The thyroid nodules are often discovered by chance. You may feel a small lump at the base of the neck or the lump may be detected during a medical visit.
The probability of having a nodule increases over the years, and women are more concerned. Also involved are environmental factors (iodine deficiency …), and family history.
Most of the time, the nodule is benign, but monitoring is necessary, via a clinical examination and an ultrasound, to check that the nodule does not become cancerous.
When to remove a thyroid nodule?
The operation concerns about 20% of the nodules, either because they cause significant discomfort Where hormonal hypersecretion, either because the doctor suspects a cancer. It involves removing part or all of the thyroid. In this case, you will need to take hormonal treatment for life.
Before deciding whether or not to operate, the following tests are carried out: dosage of TSH (a hormone that reflects the functioning of the thyroid), thyroid ultrasound associated with a doppler to analyze the vascularity of the nodule and cytological puncture. Depending on the results and the consultation between doctors and with the patient, the decision to operate is taken in the following cases.
The nodule is too big
If its diameter is greater, on average, than 4 cm, “surgery is required, because the nodule may one day or the other cause compressive signs, such as discomfort when swallowing or breathing, a persistent cough, ”says Pr Patrice Rodien, endocrinologist. In addition, punctures are less reliable when the nodule is large, because there is a risk of removing cells from a healthy area and “missing” another area containing cancer cells.
The nodules are numerous and form a goiter
If the goiter is large, it compresses the upper part of the throat. An ultrasound, or even a scanner, is performed to assess the size of the goiter and its position relative to the trachea. Next, the decision to operate or not is taken, which is generally the case. “In the event of doubtful nodules, the risk must be assessed by finding out whether one of them is cancerous: for this, a cytological analysis is carried out”, says Dr. Frédérique Albarel, endocrinologist. Finally, in the case of a goiter, surgery can meet an aesthetic demand.
The nodule is filled with fluid
Some nodules are simple cysts, filled with a thick, dark fluid. They are benign, but from 3 or 4 cm in diameter, they can be annoying and grow more or less quickly. THEthe first step is to drain them and drain them of their liquid. This is analyzed to verify the absence of cancer cells.
“But it often happens that the cystic nodules get back together, and in this case, surgery is advised,” says Dr Albarel.
The nodule disrupts the thyroid
One “Toxic adenoma” is suspected when the level of TSH in the blood is abnormally low because this hormone regulates the thyroid. This situation is confirmed by a thyroid scan. The toxic adenoma secretes thyroid hormones in addition to those produced by the thyroid. But this nodule is never cancerous.
In the elderly, especially, the medical team prefers to destroy the nodule by a dose of radioactive iodine. The other option is surgery: part or all of the thyroid will be removed depending on the number of nodules.
When there is a risk of cancer
Detected on ultrasound, it represents less than 5% of thyroid nodules and it has a very good prognosis. A cytological puncture allows the cells to be analyzed. If these two examinations indicate an almost certain risk of cancer, the operation is necessary and leads to a cure in 75% to 80% of cases.
“It is more complicated in the face of an uncertain prognosis, suggesting a cancer risk between 30 and 50%: the medical team will choose to wait and monitor the nodule closely, or to resort to surgery”, nuances the Prof. Rodien, endocrinologist.
What does the thyroid surgery involve?
The surgeon removes part or all of the thyroid. The operation under general anesthesia lasts between 1 and 2 hours.
Two surgical techniques are currently available. The most common is a 3-6cm horizontal incision at the base of the neck. The new robotic and endoscopic surgery requires a 3 cm incision is made under the armpit. It is not as precise as the classic operation.
If there is a proven cancer, the surgeon removes almost all of the thyroid and removes the neighboring lymph nodes. It will then be necessary take thyroid hormones for life. If in doubt, the surgeon has the nodule analyzed. If cancer is confirmed, the thyroid and lymph nodes are removed, otherwise, it only removes the lobe containing the nodule. In most cases, the person will be able to do without hormone treatment.