Thyroid Nodules

The experienced surgeons at Greenville Ear Nose and Throat Associates offer comprehensive management of thyroid abnormalities for patients of all ages.

Patients are frequently referred to our practice for thyroid nodules. Thyroid nodules are quite common with studies suggesting that up to 2/3 of people will have one or more by middle age. The primary concern with a thyroid nodule is cancer. Fortunately, less than 15% of thyroid nodules are cancerous. In some cases, even non-cancerous nodules can be symptomatic causing trouble swallowing or throat discomfort.

Evaluation

We will employ several tools to evaluate your thyroid nodules and help determine risk for cancer. Determining a nodule’s risk for cancer guides our decision process regarding surgery.

• Ultrasound (sonography) is the best imaging study to evaluate the thyroid gland. We use the ultrasound to evaluate and measure nodules within the gland. We then use that information to determine the likelihood that a nodule is cancerous.
• Fine needle aspirate biopsy (FNA or FNAB) is another tool we frequently utilize to evaluate thyroid nodules. During an FNA, your surgeon or radiologist will place a small gauge needle into the nodule to obtain tissue. Ultrasound guidance is often employed to make the biopsy more precise
• Blood work to assess your thyroid function is also typically part of the evaluation. Thyroid stimulating hormone (TSH) is the most commonly drawn blood test. In the vast majority of thyroid cancer cases, thyroid function is normal. In some cases, however, we perform thyroid surgery for an overactive thyroid gland or nodule.

Surgical Treatment

Once a decision is made to perform surgery, we then decide the extent of surgery. In general, we remove either one half of the thyroid gland or the entire gland. Each case is unique. Your surgeon will use the information that has been gathered to guide you through the decision-making process regarding the extent of surgery.

All invasive procedures carry the risks of bleeding, wound infection, and reactions to anesthesia medicine. Thyroid surgery also has its own unique set of risks. The recurrent laryngeal nerve takes a course just behind the thyroid gland. Damage to this nerve can cause voice changes or swallowing trouble. The parathyroid glands are also at risk during thyroid surgery. The parathyroid glands are responsible for regulating calcium in our blood stream. Most people have 4 of these glands (2 on each side). They are found very close to the thyroid gland and share a blood supply with the thyroid. Normal parathyroid glands measure about the size of a grain of rice. If the parathyroid glands are damaged or removed with the thyroid, low calcium levels in the blood can result (temporary or permanent). Fortunately, vocal cord nerve injury or parathyroid gland damage causing permanent calcium issues are rare.

Post-Surgical Care and Monitoring

After surgery, if your entire thyroid gland is removed, you will be started on thyroid hormone replacement (generic name levothyroxine). Some monitoring is required to be sure your dosage is correct. If you only have half of the thyroid removed, studies suggest there is a 70-80% chance that you will not need to take thyroid hormone replacement. The other half of the gland that remains in your neck is usually able to make the thyroid hormone your body needs.