How a nodule becomes noticeable
Small nodules cause no symptoms. Larger ones, or an overall enlarged thyroid, may make themselves felt through:
- a feeling of pressure or tightness in the neck, often described as “a lump in the throat”
- an increase in neck circumference, a collar becomes tighter
- difficulty swallowing
- hoarseness or a change in the voice
- a palpable nodule
Most often, however, a nodule is noticed without any symptom at all – on an ultrasound that was done for another reason.
At a glance
- Frequency: nodules are very common and benign in over 95 percent of cases
- First steps: measure TSH and perform high-resolution ultrasound
- Hot or cold: “hot” nodules produce hormones themselves, “cold” ones do not
- Fine-needle aspiration: only for a suspicious ultrasound appearance or relevant size
- Goitre: simply means “enlarged thyroid” – without saying anything about the cause
- Appointment: book online or by phone on +43 1 5333 654
What we look at
On ultrasound we assess every nodule by the same features: size, shape, margins, echo pattern, calcifications and blood flow. This gives a risk assessment that is described in an internationally standardised way.
At the same time we measure the TSH. If it is suppressed, this points to a hormone-producing – “hot” – nodule. A scintigraphy (thyroid scan) then follows, which we organise with a nuclear medicine centre.
Hot or cold?
The terms come from scintigraphy and describe whether a nodule produces hormones:
- Hot nodule: produces hormones autonomously. It is practically never malignant, but can lead to hyperthyroidism.
- Cold nodule: produces no hormones. It too is usually benign – but here a closer investigation is worthwhile.
When we biopsy – and when we do not
Fine-needle aspiration is not routine for every nodule. We recommend it when the ultrasound shows risk features – for instance a markedly hypoechoic pattern, microcalcifications, irregular margins or a shape that is taller than it is wide – or when an otherwise unremarkable nodule exceeds a certain size.
For a small nodule that clearly appears benign, monitoring is the better decision than a biopsy. You can read how a fine-needle aspiration is performed under Diagnostics.
What happens next
The most common scenario: the nodule is unremarkable, the values are normal, and we monitor it at a set interval – every six to twenty-four months depending on size and ultrasound appearance.
If a nodule leads to hyperthyroidism, we treat that. If it is suspicious, or if its size is compressing the windpipe or oesophagus, we discuss surgery and refer you to a specialised surgical unit – and we take over your follow-up care afterwards.
Frequently asked questions
Does a nodule always have to be removed?
No, quite the opposite: most nodules are simply monitored. Surgery is performed if malignancy is suspected, if a nodule is so large that it causes symptoms, or if hyperthyroidism cannot be brought under control any other way.
Do nodules keep growing?
Many remain unchanged for years. Some grow slowly, a few even shrink. That is exactly why we monitor them – not because we expect things to get worse, but so that we notice any change early.
Are nodules hereditary?
A tendency towards nodules and goitre does indeed often run in the family. So please mention during your consultation whether your mother, sister or grandmother had thyroid problems – it affects how closely we monitor you.