Did you notice a lump in your neck? If yes, chances are you may have developed a thyroid nodule, which is an abnormal growth of thyroid cells that forms a lump within the thyroid gland. Generally, thyroid nodules are benign, but a small proportion is cancerous and needs timely treatment to stop it from spreading. As it doesn’t cause any symptoms, the only way to detect these cells early is to take an evaluation test. Learn all the common tests that are used to diagnose thyroid nodules in this series of 2 articles.

Thyroid nodule diagnosis

If your doctor notices a lump or nodule in your neck, the doctor recommends tests to determine if a thyroid nodule is benign or malignant (cancerous) to plan your future treatment options. However, not every person with a thyroid nodule needs all of these tests.

Here are types of thyroid nodule tests the doctor may use to diagnose your thyroid nodule type and cause, including:

1. Physical examination:

In physical examination, your doctor examines your neck, thyroid gland, throat, and lymph nodes (its small bean-shaped organs that fight infection) in the neck for unusual growth or swelling. Your doctor also looks for the signs and symptoms of hyperthyroidism such as tremors, overly active reflexes, and a rapid or irregular heartbeat. Doctors may also check the signs and symptoms of hypothyroidism such as slow heartbeat, dry skin, and facial swelling.

2. Blood tests:

Doctors use several blood tests to diagnose or monitor a patient’s condition before and after treatment. These tests are called tumor marker tests. If tumor markers are found at higher-than-normal levels in the blood, urine, or body tissues of some people with cancer. Blood testing may include:

• Thyroid hormone levels: The doctor uses blood tests to check the levels of thyroid hormones including triiodothyronine (T3) and thyroxine (T4) in the body.
• Thyroid-stimulating hormone (TSH): This blood test is used to measure the level of TSH, a thyroid hormone produced by the pituitary gland to stimulate other thyroid hormone production.
• Tg and TgAb: Thyroglobulin (Tg) is a protein produced naturally by the thyroid gland. If high levels are detected, then chances are you have thyroid cancer. A tumor marker test may be done to measure the body’s Tg level before, during, and after treatment. Additionally, there’s also a test for thyroglobulin antibodies (TgAb), which are proteins produced by the body to attack thyroglobulin found in some patients. If TgAB is detected, it will interfere with the results of the Tg level test.
• Medullary type-specific tests: It is rarely a possibility that medullary thyroid cancer is checked. Doctors use blood tests to check the levels of calcitonin and carcinoembryonic antigen (CEA) levels. If they find the presence of RET proto-oncogenes, along with the family history of MTC, medullary thyroid cancer (MTC) is a possibility.

3. Ultrasound:

A doctor uses ultrasound to see a clear picture of your internal organs using sound waves. During the procedure, the doctor uses an ultrasound wand or probe and guides it over the skin of your neck area. If any nodules are detected, the doctor can see a pattern of echoes on the monitor which helps the doctor to understand the size of the nodule and whether it is a solid or a fluid-filled sac called a cyst. Doctors also use this imaging method in performing a fine-needle aspiration biopsy whether the nodule is small or large enough to feel because it can increase accuracy.

4. Biopsy:

The most common way to determine whether a nodule is cancerous or benign is through a biopsy. During a biopsy, the doctor takes a tissue sample from the nodule and sends it to a lab for testing. A cytopathologist examines the tissue to detect disease. Generally, two methods are used to diagnose thyroid nodules, including:

• Fine needle aspiration: The doctor usually performs this procedure in their office or clinic. During the procedure, the doctor injects a local anesthetic into the skin to numb the area for the biopsy. Then, the doctor inserts a thin needle into the nodule and removes cells and some fluid. This step may be repeated 2 to 3 times to get samples from different areas of the nodule. Those samples are sent to a cytopathologist for testing. If your results come positive, it usually means that you have cancerous cells, or negative (meaning no cancerous cells). If the test results are undetermined, it is not clear whether cancer is there or not.
• Surgical biopsy: If the needle aspiration biopsy result comes unclear/inconclusive, then the doctor may suggest this biopsy method in which the nodule and affected lobe of the thyroid will be removed using surgery. Removal of the nodule alone is not recommended generally because it can increase the risk of cancerous tumors left behind. That’s why enough margins are used around the area of nodule tissue. This procedure is done under general anesthesia, and you may need a hospital stay.

Click here for the second part of the article….

If you feel a lump on your neck, visit our endocrinology clinic in Brooklyn to get a proper diagnosis and treatment options. Want to learn what symptoms occur when you have abnormal levels of thyroid hormones? Call us on 13473845690 and get answers to all your queries. Log on to  www.doralhw.org or visit us at 1797 Pitkin Avenue, Brooklyn, NY 11212 to book an appointment with our endocrinologist to get the best treatment. We have the best endocrinologists who treat these kinds of diseases and helpful staff to aid you during your treatment.