Thyroid Nodules Should Be Examined

Thyroid nodules – or abnormal growths on the thyroid gland – are quite common, with the rates of thyroid cancer growing, a leading expert told physicians last week.

Kenneth D. Burman, M.D., chief of the Endocrine Section at Washington Hospital Center and professor in the Department of Medicine at Georgetown University, presented at Sinai Hospital Grand Rounds on “Thyroid Nodules and Thyroid Cancer: Recent Advances.”

Dr. Burman cited an autopsy study in which it was discovered that 12 percent of the deceased had one nodule, 37 percent had multiple nodules and 2.1 percent even had thyroid cancer – even though they did not know it and died from other causes. Women are three to four times more likely to have thyroid nodules than men, and the nodules most commonly appear in women in their 30s and 40s.

While 90 to 95 percent of thyroid nodules are benign (such as adenomas, cysts or infections), it’s imperative that they are closely monitored by an endocrinologist to make sure they are not cancerous.

Two key diagnostic tools are ultrasound and fine needle aspiration. An ultrasound can tell a doctor if the nodule is solid, has blurred edges or calcifications, or has a lot of blood vessels feeding it – all of which are potential signs of cancer. If the nodule has any of these characteristics, a fine needle aspiration biopsy, or FNA, will be ordered. During an FNA, key portions of the nodule will be removed with a small needle so that they can be evaluated to see if they are cancerous.

According to Dr. Burman, 86 percent of thyroid FNA results come back as non-cancerous, while 4 percent are malignant and 10 percent are suspicious. However, when the FNA and biopsy are repeated 6 to 12 months later, 22 percent of nodules can be categorized as malignant or suspicious. (Sixty percent of suspicious FNA results are later found to be malignant.) Therefore it is important that the patient have another FNA about 6 months later and ultrasound be repeated every 6 to 12 months to recheck the size and characteristics of the nodule.

In terms of incidence, thyroid cancer is the fastest growing cancer, with a 5 to 6 percent increase in the number of cases diagnosed each year. Dr. Burman says that there has been a 2 to 3-fold increase in thyroid cancer in the past 20 or 30 years. The most common thyroid cancer – papillary cancer, which amounts for 80 percent of cases, has a fairly good prognosis, with 93 percent of papillary cancer survivors living 10 or more years after diagnosis.

However, anaplastic thyroid cancer, which accounts for 2 percent of all thyroid cancer diagnoses, is the deadliest of all known cancers, with a 14 percent survival rate of more than 10 years. As with all cancers, the earlier thyroid cancer can be detected, the better the chances are that a patient will make a full recovery.

As with all cancers, the earlier thyroid cancer can be detected, the better the chances are that a patient will make a full recovery.

Surgery and radioactive iodine therapy are used to treat thyroid cancer. Also, if a non-cancerous nodule is a causing cosmetic problems or compressing a patient’s esophagus, it can be surgically removed.

If you or a loved one has been discovered to have a thyroid nodule and you’d like to schedule an appointment with a LifeBridge Health endocrinologist, call 410-601-WELL (9355).

-Holly Hosler