A patient who becomes aware of a mass in the neck deserves an immediate and thorough evaluation. Masses in the neck in children may be due to thyroid involvement, but also may be caused by congenital abnormalities, infections, or lymph node enlargement. In adults, such masses typically arise from either lymph nodes or from the thyroid. In adults, the examining physician can determine the difference between a thyroid and a non-thyroid mass by physical exam. A mass in the thyroid moves with swallowing while a mass outside of the thyroid does not.
Masses in the thyroid are common and the majority of thyroid masses are benign (not cancer). However, a complete workup should be done to evaluate a thyroid mass. The workup of such a thyroid mass usually entails an office visit where a history and physical exam are performed, and laboratory tests, including thyroid function tests are drawn. If these thyroid function tests determine that the mass is causing a state of over-activity of the thyroid gland (hyperthyroidism) then the physician may proceed with a radioactive thyroid scan. The scan will help to determine if the mass in the thyroid is producing an excess amount of thyroid hormone. The primary treatment of an over-functioning thyroid mass or nodule is medical. The physician may place the patient on thyroid suppression medication followed by thyroid scan six months later. These over-functioning nodules are often called autonomous nodules or “hot” nodules. They may require surgery, but often do not.
In the patient who has normal thyroid function tests, an ultrasound of the neck may be performed. This examination is effective, rapid, non-invasive, painless, and relatively inexpensive. It gives the examining physician important information about the size, location and consistency of the nodule. If the thyroid mass is cystic (fluid filled), it may be drained by needle aspiration and followed closely. If the mass is solid or indeterminate, the physician may look for additional nodules in the neck or thyroid. Your physician also will determine if the mass may be causing symptoms due to its size and location. At this point in the evaluation, the physician and patient may discuss fine needle aspiration biopsy or surgical removal of all or part of the thyroid.
Fine needle aspiration biopsy is a procedure where a very thin needle is placed into the thyroid mass. Depending on the particular situation, this procedure may be done either with or without the use of ultrasound guidance. A benign diagnosis, such as a colloid nodule or adenoma, cannot be completely confirmed by fine needle aspiration. However, a diagnosis of papillary or medullary cancer can be made with virtually 100% accuracy. In our practice at the University of Virginia, we use fine needle aspiration when the patient or doctor needs further information before deciding on the treatment plan. If available information already indicates that surgery is appropriate, a needle biopsy may not be needed.
Our goal, within the Endocrine Surgical Group, is to work with the patient, the primary care physician and/or the endocrinologist to provide the best possible care. When the Endocrine Surgical Group sees patients in consultation, a discussion concerning the proposed procedure, risks, and benefits will occur.
If you desire further information regarding thyroid masses, we recommend reviewing the “Thyroid Gland” portion of the American Association of Endocrine Surgeons (AAES) Patient Education Site. Patients may find that many websites offer confusing or conflicting information regarding thyroid disorders. The AAES site offers reliable information.