Thyroid Nodules: Deciding when to observe and when to intervene

The majority of thyroid nodules are benign (non-cancerous) and if they aren’t causing symptoms, such as pressure or swallowing difficulties, they can be left alone and monitored on a regular basis by ultrasound examinations. However, thyroid nodules can convert from a benign to a malignant state. If a patient elects observation of his/her thyroid nodule, a repeat follow-up and ultrasound examination should be performed. Six to 12 months is generally accepted as a reasonable period of time before repeating physical and ultrasound examinations. An ultrasound-guided biopsy, known as a fine needle aspiration (FNA) should be repeated if the nodule grows in size or any new concerning features appear in the ultrasound imaging. This biopsy is done with local anesthetic (similar to dental procedures). In our clinic, we eliminate the need for multiple visits by performing the biopsy during the same office visit as the ultrasound examination whenever necessary. We also understand how unnerving it can be to wait for test results to be available. We have our pathologist examine the biopsy sample while the patient waits so we can provide the results during the same visit. This reduces stress and the inconvenience of multiple appointments.

If a thyroid cancer is diagnosed, we formulate a comprehensive treatment plan through the Swedish Head & Neck Thyroid Tumor Board, a panel of experts on thyroid and parathyroid cancer from multiple specialties. We maintain constant communication with primary care and referring providers as well as the patient and family.