Comprehensive Thyroid Nodule Care
Why choose the Thyroid Institute of Utah for management of your thyroid
nodules? Here, at the Thyroid Institute of Utah, we guarantee comprehensive
care for thyroid nodules:
You should expect a
thorough evaluation with a history and physical, lab tests (if they have not been done already),
a neck ultrasound, and a clear plan about the next steps,
at your first visit!
Your doctor will perform your ultrasound, and share the results with you in real time. We not only evaluate the
thyroid itself, but we also evaluate the whole anterior neck, so you can
rest assured that if there is any visible cancer in the neck lymph nodes,
we will find it. Our endocrinologists have performed thousands of neck
ultrasounds, so you can have
piece of mind that bad things will not be missed. This is in contrast to the vast majority of radiologists, as they rely
on technicians to get the ultrasound images of the thyroid, which dramatically
decreases the quality of the exam (the best way to interpret thyroid ultrasound
images is by far to interprete them live, while doing the ultrasound).
most radiology centers will only evaluate the thyroid and NOT the rest
of the neck, so there is no guarantee that cancer in the lymph nodes will
not be missed. Even if you had a thyroid ultrasound by a radiologist, most of the time
we will need to repeat it due inadequate lymph node evaluation or thyroid
nodule description. Thus,
if you feel a lump in your neck, please schedule an appointment with us
directly, to save costs!
If biopsy is needed, you can expect this done by anexperienced endocrinologist during your second visit, with minimal pain and almostzero chance of complications! The specimen is always sent to a very experienced cytopathologist specializing
in thyroid FNA cytology reading, to make the diagnosis as accurate as
possible. When needed, we save a sample for molecular testing, to try
to avoid unnecessary surgery for indeterminate thyroid nodules.
If the biopsy result is cancer or suspicious for cancer, we will perform
lymph node mapping, and refer you to an experienced high volume thyroid surgeon in our center,
to ensure the best outcome possible! You can then expect
comprehensive thyroid cancer care with the same endocrinologist that evaluated the thyroid nodule!
If the biopsy result is benign, you will know that your nodule will be
monitored by experienced endocrinologists who are also
All the above significantly decrease your stress, costs and travel, as you get
comprehensive thyroid nodule and cancer care in 1 location with the same
doctor, with the minimum visits possible!
See below for details of our Comprehensive Thyroid Nodule Care!
What is a Thyroid Nodule?
A thyroid nodule is an abnormal growth of thyroid tissue within the thyroid
gland. When one is found, it is common to find more nodules with a thyroid
Visible thyroid nodule.
How common is it to have thyroid nodules?
These tend to form as we age. They are uncommon in children and young adults,
but they may be found in half the people over the age of 80.
How do I know if I have thyroid nodules?
Some thyroid nodules are found on palpation by a patient or a physician.
However, physical exam can only identify the larger thyroid nodules that
are on the front of the thyroid. Most thyroid nodules cannot be palpated.
In addition, when your doctor feels there is a thyroid nodule, thyroid
ultrasound will show that there was no thyroid nodule in 1 in 6-7 patients.
Most nodules (especially the smaller ones) are found incidentally on, such
as neck ultrasound, CT or MRI scan of the neck or chest, a PET scan, a
carotid duplex, etc.
What is the best way to find out if I have thyroid nodules?
The best way to see if you have a thyroid nodule is with a thyroid ultrasound.
Ultrasound is extremely sensitive, and can find the tiniest thyroid nodules.
Even if a nodule is seen with another imaging modality, ultrasound is
still recommended as it can find additional nodules. The appearance of
a thyroid nodule on ultrasound is also extremely valuable, as based on
this we can evaluate what is the chance of each nodule to be cancerous.
The only limitation of a thyroid ultrasound is that its quality is operator
dependent. The more experienced the performing and interpreting physician,
the more sensitive and specific the ultrasound gets. Another caveat is
that nowadays most thyroid ultrasounds are performed by technologists,
and are then interpreted by doctors. As ultrasound is best when images
are taken live, this decreases the quality of the ultrasound. In addition,
most of the time, the technicians will not evaluate the rest of the neck,
which can lead to missing and inadequately treating cancerous lymph nodes.
