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Treatments and drugs
By Mayo Clinic staffDepending on the type of thyroid nodule you have, your treatment options may include:
- Watchful waiting. If a biopsy shows that you have a benign thyroid nodule, your doctor may suggest simply watching your condition, which usually means having a physical exam and thyroid function tests at regular intervals. You're also likely to have another biopsy if the nodule grows larger. If a benign thyroid nodule remains unchanged, you may never need treatment beyond careful monitoring. Talk to your doctor if you're not comfortable with this approach or want more information on other options.
- Thyroid hormone suppression therapy. This involves treating a benign nodule with levothyroxine (Levoxyl, Synthroid), a synthetic form of thyroxine that you take in pill form. The idea is that supplying additional thyroid hormone will signal the pituitary to produce less TSH, the hormone that stimulates the growth of thyroid tissue. Although this sounds good in theory, levothyroxine therapy is a matter of some debate. There's no clear evidence that the treatment consistently shrinks nodules or even that shrinking small, benign nodules is necessary.
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Radioactive iodine. Doctors often use radioactive iodine to treat hyperfunctioning adenomas or multinodular goiters. Taken as a capsule or in liquid form, radioactive iodine is absorbed by your thyroid gland, causing the nodules to shrink and signs and symptoms of hyperthyroidism to subside, usually within two to three months.
Because thyroid hormone is released into your bloodstream as the nodules are destroyed, in rare cases your symptoms may worsen for a few days or weeks after therapy. You also might experience neck tenderness or a sore throat. And because this treatment eventually causes thyroid activity to slow considerably, you may develop hypothyroidism.
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Surgery. The usual treatment for malignant nodules is surgical removal, often along with the majority of thyroid tissue — a procedure called near-total thyroidectomy. Occasionally, a nodule that's clearly benign may require surgery, especially if it's so large that it makes it hard to breathe or swallow. Surgery is also considered the best option for people with large multinodular goiters, particularly when the goiters constrict airways, the esophagus or blood vessels. Nodules diagnosed as indeterminate or suspicious by a biopsy also need surgical removal so they can be examined more thoroughly for signs of cancer.
Risks of thyroid surgery include damage to the nerve that controls your vocal cords and damage to your parathyroid glands — four tiny glands located on the back of your thyroid gland that help control the level of calcium in your blood. After thyroidectomy, you'll need lifelong treatment with levothyroxine to supply your body with normal amounts of thyroid hormone.
- Thyroid nodules. American Thyroid Association. www.thyroid.org/patients/brochures/Nodules_brochure.pdf. Accessed Oct. 9, 2008.
- Ross DS. Diagnostic approach to and treatment of thyroid nodules. http://www.uptodate.com/online/content/topic.do?topicKey=thyroid/8983&selectedTitle=1~70&source=search_result. Accessed Oct. 9, 2008
- Ross DS. Overview of thyroid nodule formation. http://www.uptodate.com/online/content/topic.do?topicKey=thyroid/2323&selectedTitle=2~70&source=search_result. Accessed Oct. 9, 2008.
- Approach to the Patient With a Thyroid Nodule. The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec12/ch152/ch152b.html?qt=thyroid%20nodules&alt=sh. Accessed Oct. 9, 2008.
- Ridgway EC. Medical treatment of benign thyroid nodules: Have we defined a benefit? Annals of Internal Medicine. 1998;128:403
- Lee GA et al. Disorders of the Thyroid Gland. In: Lalwani AK. Current Diagnosis & Treatment in Otolaryngology — Head & Neck Surgery. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine.com/content.aspx?aID=2829111. Accessed Dec. 16, 2008.
- Clark OH. Thyroid & Parathyroid: Evaluation of Thyroid Nodules & Goiter. In: Doherty GM et al. Current Surgical Diagnosis & Treatment. 12th ed. Ann Arbor, Mich.: The McGraw-Hill Companies; 2006. http://www.accessmedicine.com/content.aspx?aID=2061372. Accessed Dec. 16, 2008.
