Treatment for Nodules
Deciding on a course of treatment depends on whether the nodule is benign or malignant, as well as whether it's toxic or not. The size of the nodule also matters. In this section we'll deal with benign nodules. Chapter 11 is devoted exclusively to thyroid cancer and will explore your treatment options for thyroid cancer in greater detail.
As you've read, a small colloid nodule that is causing no problems generally doesn't require any treatment. But if a nodule gets too big, it can cause serious problems. At night, you may have trouble breathing when you lie down and the nodule presses against your windpipe. At meals, you may have trouble swallowing foods because the nodule is up against your esophagus. In some cases, a large nodule may become unsightly, making you self-conscious about your appearance. All of these situations may mean that surgery is needed to remove the nodule.
Treating Indeterminate Nodules
When a nodule is indeterminate, you will probably undergo surgery. Removing the half of the thyroid gland that contains the nodule is considered the safest course of action, in the event the nodule is cancerous. Doing surgery also brings you closer to an answer to the nagging question: is it cancer? Close examination of the removed tissue can then help determine whether there is indeed cancer. If the doctor does find malignancy, you may need to undergo further surgery to remove the entire thyroid gland.
Although cysts are sometimes quite small, they can grow rapidly and unexpectedly and cause pain and discomfort. For this reason, most cysts are treated with aspiration, a technique in which the fluid inside the cyst is drained with a syringe. The problem with aspiration is that the cyst often recurs, and may even come back bigger than before. In that case, a second aspiration is required. Some doctors may use ethanol in the treatment of cysts after the fluid is drained. Under the guidance of a special needle, ethanol is injected into the cyst, causing the walls of the cyst to stick together and erode the inner space of the cyst. Studies have found that using ethanol with aspiration is more effective than aspiration alone.
Treating Toxic Adenomas
Your TSH is suppressed, and you definitely have a hot nodule churning out excess thyroid hormone. For some people, a toxic adenoma causes symptoms of hyperthyroidism, such as nervousness, trouble breathing, and a rapid heart rate. If you're experiencing symptoms of hyperthyroidism, your doctor may prescribe a beta-blocker to control your symptoms until you treat the nodules.
To actually treat the toxic adenomas, however, you will need RAI or surgery since these nodules will not go into remission, even with the help of antithyroid drugs. The dosage of RAI used with toxic adenomas is slightly higher than that used in treating Graves' disease, but it is lower than the amount used to treat thyroid cancer. You'll know that you got the right dosage if thyroid hormone levels start to dip in a few weeks, and then TSH starts to rise, as the pituitary gland begins responding to the lower amounts of thyroid hormone in the body.
For some people, RAI is not a good option. People with extremely large toxic adenomas, who are pregnant, or who have had no success with RAI may need to consider surgery instead. Surgery usually involves removing all or part of the thyroid gland. Even if you remove only part of the thyroid gland, you will probably need to take thyroid hormone replacement after surgery. The medication will stabilize the production of thyroid hormone and help ensure that the nodule does not recur.