Here, at the Thyroid Institute of Utah, all our endocrinologists are very
experienced in thyroid ultrasound. They perform the ultrasound themselves
and interpret the images live, and share the results with the patient
at the bedside!
Ultrasound of a large thyroid nodule.
I was told I have a Thyroid Nodule. Is it cancer?
Overall, the chance that a thyroid nodule is cancerous is about 5-10%,
but this changes with age. A thyroid nodule found in a child or young
adult is more likely to be cancerous. For older people, thyroid nodules
are more common, but they are less likely to be cancerous. However, in
general, thyroid cancers found in older people tend to be more aggressive
that the ones found in younger people.
The best way to find out if a thyroid nodule is benign or cancerous is
to undergo an Ultrasound Guided Fine Needle Aspiration Biopsy (FNA).
Do I need to get a Thyroid Ultrasound?
We recommend a consultation with a thyroid specialist for the decision
about obtaining a thyroid ultrasound, in order to incorporate your symptoms,
a careful physical exam, and a targeted medical and family history into
the decision making. This way, you will avoid an unnecessary ultrasound
which could lead to unnecessary further testing and even unnecessary procedures
These are the most common indications for a thyroid ultrasound:
- Evaluation of a palpable lump in the neck, either inside or outside of
- Evaluation of a thyroid nodule incidentally found on other imaging (such
as CT, MRI, PET/CT, etc)
- Follow up of thyroid nodule to assess if they get bigger
- Screen for thyroid cancer in high risk patients (positive family history
of thyroid cancer, history of neck radiation as a child, exposure to nuclear
fallout as a child)
- Large or irregular thyroid on palpation
- Suspicion that there is ectopic thyroid (thyroid tissue not in the expected location)
- Lymph node mapping prior to surgery, in a patient with biopsy-proven thyroid cancer
- Monitor for lymph node metastases or recurrence in the neck, for patients
who have undergone surgery of thyroid cancer
- Evaluation of the thyroid for suspicious nodules, for patient who will
undergo neck surgery for a disease not related to the thyroid
- Evaluation of the thyroid for suspicious nodules, in patients planned for
radioactive iodine treatment of hyperthyroidism
- Positive anti-thyroid antibodies
- Assessment of the thyroid structure in patients with congenital hypothyroidism
- Evaluation of the parathyroids for abnormalities, in patients planned to
undergo thyroid surgery
- Evaluation of the parathyroids in patients with recurrence of hyperparathyroidism
after undergoing surgery or ablation
What is a thyroid FNA? What are its risks?
This is a simple procedure that is performed in the office. The skin over
the thyroid is numbed with local anesthesia (such as lidocaine gel or
injection). Then, the physician takes a very thin needle, and inserts
it inside the thyroid nodule, using ultrasound guidance, which helps make
sure the sample comes from the actual nodule and not somewhere else, and
also decreases the chance of complications. The physician jabs the needle
inside the nodule for a few seconds, and then removes it. This is repeat
a few times (usually 2-4), and then the procedure is completed. The complication
rate is very low, and it may include pain, infection or bleeding. Serious
complications are extremely uncommon. There are no restrictions after
the procedure, apart from avoiding NSAIDs for some time to avoid bleeding.
At the Thyroid Institute of Utah, our endocrinologists are very experienced
in ultrasound guided thyroid FNA, and we have performed thousands of FNAs
at our center. This helps reduce the number of needle sticks, make sure
the sample is adequate, and lowers the risk of complications!
I have a thyroid nodule. Do I need FNA?
