Get a full thyroid nodule evaluation today at the UCLA Endocrine Center in Los Angeles, CA.
Thyroid nodules are very common. Fortunately, most of them are benign. The biggest challenge in the evaluation of thyroid nodules is avoiding overtreatment, i.e. knowing when a patient can safely avoid surgery. Initial evaluation of a newly discovered thyroid nodule includes assessment by an endocrinologist, ultrasound evaluation, and fine-needle aspiration biopsy when appropriate.
We do recommend surgery for about 10-20% of thyroid nodules for known or suspected thyroid cancer. At the UCLA Endocrine Center in Los Angeles, multiple layers of evaluation are designed to help you avoid invasive tests and surgery whenever possible. Careful ultrasound evaluation by a doctor (not a technician) helps assess the risk level of a given nodule – which ones require biopsy and, importantly, which ones do not. If biopsy is needed, our cytopathologists evaluate over 1000 samples per year, which has led to expert performance allowing the majority of nodules to be confidently called benign so that surgery can be avoided. For indeterminate (suspicious) nodules, another layer of molecular profiling is automatically applied to refine the diagnosis. Surgery is then reserved for the small fraction of patients with nodules that are highly suspicious for cancer.
In 20% of patients who have a thyroid biopsy, the biopsy results are indeterminate (this means that we cannot be certain whether the thyroid nodule is benign or cancerous). These indeterminate cases, which carry a 10-30% risk of cancer, were traditionally managed with surgical removal of part of the thyroid to establish a definitive diagnosis. Molecular profiling provides additional genetic information for indeterminate nodules, allowing more patients with benign nodules to avoid surgery.
An endocrinology consult, ultrasound, and FNA can all be performed in a single visit with on-site cytopathology adequacy evaluation and immediate surgical consultation if needed.
Thyroid nodules may be discovered on routine physical examination, incidentally on imaging (CT or MRI scans of the chest, spine or ultrasounds of the carotid arteries). Thyroid nodules are common and increase in frequency with age, affecting approximately half of the adult population by age 45. Fortunately, most thyroid nodules are benign and therefore require no treatment. Thyroid cancer is found in only 6 percent of nodules. Therefore, one of the highest priorities in managing thyroid nodules is to avoid overtreatment (unnecessary surgery). The evaluation of thyroid nodules includes a complete history, physical examination, dedicated thyroid ultrasound, and fine needle aspiration biopsy when appropriate. If thyroid nodules are large and cause symptoms such as difficulty swallowing, change in voice or neck pressure, they may require removal by a surgeon.
Thyroid cysts are fluid-filled nodules within the thyroid. Like thyroid nodules, these may be diagnosed on physical examination or incidentally on imaging. If very large, these may cause some discomfort on the front of the neck. Pure thyroid cysts are usually benign (non-cancerous).
Patients who were exposed to radiation during childhood or adolescence, such as treatment with radiation for acne or tonsillitis, environmental exposure (such as proximity to Chernobyl or Fukushima) or whole body or head and neck irradiation for childhood cancer are at a higher risk of developing thyroid nodules and thyroid cancer. Patients should be evaluated with thyroid blood tests and ultrasound. Fine needle aspiration biopsy may be performed on thyroid nodules, as needed.
Multinodular goiter describes an enlarged thyroid gland containing multiple nodules. Most often, these nodules are benign. Thyroid function is typically not affected by the presence of thyroid nodules unless a nodule is over-producing thyroid hormone (see toxic multinodular goiter). Evaluation of thyroid nodules will include a complete history, physical examination, thyroid ultrasound, and fine needle aspiration biopsy when appropriate. If a multinodular goiter is large and causes symptoms such as difficulty swallowing, change in voice or neck pressure, they may require removal by a surgeon. Endemic goiter occurs in people who were born and raised in iodine-deficient areas. In Southern California, we see many patients from Iran and Armenia with endemic goiter.