Solitary thyroid nodules (STNs) are discrete masses within the thyroid gland, located in front of the neck. While most are benign, some can be malignant, requiring thorough evaluation. A team from the All India Institute of Medical Sciences (AIIMS) Delhi, Surgical Department, led by Dr Sunil Chumber tells ARCHANA JYOTI that proper assessment to determine nature and risk is vital for a patient's well-being

WHAT IS STNs

BY Dr. Sunil Chumber, Dr. Piyush Ranjan, Dr. Suneha

If you've ever felt a lump or swelling in the front of your neck that moves up and down with swallowing, it could be a solitary thyroid nodule (STN). But what exactly is it, and does it pose any health risks? Let's break it down.

Imagine your thyroid gland as a butterfly-shaped organ located in the front of your neck, just below your Adam's apple. Normally, it functions smoothly, regulating various bodily functions through hormone production. Sometimesa single abnormal lump or nodule can develop within an otherwise normal thyroid gland, this is known as a solitary thyroid nodule.This can happen due to a variety of reasons.

Solitary thyroid nodules can affect individuals of all ages, including children, and in both genders but are more common in women. At any given time, about 4 to 8 out of every 100 people may have these nodules, which sometimes may not be visible to the naked eye, but are seen on ultrasound of the neck. The good news is, not all Solitary thyroid nodules require treatment. Although it is advisable to get them checked by a doctor since a small number of these nodules can harbor cancer.

Symptoms

BY Dr Sunil Chumber & Dr. Suneha

Thyroid nodules can be tricky because they might not show any signs, especially if they're small. You might not even feel them or notice any symptoms. But sometimes, they can be found during a regular check-up or when you're getting another scan done for something else.

However, if a nodule grows bigger, you might notice it yourself when you look in the mirror or someone else might spot it. You might even be able to feel it with your hand. As they get bigger, they can cause problems like:

Breathing Difficulty: Especially when lying down.

Swallowing Difficulty: It might feel like something is stuck in your throat.

Voice Changes: Your voice might sound different.

Feeling Something's There: You might feel like something's pressing on your throat.

In some cases, these nodules can also mess with your hormones, causing symptoms like:

Weight Loss: Even though you're eating more.

Hand Tremors: Your hands might shake.

Heart Palpitations: Your heart might race.

Feeling Nervous or Sweaty: You might feel jittery or sweat a lot.

Menstrual Irregularities: Your periods might not be regular.

If you notice a nodule growing quickly or if you have any of these symptoms, it's really important to see a doctor right away. Don't ignore any changes in your thyroid, no matter how small they seem. Your health is worth taking care of!

Classification                                                       

Dr Gopal Puri & Dr. Devender Singh

The STN can be broadly classified into benign, indeterminate, and malignant.

• Benign nodules are not cancerous and are not likely to cause harm. Most thyroid nodules are benign.
• Malignant nodules are cancerous. However, it is important to note that most thyroid nodules are benign, not cancerous.

Indeterminate: Sometimes, the results of tests (Fine needle aspiration biopsies- FNAC) are inconclusive, meaning they can't definitively say whether the nodule is cancerous or not.

The classification is based on features of cells seen under a microscope using Bethesda System and the American Thyroid Association guidelines. The risk assessment is done using ultrasound characteristics, and staging based on clinical and pathological factors. These classification systems help surgeons determine the appropriate management and treatment plan for patients with thyroid nodules, including whether surgical intervention is necessary and the extent of surgery required.

Investigations    

BY Dr. Ankita Singh & Dr. Kamal Kataria

When doctors need to figure out what's going on with your thyroid nodules, they use a few different tests to get the full picture. These tests help them understand if the nodules are harmless or if they could be cancerous. Here's what they do:

Neck Ultrasound: This is like taking a picture of your neck using sound waves. It helps the doctor see the thyroid gland and any nodules clearly without any pain. They can tell a lot about the nodules, like how big they are and what they look like inside.

Fine Needle Aspiration (FNA) Biopsy: This sounds scarier than it is. It's a procedure where they use a tiny needle to take out some cells from the nodule. Then, they look at these cells under a microscope to see if there's anything abnormal, like cancer cells.

Blood Tests: These tests help the doctor check how well your thyroid is working and if there are any signs of trouble. They look at different things in your blood:

Thyroid Function Test: This checks levels of thyroid hormones and a hormone called TSH that helps control your thyroid. If these levels are off, it could mean your thyroid is not working right.

Thyroglobulin Levels: This checks for a protein that the thyroid makes. High levels could mean there's a risk of thyroid cancer.

Calcitonin Levels: Doctors check this hormone to see if there's a rare type of thyroid cancer called medullary thyroid carcinoma.

By doing these tests along with imaging studies like ultrasound and looking at cells under a microscope, doctors can get a good idea of what's going on with your thyroid nodules. This helps them decide the best way to take care of you and make sure you stay healthy.

Treatment                                                           

BY Dr Richa Garg & Dr. Ankita Singh

When it comes to dealing with thyroid nodules, doctors consider your medical history, do a physical exam, and often use ultrasound to get a better look. They might also do a biopsy, where they take a tiny sample of the nodule to check for cancer cells.

Here's what happens next based on the results:

Benign Nodules: If the biopsy shows that the nodule is harmless and your thyroid is working fine, you might not need any special treatment. But if the nodule is big and causing problems or you don't like how it looks, you might consider surgery. Sometimes, if the nodule is making too much thyroid hormone and causing symptoms, you'll need medicine or other treatments.

Malignant Nodules: If the biopsy shows cancer, you'll likely need surgery to remove all or part of your thyroid gland. Sometimes, they might also remove nearby lymph nodes. After surgery, you might need more treatment like radioactive iodine to make sure all the cancer cells are gone. You'll also need to take thyroid hormone pills every day for the rest of your life to keep your body working right.

Uncertain Results: If the biopsy doesn't give a clear answer, you might still need surgery to remove the nodule. But there are some new tests that can help doctors decide if surgery is really necessary, especially if the risk of cancer is low.

Cysts and Tough Cases: Nodules that keep coming back or are really big might need surgery. And if a nodule looks suspicious on ultrasound but the biopsy doesn't show anything, it's still a good idea to talk to your doctor about removing it, especially if you have a family history of thyroid problems or were exposed to radiation as a child.

Remember, your doctor is there to help you figure out the best plan for your nodules. Don't hesitate to ask questions and make sure you understand your options.

(To be continued)