Thyroid nodules are in most cases benign (non-cancerous) tumors which are commonly seen in clinical practice. In the majority of cases nodules are small in size and located some distance from sensitive structures so they are usually asymptomatic and often not even recognized. However, nodules can cause symptoms such as shortness of breath or – in the case of hot nodules – hyperthyroidism (overactivity of the thyroid).
Do I need treatment for my thyroid nodule?
Often, patients are not even aware that they have thyroid nodules prior to an imaging test of the neck due to other medical issues. These asymptomatic and “hidden” nodules are almost always benign and are often left untreated. However, regular safety check-ups and initial diagnostic are commonly conducted in order to rule out any risk of malignancy. Therefore, it is always advisable to discuss with a physician if you suspect you have a lump in the thyroid or neck area.
Sometimes, nodules cause symptoms such as pressure on the trachea or gullet, or hyperthyroidism which requires therapy. In the few cases, where diagnosis reveals thyroid cancer, treatment options also have to be carefully discussed with a physician in order to keep the disease from spreading.
Which non-surgical treatment options are available?
A wide variety of treatment alternatives exist for thyroid nodules and the choice of method depends on clinical characteristics of the lump as well as patient preferences. Surgical excision is often no longer required and can be replaced by gentler and less invasive treatment options.
Medication, suppressive doses of the thyroid hormone levothyroxine are still common. However, recent studies and observations have increased doubt about the efficacy of this treatment approach. Significant side effects have been revealed, especially in postmenopausal women and elderly patients. Consequently larger sections of the medical community no longer recommend this treatment.
- Radioiodine therapy
For radioiodine therapy the patient swallows a dose of radioactive iodine which gets transported to the thyroid. The therapy is often recommended in cases of hot nodules and hyperthyroidism because the more active tissue takes in more of the radioactive substance and is therfore destroyed. Studies have shown effective results with this treatment approach. However, pregnant or breast-feeding women are not eligible for this therapy due to the potential side effects and risks of developing cancer or hypothyroidism (underactive thyroid) as large amounts of the thyroid tissue are destroyed. In recent years there has been some concern and discussion amongst physicians about the negative long-term effects of a radioiodine treatment.
Over the past decade, studies have focused on developing alternative methods to traditional treatments. Various nonsurgical, minimally invasive techniques have been developed, favoring ablating the thyroid nodules as opposed to removing them. Percutaneous (“through the skin”) ethanol injection has shown to be effective for cystic nodules, although application in solid nodules is limited due to the seepage of ethanol into tissues around the nodule. The most serious adverse effects include recurrent nerve palsy, Horner syndrome or neck hematoma. Innovative thermal procedures such as laser, radiofrequency or microwave ablation considerably reduce the size of thyroid nodules. Although all procedures are considered safe, transient side effects including pain, bleeding, hematoma formation, nodule rupture, fever, skin burn, and impaired vocal cord mobility have been observed. Some of the complications are associated with the insertion of a needle into the nodule and the transmission of heat to the surrounding tissues.
- Non-invasive therapy
Echotherapy is the only non-invasive treatment option besides the questionable treatment of medication. Echotherapy treats benign thyroid nodules with ultrasound beams. Each individual beam passes through the patient’s skin and the tissue surrounding the thyroid nodule at a low energy level. Only at the focal point where ultrasound beams come together the therapeutic effect of echotherapy takes place. Thus, only the thyroid nodule is treated, and surrounding tissue is protected. Studies have shown that Echotherapy is a highly efficient and safe treatment method.
Which therapy is the best for me?
The therapy that is best for you depends on the type of thyroid nodule and your diagnostic results. Therefore, individual consultation with a physician is important in order to find the best treatment for you. Your own personal preference is also important and you should discuss this with you physician.