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Thyroid nodules are simply areas of the thyroid gland that appear differently than normal thyroid tissue. They are very common and sometimes are found by patients themselves, by physicians and sometimes incidentally on testing. Most of the time (95%), these nodules are benign and non- cancerous. When one or many of these nodules are found, the next steps are mainly to rule out that a thyroid cancer is present.
The first step is the diagnosis phase is typically to test the function of the thyroid gland. This is done by measuring the TSH (Thyroid Stimulating Hormone) as well as levels of the thyroid hormone levels themselves. If the testing is normal, often an ultrasound is done and if the thyroid gland appears to be hyper-functioning, with an elevated TSH, a thyroid scan is often done. At Sparkle Health, we always will check for thyroid antibodies to look for immune system dysfunction.
If the nodules are benign in appearance on imaging, we then start to think about and look at why the nodules are present. If the nodules appear to be more suspicious for malignancy, then we usually will refer out for a biopsy using a fine needle to take a core of tissue to look at it under the microscope for cancerous cells.
Sometimes nodules are monitored over time to make sure they are not changing and getting larger. Typically, size is one of the criteria for biopsy. Nodules greater than 1 cm in size are often considered for biopsy depending on the radiologic appearance.
Our goals when a dominant large nodule are present are the following:
As with everything in functional medicine, we look at the presence of nodules as a “symptom” of an imbalance in the system. In the case of thyroid nodules, the main systems we look at are the immune system and the balance of hormones in the body.
References:
Thyroid nodule update on diagnosis and management
Shrikant Tamhane, Hossein Gharib
Clin Diabetes Endocrinol. 2016; 2: 17. Published online 2016 Oct 3.
2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodulesand Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer
Bryan R. Haugen, Erik K. Alexander, Keith C. Bible, Gerard M. Doherty, Susan J. Mandel, Yuri E. Nikiforov, Furio Pacini, Gregory W. Randolph, Anna M. Sawka, Martin Schlumberger, Kathryn G. Schuff, Steven I. Sherman, Julie Ann Sosa, David L. Steward, R. Michael Tuttle, Leonard Wartofsky
Thyroid. 2016 Jan 1; 26(1): 1–133.
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