Most nodules actually do not need FNA! There are many parameters that the
endocrinologist takes into account, including the size of the nodule,
if it is mostly solid or liquid, the structure of the nodule on ultrasound,
if there are calcifications, if there are lymph nodes in the neck that
look cancerous, etc. The patient’s history is also very important,
as trouble swallowing, voice changes, history of neck radiation, family
history of thyroid cancer, and other things, are very important in the
decision making process. These parameters are outlined in the American
Thyroid Association guidelines, which are followed our endocrinologist
follow. It is very important for your doctor to be up-to-date on the latest
guidelines, recommendations, and research. If they are not, this may lead
to unnecessary biopsies, anxiety, and cost for patients with clearly benign
thyroid nodules, or inappropriate reassurance and recommendations for
incomplete treatment (for example when cancerous lymph nodes are not identified
or biopsied), for patients with cancerous thyroid nodules.
What are the results I may get from a thyroid nodule FNA? What do we do
with these results?
The cytology result from a thyroid FNA can be:
- Non-diagnostic (not enough cells. This is rare with an endocrinologist
experienced with biopsies)
- Benign (<3% chance of cancer)
- Indeterminate (15-30% chance of cancer)
- Suspicious (~70% chance of cancer)
- Malignant (95-99% chance of cancer)
The treatment is simple for benign nodules, as we typically monitor them
and do not refer for surgery, unless they cause pressure symptoms. The
treatment for suspicious and malignant nodules is also simple, as we recommend
surgery in most patients, unless there is a reason not to do it.
However, the indeterminate results are a grey area. In the past, depending
on the whole clinical picture, we may recommend surgery, repeat biopsy,
or monitoring. In the past few years, new molecular testing techniques
became available, and we can now further separate indeterminate nodules
to benign or suspicious. This can help us find out which nodules should
be monitored, and which nodules should be removed. Overall, these molecular
tests have decreased the number of diagnostic thyroid surgeries performed!
Here, at the Thyroid Institute of Utah, we utilize these molecular tests,
and have been very successful in preventing patients from getting unnecessary surgery.
What if my FNA result shows that I have thyroid cancer?
If you have biopsy-proven thyroid cancer, you will need an experienced
endocrinologist coupled with an experienced thyroid surgeon, for the best
outcome. The endocrinologist’s job is to carefully examine the whole
anterior neck with the ultrasound, to assess if there are any lymph nodes
with thyroid cancer metastases. In addition, the endocrinologist should
get a careful history and physical to see if there is any clinical evidence
of thyroid cancer metastases in the rest of the body. Then, the endocrinologist
will make a recommendation about type and extent of surgery (should we
remove half or the whole thyroid? Should we remove lymph nodes, and if
yes, which ones?). Here, at the thyroid institute of Utah, our endocrinologists
perform these evaluations. We are very experienced with neck ultrasound,
and wecreate a surgical map for the surgeons, so that the cancerous areas
are clearly visible. This way, we make sure we get the desired outcome.
Then, the surgeon will take over and perform the surgery. It is very important
to have an experience surgeon, as this decreases the risk of complications
(voice nerve damage and hoarseness, low calcium due to damage of the parathyroid
glands, big blood collections in the neck), and helps decrease the chance
that cancerous thyroid tissue is left in the neck. 50% of thyroid surgeries
in the US are performed by surgeons who only do 1 thyroid surgery per
year. An experienced surgeon does more than 25 thyroid surgeries per year
according to available clinical trial data. Each of our surgeons performs
50-100 thyroid surgeries per year, so our complication rate is extremely low.
After the surgery, your care returns to the endocrinologist. If it turns
out the nodule was benign, we monitor your thyroid hormone replacement
(and the calcium supplements in the rare case the parathyroid glands are
damaged). If the nodule was indeed malignant, then we perform monitoring
of the hypothyroidism AND the thyroid cancer with the tumor marker thyroglobulin,
neck ultrasound, and other labs and scans if needed. Please see the Thyroid
Cancer section for more details.
Shahzad Ahmad, MD.
Servicing Draper and Provo
Jules Aljammal, MD
Servicing Lehi and Salt Lake City
Konstantinos Segkos, MD
To discuss your case with our doctors, contact the Thyroid Institute of Utah.