DRLUGO BLOG

Thyroid disease can present in the form of a nodule or a lump.  This is most commonly seen in females, but can be seen also in males.  Most nodules are benign in nature and we observe them.  The first step in evaluating a thyroid problem is to determine the function of the thyroid gland by testing the leves of thyroid hormones.  Then we can evaluate the nodule using u/s.  Most cystic nodules (fluid filled) are benign and are observed.  solid nodules can be observed also, but these we like to test further and assure that there are no malignant cells or indication that they may be malignant.

The decision to operate may be made based on the appearance and behavior of the nodule, but also on the symptoms the pt has.  If there is discomfort, or a growing nodule than we can go to surgery and eliminate the problem area of the thyroid.  A needle biopsy can be done on a thyroid nodule and that can be helpful at times if enough tissue is obtained to r/o cancer.  Most of the time the findings are indeterminate and the decision to go to surgery is based on pt symptoms and u/s finings.  nother tool that is not used anymore as much is the thyroid scan.  this tells the physician if the thyroid nodule is cold or hot.  A hot nodule is a nodule that is actively producing thyroid hormone.  A cold nodule is inactive.  a hot nodule is less likely to be malignant than a cold nodule.  This is a good test if the decision to operate is not based on pt symptoms.  If the pt is having difficulty swallowing or other symptoms, the scan may not give information that would be helpful.

Every pt with thyroid problems is different and the decision to operate is made between the surgeon, endocrinologist and pt.  There are medical therapies that were not mentioned here, but that can be used to treat some thyroid nodules.  I do not go in detail this since this is a surgeons blog, but we consider all those when making an assessment and decision to operate.

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