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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). In addition, 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 experienced ultrasonographers!
  • 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 ultrasound.

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!

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 or surgery.

These are the most common indications for a thyroid ultrasound:

  • Evaluation of a palpable lump in the neck, either inside or outside of the thyroid
  • 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
  • Hyperthyroidism
  • Hypothyroidism
  • 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.

Servicing Provo

Jules Aljammal, MD

Servicing Lehi and Salt Lake City

Konstantinos Segkos, MD

Servicing Provo

To discuss your case with our doctors, contact the Thyroid Institute of Utah.

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The Skilled & Compassionate Care You Need

Why The Thyroid Institute of Utah is the Clear Choice for Your Treatment
  • Experienced endocrinologists

  • Skilled thyroid surgeons

  • Thousands of biopsies performed

  • Specialize in minimally invasive surgery

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