Cystic nodules can remain stable, occasionally get smaller and sometime continue to expand. Some cysts may rapidly expand due to bleeding or hemorrhage within the cyst. Rapidly expanding cysts can become symptomatic producing a noticeable lump in the neck, pain, difficulty swallowing and very rarely change in voice.
Cysts that are completely fluid filled have a much lower risk of thyroid cancer compared to cysts that have solid components. Diagnosis of a cystic thyroid lesion may be made at the time of ultrasound, or following a fine needle biopsy when fluid is obtained from the thyroid cyst. Spontaneous resolution of a thyroid cyst is rare but may occur in up to 15% of cases. Most large cysts or complex cysts should be aspirated with a fine needle to rule out the possibility of malignancy. Ultrasound-guided needle biopsies of a complex cystic nodule is necessary to insure that the biopsy material contains thyroid cells, and not just cystic fluid. Only these cells of the solid component will provide the necessary information whether the cystic nodule is of concern or not.
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For evaluation of a partly cystic nodule, the risk of cancer seems proportionate to the degree to which the nodule also contains solid components. Partially cystic nodules which contain at least 50% solid tissue, have a risk of malignancy that is similar to equal size nodules that are completely solid. On the other hand, largely cystic nodules with smaller solid components have a much lower risk of thyroid cancer, usually less than 5%.
Pure thyroid cysts may be managed in a variety of ways. Most commonly, pure thyroid cysts which are 3cm or less in size are merely observed and monitored for changes. Alternative management approaches for thyroid cysts are many including aspiration and instillation of ethanol or other ablative approaches. Simply aspirating thyroid cysts is largely ineffective with very rapid return of the cyst fluid. Thyroid surgery effectively removes thyroid cysts but is not commonly utilized unless there are multiple large thyroid cysts and they have become noticeable or symptomatic to the thyroid patient.
Become Our PatientFounded by Dr Gary Clayman, the Clayman Thyroid Center is widely known as America’s leading thyroid surgery center performing nearly 2000 thyroid operations annually. Our reputation as the best thyroid surgeons means patients from all over the US and many foreign countries travel to Tampa for their thyroid surgery. With same-day evaluation and surgery scheduling, we make traveling for thyroid surgery convenient for every patient.
What to read next
- Thyroid Cancer Overview - An introduction to thyroid cancer, what it is, and the prognosis of the different thyroid cancers.
- Thyroid Nodules - what are Thyroid Nodules and how are they treated (or not treated)?
- Types of Thyroid Cancer: Papillary, Follicular & Medullary.
- Surgery for Thyroid Cancer - learn about the different types of surgery and when they are appropriate.
- How to become our patient