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How Can Thyroid Nodule Be Treated?
My wife saw a specialist today and was told that she has two nodules, 1 on each side of the thyroid. 1 is 1.5 cm the other is 2.6 cm they took an biopsy of the larger one and it was deemed benign. The specialist say that he would recommend having the larger one removed. But as per him his opinion is biased. What do you think would be the best course of action.
Fri, 21 Oct 2016
Short answer: Surgery not always necessary, you have to take into consideration many other factors before deciding to remove it or not.
Long answer:
Hi there,
It sounds like your wife has been diagnosed with multinodular goitre, which is in itself a benign condition. There is a risk that the nodules could turn cancerous (research varies from 5-10% or more), but many patients also choose the wait and see approach. Surgery is done for two reasons - either when the thyroid gland is overactive (producing too much hormones), or to reduce risk of cancer (which in this case would mean taking out the whole gland, not just the larger nodule).
The decision has to be a discussion that takes into consideration your wife as a whole. Factors to be considered include:
1. Her risk of cancer - Does anyone in the family have thyroid cancer? Any other cancers? Did she have chest or neck X-rays as a child? In general, would you rather not have that increased risk of cancer to deal with?
2. Are the nodules causing her problems? - Is it overactive and causing her thyroid hormones to be high? If so, is it difficult to control with medication? Does she feel pressure on her neck or when she swallows? Is it growing rapidly?
3. Is she able to commit to regular monitoring (usually with ultrasounds and blood tests 1-2 times a year) to look for cancer if she does not surgically remove it? Is she able to commit to long term thyroid hormone replacement if she does decide to take the whole gland out?
4. Does she have health problems that will make surgery riskier for her? Does she understand the risks of thyroid surgery?
As you can see, it may not be a simple yes or no question here. Ultimately recommendations are basically just that, a recommendation based on what your doctor has taken into account about you. If you do decide to refuse surgery, explain to him why, and then you can work out a plan that would make sure you are safely monitored. And if you do decide to change your mind in the future, just bring it up again with him.
Hope this helps, stay well.
Regards,
Dr. Teh
Long answer:
Hi there,
It sounds like your wife has been diagnosed with multinodular goitre, which is in itself a benign condition. There is a risk that the nodules could turn cancerous (research varies from 5-10% or more), but many patients also choose the wait and see approach. Surgery is done for two reasons - either when the thyroid gland is overactive (producing too much hormones), or to reduce risk of cancer (which in this case would mean taking out the whole gland, not just the larger nodule).
The decision has to be a discussion that takes into consideration your wife as a whole. Factors to be considered include:
1. Her risk of cancer - Does anyone in the family have thyroid cancer? Any other cancers? Did she have chest or neck X-rays as a child? In general, would you rather not have that increased risk of cancer to deal with?
2. Are the nodules causing her problems? - Is it overactive and causing her thyroid hormones to be high? If so, is it difficult to control with medication? Does she feel pressure on her neck or when she swallows? Is it growing rapidly?
3. Is she able to commit to regular monitoring (usually with ultrasounds and blood tests 1-2 times a year) to look for cancer if she does not surgically remove it? Is she able to commit to long term thyroid hormone replacement if she does decide to take the whole gland out?
4. Does she have health problems that will make surgery riskier for her? Does she understand the risks of thyroid surgery?
As you can see, it may not be a simple yes or no question here. Ultimately recommendations are basically just that, a recommendation based on what your doctor has taken into account about you. If you do decide to refuse surgery, explain to him why, and then you can work out a plan that would make sure you are safely monitored. And if you do decide to change your mind in the future, just bring it up again with him.
Hope this helps, stay well.
Regards,
Dr. Teh
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