Treating thyroid nodules

Depending on the cytology results, one procedure or another will be performed: 

• If the cytology shows malignancy or suspicion of malignancy, the entire thyroid gland is removed (total thyroidectomy) by an expert surgeon. A very high percentage of thyroid cancers are curable.  
• If the cytology results show the nodule is benign, small and the patient has no symptoms, a follow-up physical examination and ultrasound are performed to assess its growth. Initially this takes place at six months, and then afterwards, depending on the size of the nodule, at more or less frequent intervals. If the nodule shows a significant increase in size, it may be necessary to repeat the FNA to re-evaluate it.  If it enlarges to such an extent that it causes symptoms of cervical compression, surgery is recommended.  

In cases of overactive thyroid nodules, treatment is recommended to prevent the development of hyperthyroidism. The main treatment options are (depending on the size of the nodule and the degree of hyperfunction): removal of the nodule by surgery or radioactive iodine treatment and, less frequently, iodine treatment combined with percutaneous thermal treatment (high temperature vaporisation of these nodules using a radiofrequency probe introduced with a special needle). Prior to the treatment, it is sometimes necessary to take low doses of antithyroid drugs to control the symptoms of hyperthyroidism.  

If the nodule is cystic and it is large or uncomfortable, ultrasound-guided drainage of the fluid content may be performed. If this is not sufficient, it can be treated percutaneously by introducing sterile alcohol into the cyst to sclerose (harden) the cyst walls, thereby preventing recurrence. This may or may not be followed by percutaneous thermal treatment.   

Thyroid surgery is performed at the level of the anterior neck, although it can also be performed through the axilla or the oral cavity to avoid a visible scar. The risk of complications from this surgery is usually low, and depends on the size of the thyroid and the individual's anatomy.  

Specific complications include bleeding and cervical haematoma, decreased calcium levels due to involvement of the parathyroid glands and hoarseness or dysphonia resulting from damage to the nerves controlling the vocal cords.  

In cases of partial thyroidectomy, hemithyroidectomy +/- isthmectomy or percutaneous treatments, local complications are even less frequent, but the thyroid function should be monitored and an ultrasound performed to check whether any nodules are left in the remaining thyroid.  

In cases of total thyroidectomy for multinodular goitre, lifelong treatment with thyroxine is required. 

If the patient chooses not to undergo surgery voluntarily or cannot undergo surgery due to a high surgical risk, percutaneous thermal ablation/reduction of the thyroid nodule is recommended.  

These percutaneous treatments are performed in specialised centres, guided by ultrasound, with or without the patient being sedated. Laser probes, radiofrequency, microwaves or ultrasound waves are used to necrotise the nodule by subjecting it to high temperatures. This preserves the rest of the thyroid as well as its function.