Thyroid Nodules | Diagnosis & Treatment

How are thyroid nodules diagnosed?

Thyroid nodules in children should be evaluated by a physician with special expertise in this area, usually a pediatric endocrinologist. In addition to taking a medical history and performing a physical exam, the doctor may order certain tests.

  • Blood tests are used to determine if the thyroid is working properly, or excessively. 
  • Ultrasound is the best imaging technique to visualize a known or suspected thyroid nodule. Ultrasound uses sound waves to assess the location and characteristics of nodules in the thyroid gland. Because ultrasound uses only sound waves, it does not expose the patient to any harmful radiation.
  • Fine-needle aspiration (sometimes called a biopsy) uses a very thin needle to take a sample of a thyroid nodule. A pathologist examines the cells in the sample to determine whether the nodule may be a thyroid cancer. Not all thyroid nodules require a biopsy. If the doctor determines that a biopsy is needed, it can be performed on the same day as the ultrasound, almost always without sedation.
  • Nuclear medicine imaging is used in some cases to determine if a thyroid nodule is producing too much thyroid hormone. Such autonomous nodules (also known as “toxic” or “hot” nodules) are usually benign (not cancer).
  • Surgery is sometimes needed to determine whether a thyroid nodule is a thyroid cancer, if the result of fine-needle aspiration (biopsy) is not definitive.
  • Genetic testing may be recommended in some cases when thyroid nodules occur as part of a possible genetic condition.

How are thyroid nodules treated?

Treatment of a thyroid nodule will vary depending on the results of the evaluation.

Observation may be appropriate for thyroid nodules that do not require biopsy, or for nodules that are biopsied and found to be benign. Periodic ultrasounds may be recommended to monitor these nodules for changes, and additional biopsies may be needed in the future if changes are seen.

Surgery may be recommended to remove thyroid nodules that have abnormal biopsy results that suggest a possible thyroid cancer, or nodules that cause bothersome symptoms (like difficulty swallowing).

  • Lobectomy is removal of one-half of the thyroid that contains a nodule. 
    • Lobectomy may be appropriate to remove nodules that have a low risk of being cancer, including benign nodules that are removed just because they cause symptoms.
    • Lobectomy is a relatively quick and safe procedure, and most patients do not need to take thyroid medication afterward.
  • Total thyroidectomy is removal of the entire thyroid gland.
    • Total thyroidectomy is usually appropriate for nodules that have a high risk of being cancer.
    • Lifelong treatment with thyroid medication is needed after total thyroidectomy.
    • This procedure is generally safe but rarely can have serious complications. For this reason, it is important that the procedure be performed by an experienced thyroid surgeon. Our thyroid surgeons have extensive experience in pediatric thyroid surgery and work closely with the rest of the Thyroid Center team to provide seamless, coordinated care before, during, and after surgery.

Autonomous nodules are usually benign. Their treatment depends on how much thyroid hormone they produce, and on whether this is causing symptoms of thyroid hormone excess.

  • Autonomous nodules that are slightly overactive and cause no symptoms can often be observed without treatment.
  • Nodules that are very overactive or that cause symptoms can be treated with medication, surgery, or (in patients over 18 years) radioactive iodine ablation.

Our approach to treating autonomous nodules is slightly different than that recommended by the American Thyroid Association, which recommends surgery for all autonomous nodules in children. Our 15_approach is based on our extensive experience with this condition — which was published after the release of the American Thyroid Association guidelines — showing that with careful evaluation, some autonomous nodules can be managed safely without surgery.

Thyroglossal duct cysts and other neck masses are managed differently than thyroid nodules, often with surgical removal.