Thyroid Mass (Nodule): Causes, Evaluation, and Treatment

Discovering a lump in your thyroid can be alarming, but most thyroid nodules are benign. Prompt medical evaluation is essential to determine the cause and appropriate management.

Common Causes

• Thyroid nodules: Very common; >90% are benign. Can be solid, cystic, or mixed.
• Thyroid cysts: Fluid-filled sacs, usually benign.
• Thyroiditis: Inflammation (Hashimoto's, subacute, postpartum) causing diffuse or nodular enlargement.
• Graves' disease: Autoimmune hyperthyroidism with diffuse goiter.
• Thyroid cancer: ~5–10% of nodules; excellent prognosis for most types (papillary, follicular).

Diagnostic Workup

• TSH, free T4, T3: Assess thyroid function.
• Thyroid antibodies: TPO, TgAb, TRAb for autoimmune etiology.
• Ultrasound: Size, composition, vascularity, suspicious features (microcalcifications, irregular margins).
• Fine-needle aspiration (FNA) biopsy: For nodules >1 cm with suspicious features or >1.5–2 cm regardless. Bethesda classification guides next steps.

Treatment Depends on Diagnosis

• Benign, asymptomatic nodules: Observation with periodic ultrasound.
• Toxic nodules: Radioactive iodine or surgery.
• Cancer: Thyroidectomy ± radioactive iodine ± TSH suppression.
• Large compressive goiters: Surgery.

Early evaluation leads to better outcomes. Don't ignore a thyroid mass—schedule an appointment with an endocrinologist or ENT specialist.