Thyroid nodules

Questions and answers

Thyroid nodules occur relatively commonly. The diagnosis is a cause for concern only in the rarest cases.

What are hot and cold nodules?

Hot and cold nodules have nothing to do with temperature. Instead, this refers to how active the nodules are and whether they produce hormones or not.

The cells found in a “hot nodule” produce hormones in an uncontrolled fashion, take up large quantities of iodine and can lead to excessive function. Hot nodules are the rarest and benign in nature.

We refer to a “cold nodule” as this area is dead, in a manner of speaking. Cold nodules are inactive. They do not produce any hormones and take up little or no iodine. A cold nodule can, in rare cases, indicate thyroid cancer and should always be investigated. However, only a minimal number of cold nodules are actually malignant. Cysts are also considered to be “cold nodules”, since they have no function.

Can nodules become dangerous?

Many people believe: a nodule means cancer. They can be put at ease, since thyroid nodules are almost always benign. Only approximately five percent of the nodules are cancers (malignant nodules). Hot nodules are actually always benign. They can, however, lead to excessive function of the thyroid, which can throw the entire hormonal balance into disorder and have a negative influence on the individual.

Must a thyroid nodule be treated?

Do you sweat a lot, are you irritable or have you recently lost weight without trying? Or are you always tired and liable to feel cold and gain weight easily? All of these could be signs of a thyroid that is functioning “incorrectly”. In addition, nodules can grow and cause problems during swallowing, hoarseness, a feeling of pressure in the neck or even breathing difficulty. In these cases, the nodules should be treated. The decision to treat should be made on an individual basis. Discuss this with your doctor.

But, don’t panic: Most thyroid nodules are small and harmless. If your thyroid test values are normal, the nodule is benign and you have no symptoms, no further treatment is necessary. However, it is important that the nodule is regularly followed up.

What does the thyroid do?

The thyroid is a small, butterfly-shaped organ with a great influence. It is the control center and the motor of our bodies. The thyroid produces hormones essential for life which regulate our metabolism and energy management. Thyroid hormones act on e.g. the heart and circulatory system, our digestion and sleep, the mind, growth and fat metabolism. If the thyroid starts to function abnormally, this can affect several processes in the body.

Why do nodules form in the thyroid?

First of all, you can put your mind at rest Thyroid nodules are almost always benign.
Only approximately 5% of the nodules are malignant, i.e. thyroid cancer.

Most thyroid nodules occur through iodine deficiency. If the thyroid receives too little iodine, it grows and enlarges its tissues. As a consequence, the thyroid cells enlarge and tissue nodules are formed.

Genetic changes can also cause thyroid nodules. An error in the genetic make-up manipulates the receptors for thyroid-stimulating hormone (TSH), the hormone formed in the thyroid, so that the cells produce increasing amounts of thyroid hormone Nodules may form because of the constant stimulation of the cells.

How common are thyroid nodules?

If you have a thyroid nodule, you are not alone: These nodular tissue changes occur in approximately 30% of adults, and among those aged over 65, this increases to 50%. You must therefore already know many other people who have nodules and many of whom are not even aware of it. Besides elderly patients, women are particularly commonly affected. They develop a nodule four times more often than men.

How are thyroid nodules discovered?

Thyroid nodules often grow very slowly and rarely exceed one centimeter in size. For this reason, most people simply don’t notice the nodule. They are often discovered during routine investigations or, sometimes, by the patients themselves.

If the nodules are enlarged, there could be problems in swallowing, hoarseness, neck pains or an unpleasant sensation of pressure in the neck region. Moreover, large nodules could also present cosmetic problems. Always consult your doctor if you discover a nodule or have symptoms.

How does the doctor make a definite diagnosis?

It is best to visit a thyroid specialist, known as an endocrinologist. During the examination, the doctor will first feel the area around the thyroid, and will then perform an ultrasound examination. If the doctor meanwhile notices a change, he will take a blood sample to check the thyroid values. If the nodules are enlarged or the blood values are suspicious, the doctor will perform scintigraphy. With the help of this imaging procedure, the doctor can check whether this is a so-called hot or cold nodule (see also: What are cold and hot nodules?) after administration of radioactive iodine. Usually a fine-needle biopsy – a tissue sample – is also helpful. This shows whether the nodule could be malignant.

How can thyroid nodules be prevented?

A diet with sufficient iodine can, under certain circumstances, prevent thyroid diseases. In an adult, the thyroid usually requires approximately 200 micrograms (millionth of a gram) of iodine daily. Iodine can be obtained e.g. from sea fish and iodised salt. In addition to the well-known iodised salt, several other foods also play an important role: Thus bread, milk and milk products as well as fish and seafood can help to cover the daily iodine requirements.

How do I cover my daily iodine requirements?

The body cannot make its own iodine. For this reason, you have to include it in your diet.
According to the WHO, adults have an iodine requirement of approximately 200 micrograms (µg) per day, while children and elderly people require approximately 150 to 200 µg per day.
Iodine-rich nutrition
In order to provide the body with sufficient iodine, you should deliberately make sure that you consume foods that contain iodine:
milk and milk products daily,
sea fish or seafood once or twice a week,
always use iodized salt at home,
preferably buy foods that have been produced with iodized salt.