Consultant Thyroid, Parathyroid, Hernia and Gallbladder Surgeon

02380 178 991
A thyroid nodule is a discrete or dominant lump in the thyroid gland. They are very common and the vast majority of these are completely benign - Non Cancerous lumps.

Thyroid Nodules and Cancer

Some are found by accident on a scan done for another reason. Most are a visible or palpable swelling in the neck. They affect all ages and both Women and men.
They usually grows slowly until discovered for the first time one day - Making them initially feel quite scary. So what should you do about them?

Make an appointment to see me.

At this consultation I can answer all the questions that suddenly arise and make a clinical assessment of the Thyroid. 

Have specific blood tests and biochemical work up

It will diagnose problems in over or under activity and if there is an autoimmune component called thyroiditis present.

Nodules and cancer usually do not affect thyroid function and do not cause thyroiditis. 

Get an Ultrasound assessment for diagnosis

This test is excellent at reassuring us the thyroid nodules are benign when they are benign.

In some a small needle sample called an aspirate is required.
How we manage most

Diagnosing Benign Nodules

Usually this is diagnosed on the Ultrasound scan (+/- needle biopsy)

Benign US scan 

If the nodule is causing compressive symptoms it is better to remove it via an operation called a thyroid lobectomy where we remove either the left or the right side of the thyroid gland. If this is benign and you have no symptoms I would suggest leaving it alone. No further follow up is needed. It won't change into a cancer.

Inconclusive US scan having had a needle biopsy.

If at US the nodule is not definitely benign the doctor doing it will take a small needle biopsy. If both come back as 'indeterminate' then we cannot say for sure if this is benign and the risk of it being a cancer is around 25%. Once we have a diagnosis from this operation we can advise if any further treatment is needed such as removal of the rest of the thyroid. 

Thyroid cancer is diagnosed

Normally cancer is diagnosed after a diagnostic thyroid lobectomy (second box). But if we know for sure before that it is a cancer we can do a total thyroidectomy at the initial operation.

See below for treatment strategy in Thyroid cancers.

Managing Thyroid Cancer

There are 4 main types of Thyroid cancer. 2 are very rare and 2 are what we see >95% of the time. We call these well-differentiated thyroid cancers and they have an excellent outcome with the right surgery. I would expect >90% of these people to have a normal life expectancy without recurrent disease after good initial care and follow up.

Step 1: Making a diagnosis

This is done following the steps outlined above. Often an operation (thyroid lobectomy) has been needed to make a definite diagnosis. Once made we can move to Step 2.

Step 2: Multi-disciplinary discussion

This is a meeting of specialists from Surgery, Imaging, Pathology and Cancer Care. Once the diagnosis is made we can discuss specific features of your case and make a team recommendation on further care.

Step 3: Further care

We don't always recommend any further care as the Prognosis is so good in so many. But when further care is needed it is usually an operation to remove the rest of the thyroid gland sometimes followed by radioactive iodine as a one off tablet and Thyroid hormone replacement that suppresses any signalling to reactivate any scattered thyroid cells. Very occasionally further surgery to remove lymph node spread is needed either at the outset or after follow up.

Step 4: Surveillance

This is ongoing surveillance by the Cancer Care team who can advise on and administer any other treatment such as radioactive iodine, Monitor you get adequate thyroid hormone replacement and measure blood markers for signs of recurrence. This can go on for 5-10 years. 
Call us to book an appointment 02380 178991