The treatment of these thyroid nodules varies on the nature of the nodules as well as the symptoms produced. Any malignancy will need to be removed if it is over 15 mm. Some smaller malignancies are now being followed without surgery. These are followed utilizing strict criteria and under research- based protocols. The success of this non-operative surveillance of small cancers has been very successful.
Small nodules tend not to create symptoms, whereas large nodules can create many problems such as difficulty with breathing when laying flat, difficulty with swallowing solid food (pills), and even a chronic cough. Nodules with compression symptoms can be removed with surgery. If they are not cancer and not suspicious for the possibility of cancer, than a minimally invasive, ultrasound guided therapy can effectively destroy the nodule. This treatment applies energy directly to heat it up to the point of tissue death. Once the tissue is devitalized, the body walls off and slowly reabsorbs the treated tissue. This method leaves the adjacent normal tissue unharmed and thus preserves the thyroid function. Unfortunately, with surgery the entire side (lobe) is generally removed due to safety concerns. This unavoidably removes the abnormal and normal tissue on the entire side. Approximately 60-75% of these patients will require thyroid hormone supplementation.
If a biopsy raises a concern for the possibility of cancer, then surgery is recommended to allow for proper analysis of the tissue by pathologist. The surgery should be performed by a surgeon very familiar with thyroid operations, and who performs them regularly. The definition of a high- volume thyroid surgeon is currently established at 25 operations annually.
The Thyroid Nodule Treatment Center is available to navigate the numerous diagnostic and therapeutic options with you. Patients with normal thyroid function and who are symptomatic from large thyroid nodules can present immediately to review treatment options. This includes large visible nodules which are cosmetically distracting. The most innovative therapy may be available to you. International studies demonstrate excellent immediate and long- term results with radiofrequency ablation. A list of expert endocrinologists will be provided for those patients who have a complex endocrine history and require further evaluation, and long term care.