to Know: Hot (toxic nodules) can cause different problems

There are some rare circumstances where a patient has a hot/toxic nodule. In this instance, a thyroid nodule forms and starts to function on its own (goes rogue). The nodule makes thyroid hormone when the body does not need it. Therefore, a patient with a toxic/hot nodule will have too much thyroid hormone (hyperthyroidism). While larger toxic nodules also can cause compressive symptoms noted above, they also can cause different symptoms related to their overproduction of thyroid hormone. This is a more dangerous clinical situation than not having enough thyroid hormone for a couple of important reasons. First, your body can get overwhelmed by too much thyroid hormone causing the patient to be sick and need medical attention (thyroid storm). Secondly, too much thyroid hormone can cause the heart to beat dangerously fast and/or irregularly. This will also land a patient in the hospital.

Hyperthyroidism can also cause other symptoms that will make a patient feel ill or symptomatic: hair loss, palpitations, tremors, anxiety, hair loss, weight loss, change in appetite, insomnia, and more. Toxic/hot nodules can be definitively cured with thyroid surgery to remove the affected half of the thyroid. Radiofrequency ablation is also a great option to treat and shrink a hot nodule. This procedure is less invasive and has a greater chance of preserving normal thyroid function.

Summary

To conclude, thyroid nodules are very common, more so in women than men. While most thyroid nodules are benign, some are symptomatic. Not surprisingly, as nodules enlarge, they are more likely to be symptomatic. Location of nodules is also important as it relates to when and if symptoms will present. Smaller nodules can cause symptoms sooner than expected if they are in the right location. Finally, nodules that are hot/toxic and cause overproduction of thyroid hormone are almost always symptomatic, but in a different way. Finding an expert team to work up, diagnose, and treat your thyroid nodule that is causing symptoms is essential. Inexperience in evaluation, biopsy, and surgery or intervention for thyroid nodules will lead to poor outcomes and complications. Entrust only the best when it comes to care and treatment of your symptomatic thyroid nodules.

Additional Resources

• Become our patient at www.thyroidcancer.com/become-a-patient
• More about the The Clayman Thyroid Center at www.thyroidcancer.com
• More about the Hospital for Endocrine Surgery