What If My Thyroid Nodule Grows Larger?

Size of nodules is an important consideration in patients with nodular thyroid disease. When nodules change in size, it is of potential concern. But size alone in not the only consideration in these cases.

We generally recommend ongoing surveillance and monitoring of patients with thyroid nodules, even if a prior fine needle aspiration biopsy suggests the thyroid nodule is benign. Invariably, we encounter some nodules which increase in size during observation and monitoring.

Most nodules that increase in size are benign nodules. However, 1% of fine needle aspiration biopsies are false negative (ie-a cancerous nodule was misdiagnosed as being benign). It is important to consider such a possibility in every ‘benign’ nodule when increases in size.

Several factors are important to consider in these circumstances:

How is the size increase documented? Physical examination can be an unreliable way to follow nodules. It may not be sensitive enough to carefully document changes in nodule size. Thyroid ultrasound is the best tool to follow the size of a nodule.
Are the thyroid function tests normal? Nodules that are overactive may grow in size and are rarely malignant. Patients with hypothyroidism may experience increase in nodule size due to elevation of TSH, which may stimulate nodule growth.
How much has the nodule grown? Nodules that show significant growth need to be re-evaluated for to determine malignant potential.
Does the nodule have worrisome ultrasound characteristics? Ultrasound imaging can tell us a lot about the malignant potential of a nodule.

Growing nodules should therefore be individually evaluated by a qualified thyroidologist to see if another biopsy is warranted, or if surgical resection is advisable. It is important for thyroid function tests to be optimized in these situations. Some patients will benefit from suppressive thyroid hormone therapy.

Back to articles list |