Thyroid Nodules

What are Thyroid Nodules?

A thyroid nodule is an abnormal growth of tissue that forms a lump or swelling within the thyroid gland. They are very common with more than 50% of the population having a thyroid nodule at one time or another. Thyroid nodules can occur at any age, however they become more common as you age and are more common in women than men.

Characteristics of Thyroid Nodules

Thyroid nodules can be: 

  • Solid or filled with fluid (cyctic) or have elements of both
  • Single nodule or be present as multiple  nodules
  • Small or large
  • Typically slow-growing, some nodules may grow rapidly while others may shrink
  • Occasionally large enough to compress throat structures, causing pain, or difficulty swallowing or breathing
  • Rarely affect the vocal cords and cause hoarseness
  • Produce thyroid hormones (T4, T3), but most do not (non-functional thyroid nodules)

95% OF THYROID NODULES ARE BENIGN (NON-CANCEROUS), HOWEVER THEY SHOULD STILL BE CHECKED

What is the difference between Hot, Warm and Cold Nodules?

If your testing discovers a hot nodule, the nodule may become more metabolically active as it enlarges, in turn, increasing amounts of thyroid hormone and the TSH will become lower. If excess amounts of thyroid hormone are being produced by a hot nodule, the remainder of the thyroid gland may appear cold or absent on a thyroid scan – “turned off”.

Warm nodules suggest normal thyroid function and cold nodules indicate hypofunctional or non-functional thyroid tissue.

What factors contribute to Thyroid Nodules?

What are the symptoms of Thyroid Nodules?

  • A noticeable lump or swelling at the base of your neck
  • Difficulty swallowing due to pressure on the esophagus
  • Difficulty breathing due to pressure on the windpipe
  • Hoarseness or changes in your voice
  • Pain in the front of the neck

In some cases, thyroid nodules may produce additional thyroid hormones, causing hyperthyroidism. The symptoms of this are:

  • Diarrhoea 
  • Irregular menstrual periods
  • Hair thinning (or loss of hair)
  • Shortness of breath
  • Intolerance to heat (feeling hotter than others)
  • Anxiety or tremors

Thyroid Nodules Testing and Investigation

It is vital to have your nodules properly tested to ensure you get the best treatment. Testing through your Dr may include:

  • Thyroid Ultrasound
  • Fine needle aspiration biopsy (FNA, FNAB) – in this procedure a thin needle is inserted into the thyroid and a small amount of tissue and/or fluid is removed.
  • Functional thyroid tests – TSH, fT3, Ft4 minimum. We would also add reverse T3 and antibody testing.
  • FDG-PET scan (fluorodeoxyglucose positron emission tomography)
  • Additional testing can also include; calcitonin, Molecular tests.

Our Recommended Testing

From a Functional Health perspective, we are not trying to diagnose a disease but to understand how and why a thyroid may be developing nodul. Therefore, further testing is used to find the complete picture behind the symptoms. We aim to treat the cause, not just the symptoms.

Thyroid Profile

FASTING BLOOD
TEST

This panel tests 8 markers which are essential to understanding the function of your thyroid, and if you are producing too much, too little, or having an issue with the thyroid hormone conversion pathways.

Halide Profile

24 HOUR URINARY IODINE LOADING EXCRETION TEST

Many people with thyroid nodules will have an iodine ‘blockage’ occurring which is a dysfunction of the sodium iodide pumps which transport iodine into the thyroid cells. This test helps to identify this and guide the best treatment.

Stress & Sleep Profile

DIURNAL SALIVARY CORTISOL TEST

Your thyroid works in tandem with your adrenal glands which produce cortisol and other important hormones.  Increased cortisol due to ongoing stress can cause the thyroid to move into a hypothyroid state.

Sugar & Fat Storage

FASTING BLOOD
TEST

Thyroid nodules can affect insulin levels and blood sugar levels, which can increase the risk of diabetes or make diabetes harder to control. This test is always part of a thorough assay of tests.

Cardiovascular Profile

FASTING BLOOD
TEST

Too little thyroid hormone slows the heart rate and too much can trigger palpitations, high blood pressure, and increases cardiovascular disease risk. Screening helps to identify risk factors and early signs of change.

Metabolic Markers

FASTING BLOOD
TEST

The thyroid gland helps regulate your body’s metabolism—most importantly, how much oxygen and energy your body uses. When nodules are present, even small changes to the levels of thyroid hormones affect the body’s metabolism.

Detox Profile

FASTING BLOOD
TEST

Understanding a patient’s detoxification strengths and weaknesses is a vital part of our testing to best support treatment success and outcomes. The detox profile offers important information that will identify potential concerns that could otherwise be missed.

Sex Hormone Profile

FASTING BLOOD
TEST

Both hypothyroidism and hyperthyroidism are associated with changes in concentrations of sex hormones (SHBG, testosterone and estradiol) in both sexes, ovulatory function (menstrual irregularities, menarche and menopause) in women, and erectile dysfunction in men.

