Thyroid Nodules and Goiter
Diagnosis

If a thyroid nodule or goiter is suspected, your doctor will examine you for signs of thyroid enlargement. Your doctor will also check to see if any lymph nodes near your thyroid are enlarged, and look for indications that you are producing too much or too little thyroid hormone. We will ask about your medical history and any symptoms you've been experiencing.

You will likely need additional diagnostic tests, which may include:

• A thyroid ultrasound This test beams sound waves into the neck to create images of the thyroid and surrounding tissues.
• A blood test for thyroid-stimulating hormone (TSH) This hormone is produced by the pituitary gland and helps regulate the production of the two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). The test can rule in or out common causes of hyperthyroidism and hypothyroidism. If your TSH is low, you may have a benign thyroid tumor that is producing large amounts of thyroid hormone. If your TSH is high, you may have an underactive thyroid gland; its enlargement may stem from inflammation caused by an autoimmune disorder.
• Radionuclide thyroid scan This test uses a radioactive tracer — which you either swallow or have injected — and a special camera to assess how your thyroid is functioning.
• Fine needle aspiration During this test, a doctor will use a thin needle to remove a small amount of the nodule to check for cancer. If your TSH is normal or high and your thyroid nodule is more than ½-inch in diameter, you will likely need a biopsy.

Fortunately, most biopsied thyroid nodules turn out to be benign (non-cancerous) and don't require surgery. You'll just need to be checked periodically by your doctor to be sure the nodule is not growing.

For all patients with nodules or goiters, our goal is to answer the following questions in our evaluation:

1. Is the thyroid (or part of the gland) so large that it is stretching, compressing or invading nearby structures in the neck?

2. Is the thyroid working normally, or is it producing too much or too little thyroid hormone?

3. Is the goiter or nodule due to cancer?

The answers to these questions will determine the best course of treatment for you.