W. Reid Litchfield

MD, FACE

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Nodular thyroid disease

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What Are the Chances My Thyroid Nodule is Malignant?

Most nodules are benign, but thyroid cancer is one of the fastest growing cancers in the USA. Knowing when a nodule is suspicious and what to do about it, is the focus of this article.

Thyroid nodules are common—up to 50% of women will have nodules detectable by ultrasound at some point in their life. Nodules are less prevalent in men, but still fairly common as well. On the other hand, thyroid cancer is uncommon, with approximately 5% of nodules being malignant.

It is therefore unreasonable to consider surgical resection of all thyroid nodules, since the vast majority of nodules are benign. Clinical evaluation to determine which nodules are suspicious for malignancy and warrant surgical resection is very important.

At Nevada Thyroid Institute we use a number of criteria and procedures to evaluate the malignant potential of a thyroid nodule.

1. Medical History—There are established risk factors (link to Thyroid Cancer Risk Factors) for thyroid cancer which are important to consider. Nodules that grow very rapidly are also somewhat suspicious.
2. Ultrasound Characteristics—Sonographic characteristics of nodules (link to Ultrasound Characteristics of Malgnant Thyroid Nodules) can be very useful in predicting the malignant potential of thyroid nodules. It takes an experienced thyroidologist to be able to recognize subtle features on thyroid ultrasound that may indicate higher risk for malignancy.
3. Thyroid Function Tests/Thyroid Scans—Nodules that are overactive or hot on thyroid scan have a very low incidence of malignancy. Since most nodules are cold on a thyroid scan, we generally do not recommend the routine use of thyroid scans unless we suspect a nodule is overactive. Instead, we generally proceed with biopsy of all nodules that meet biopsy criteria.
4. Fine Needle Aspiration Biopsy (FNAB)—FNAB (link to FNAB) is generally recommended on all nodules that are over 1 cm in size. If multiple risk factors are present, or the nodule has worrisome characteristics on ultrasound, FNAB will also be recommended—even if the nodule is less than 1 cm in size. FNAB is not recommended in patients with overactive (hot) nodules.

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