Benign Thyroid Nodules Treatment

Observation

If the biopsy suggests that the thyroid nodule is benign, the doctor may suggest simply watching the patient and the thyroid nodule. The duration of observation is however somewhat arbitrary. Observation usually implies repeating thyroid blood tests, ultrasound, and physical examination in approximately one year. If the thyroid nodule should increase in size or establish symptoms, repeat biopsy or another intervention may be indicated. Thyroid nodules that don’t change over a period of years may never require any treatment whatsoever.

Thyroid Hormone Therapy

Although there is little to no evidence to support that taking thyroid hormone effects the growth of benign thyroid nodules, the practice of prescribing thyroid hormone for benign thyroid nodules continues. In theory, prescribing thyroid hormone can lower the thyroid stimulating hormone (TSH) production of the pituitary gland and thus decrease the stimulation to growth of thyroid tissue.

Surgery

Sometimes clearly benign thyroid nodules are managed with surgery. Some potential indications for removing benign thyroid nodules include:

  • The thyroid nodule is large (producing a visible mass in the neck)
  • The thyroid nodule is producing symptoms on the breathing tube or swallowing tube
  • The thyroid nodule is producing excessive thyroid hormone
  • Thyroid nodules which have Indeterminate or suspicious for cancer FNAs.
  • Multinodular goiters producing symptoms
In some circumstances, clearly benign thyroid nodules which are symptomatic, can be managed with a process called radio frequency ablation (also called RFA). If RFA is used to treat a clearly benign thyroid nodule, either general anesthesia or at times, local anesthesia can be utilized. RFA can work for some benign nodules but may require a period time for the nodule to get smaller. Additionally, retreatment with RFA can be used as well. For nodules that are located on the "back" side of the thyroid gland in the area of the nerve to the voice box, RFA should not be used because it can permanently damage the voice bo nerve.

Malignant Thyroid Nodules (Cancer) Treatment

We have written a very informative section on Thyroid Cancer Surgery. Almost all thyroid nodules which are malignant are treated by surgery. The options of extent of surgery including total removal of the thyroid gland (total thyroidectomy) versus removal of half of the thyroid gland (thyroid lobectomy) are discussed in detail. Only expert thyroid cancer surgeons should be performing thyroid surgery because the risk to the patients including the nerves to the voice box and glands that control calcium are significantly higher in those that do not do these types of surgery routinely and frequently.