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Medical Imaging

Thyroid Nodules: What Happens When You Find a Lump on Your Neck

woman rubbing neck

It’s common to get lumps on your neck. When your body’s fighting an infection, your lymph nodes can swell up. Those lumps appear under your jaw and typically go away when your illness does.

A lump lower down at the base of your neck is different. That’s where your thyroid gland is — just under the Adam’s apple and above the collarbone. A lump there isn’t as regular of an occurrence as a swollen lymph node, but it is the most common endocrine problem in the country. Except these lumps don’t go away on their own.

What does a lump on my thyroid mean?

Most likely, nothing. In rare cases, thyroid cancer.

Sometimes, the thyroid just grows lumps. It’s not clear why. The gland begins to grow abnormally, forming one or more nodules. Most of the time, the lumps are so small that you don’t even notice them. Instead, they’re picked up by an ultrasound or CT scan that you’re getting for a completely unrelated reason.

If the nodules keep growing, they form a more noticeable lump on your neck. You may be able to see it when you tilt your head back. You may only be able to feel it. Often, that little lump is the only symptom. But when they’re large or abundant enough, thyroid nodules start to press up against other parts of the neck, causing these symptoms:

  • Hoarseness or voice changes
  • Choking or trouble swallowing
  • Difficulty breathing
  • Neck pain
  • Goiter

What was that about thyroid cancer?

Most thyroid nodules are small and harmless. It’s estimated that half of adults will have developed a thyroid nodule by age 60 and 95 percent of them won’t have cancer. But a nodule is a symptom of thyroid cancer and you should always get it checked — even if your lump is causing no other issues.

The symptoms for thyroid cancer are the same as for thyroid nodules. Cancer is just as silent too, often showing no signs until the nodules grow larger. Both are more common in women, who make up 75 percent of thyroid cancer cases every year. And it strikes them younger, between the ages of 20 and 55.

Fortunately, thyroid cancer is one of the more curable types of cancer. The five-year survival rate is between 90 and 100 percent for the three most common types: papillary, follicular and medullary thyroid cancer.

How do you know if a thyroid nodule is cancerous?

Whether you found the lump or your doctor did, an evaluation is your next step. Your doctor will determine if your entire thyroid is enlarged and if the nodules are causing related issues like hypothyroidism or hyperthyroidism.

And then you’ll get tested. Thyroid nodules may cause overactive and underactive thyroid, but most of the time they’re non-functioning. So the traditional thyroid test, a TSH blood test, will come back normal. Instead, you may get an ultrasound to identify the size, type and number of nodules.

Cancerous thyroid nodules act and look differently. With an ultrasound, your doctor can see if the nodules look suspicious and potentially order a biopsy to check for cancer.

Thyroid Biopsy

Thyroid cancer is detected through a procedure called thyroid fine needle aspiration (FNA). Sticking a sharp object in your neck might sound scary. But a thyroid FNA uses a needle so small that the procedure is painless — more like a quick pinch than a poke or prick.

A thyroid FNA is often done in conjunction with an ultrasound so a radiologist can find the nodule and precisely insert the needle into it to take a tissue sample. Then, your thyroid tissue is sent off for analysis to determine whether it’s cancerous.

Thyroid FNA Analysis

Biopsied tissue is examined under a microscope by a cytopathologist, a doctor trained to identify diseases. But they can’t always tell whether the tissue is cancerous or not. In up to 30 percent of cases, the results are “indeterminate.”

Genetic testing helps take away the uncertainty. Thyroid FNA analysis uses a genomic test that gets past the cell level seen under the microscope and down to the molecular level. Half the time, this genetic testing clears you of thyroid cancer. The other half, it finds that the nodule was cancerous and you need treatment like surgery or chemotherapy to remove the cancer from your thyroid.

What do I do if I find a lump near my thyroid?

Remember, it’s not like your lymph nodes. You can’t wait it out, expecting a little lump to go away. By the time thyroid nodules are large enough to create a noticeable lump, your condition has progressed. And any time cancer is in the equation, early detection and treatment are important.

Schedule an appointment with your primary care provider to talk about your thyroid troubles or any suspicious lumps on your neck. If your symptoms point to thyroid nodules, you’ll be referred for an ultrasound and possibly a thyroid FNA with Medical Imaging.

There are less than 500 thyroid cancer diagnoses every year in Iowa, so you’re likely to find that your abnormal lump is a normal thyroid nodule and get on with treatment to resolve any symptoms it’s causing.