Food Intolerance Profile

NON-FASTING BLOOD TEST

People with sub-optimal thyroid levels see early changes in the health of the digestive system which lead to food intolerances ranging from subtle to overt. Discovering your unique food intolerances helps to minimise inflammation quicker, facilitating better and faster clinical outcomes.

Treatment Options for Thyroid Nodules

Medical Treatments

Below are some commonly used medical treatments offered when a patient is diagnosed with thyroid nodules.

Often if the nodule is benign and blood tests within acceptable ranges, no treatment is offered, and a follow up scan will be scheduled to review growth or change to the nodule.

If your thyroid blood tests show that you are hypothyroid, you will be prescribed thyroid replacement medicine to bolster low levels of thyroid hormone. In Australia, the most commonly prescribed thyroid medication is Levothyroxine (Oroxine/Eutroxsig/Eltroxin/Levoxine).

These are synthetic forms of the hormone Levothyroxine (T4) that our thyroid gland produces.

Tertroxin is a synthetic form of “liothyronine” (T3) usually prescribed by a thyroid treating specialist (Endocrinologist) and is the active form of thyroxine. It can be prescribed to take with Levothyroxine (T4) medication or alone. 

Antithyroid medications – also called anti-thyroid medications – are a common treatment for hyperthyroidism (over-active thyroid), particularly if there is an ongoing form of hyperthyroidism caused by Graves’ disease or a goiter (enlarged thyroid).

The medications prescibed in Australia are Neo-Mercazole or PTU.

Antithyroid agents prevent or suppress the biosynthesis of thyroid hormones.

Your doctor will tell you how long to stay on the medication, but generally, it is a minimum of 3 weeks and sometimes can be ongoing.

Like all medications, there can be side effects, so please consult your doctor if you notice any changes.

Up to 15 percent of people who take an antithyroid drug have minor side effects. Both methimazole and propylthiouracil can cause itching, rash, hives, joint pain and swelling, fever, changes in taste, nausea, and vomiting. Major side effects are rare, but a risk. (source)

Radioactive iodine (RAI) is a medical treatment method for hyperthyroidism and thyroid cancer. RAI is a form of radioactive nuclear medication that permanently destroys the thyroid tissue.

This means that people will need to take lifelong thyroid hormone replacement medication following RAI treatment.

After treatment, people need to isolate themselves after for a window of time to prevent infecting others from radiation exposure. Your doctor will instruct you on specific timelines and spacing distances needed to adhere to for the safety of others – particularly children and pregnant or breastfeeding women.

This surgical procedure removes all or part of the thyroid gland which is the butterfly-shaped gland in the front of the throat.

If the entire gland is removed, the patient will require thyroid medication for life as the thyroid is no longer there.

If a part of the thyroid has been removed, you may or may not require medication. Your doctor will monitor you with regular blood tests in the months after the surgery to assess medication needs or dosage changes.

Thyroidectomy is considered a relatively safe surgery, but like all surgery has risks that your doctor will inform you of.

Damage to the vocal cords is rare and if it does occur is normally temporary. Up to 1 in 50 cases have a  permanently hoarse voice post-surgery.

If there is damage to the parathyroid glands you may need to be treated with calcium and vitamin D tablets as well.

Integrative Treatments

There are several alternative and integrated treatment options available for thyroid nodules.

Their suitability needs to be assessed by an expert to ensure the best and safest treatment options are put into place for the individual person.

Naturopathy – and functional medicine – both treat the person, not the disease. Therefore no two treatment plans will be identical.

Integrative treatments have the best outcomes when thyroid nodules are small and can be curative.

For more advanced or chronic diseases, combining conventional treatments with a holistic approach can result in the best outcomes, better disease management, and better patient quality of life.

Common deficiencies that contribute to nodules include iodine, vitamin D3, magnesium, B12, and active folate (L-Methylfolate). A functional health practitioner can test for vitamin and mineral deficiencies so these can be adequately treated.

In some cases we can use high-dose iodine therapy to reverse small benign nodules, preventing further complications in the future.

An antiangiogenic diet coupled with nutritional and herbal treatment can have powerful effects on nodules.

Antiangiogenic therapy represents a new approach to the early intervention and prevention of malignant disease.

Potent antiangiogenic molecules have now been identified in dietary sources, suggesting that a rationally designed antiangiogenic diet could provide a safe, widely available, and practical strategy for preventing tumorous growths fed by angiogenesis.

It is also useful to avoid any foods that specifically cause inflammation in your body (which can be detected by doing a food intolerance test).

Whilst iodine is the key nutrient that is King in treating nodules, herbal medicine can support the body along its healing path for the best outcomes.

Thyroid patients can suffer from maladies of different symptoms, so herbal medicine needs vary greatly.

Herbal medicine and teas can assist with sleep, stress, energy, detoxification, thyroid function, and much more.

Diagnosed with thyroid nodules?

We work with patients across the spectrum of thyroid complaints, from undiagnosed thyroid complaints to cancer patients. Book a free 15-minute consult with one of our practitioners and find out how we can help you get your thyroid condition into remission and get you back to living your life to the fullest.