What are thyroid nodules?
Thyroid nodules are lumps that form within the thyroid gland. They can be solid or fluid-filled cysts and vary greatly in size and number.
“They’re very common, if I went out and did a thousand ultrasounds on random people, I’d probably find nodules in 500 to 600 of them,” says Dr. VanDyke. “Some people make none. Some make one. Some make so many their thyroid looks like a cluster of grapes.”
Nodules may be small and harmless, or large enough to cause symptoms like difficulty swallowing, speaking, or even breathing. Most are benign, but a small percentage may need closer evaluation.
Why do they develop?
In many cases, the exact cause isn’t clear. However, certain risk factors increase the likelihood:
- Family history of thyroid cancer, especially with specific genetic changes like the RET oncogene
- Radiation exposure (from certain jobs, past cancer treatments to the head/neck/chest, or environmental exposure)
- Living near nuclear accident or testing sites, such as Chernobyl or historic atomic test zones
“If thyroid cancers are in the family, we may be more concerned about nodules being cancerous,” Dr. VanDyke explains. “Radiation exposure, whether medical, occupational, or environmental, is also an important factor.”
Thyroid nodules and cancer risk
The good news? About 95% of nodules are benign. Of the remaining 5%, most are papillary thyroid cancers, a slow-growing, highly treatable form. Less common variants, such as follicular or tall cell thyroid cancer, tend to be more aggressive.
“Generally speaking, thyroid cancers are not treated by oncology,” says Dr. VanDyke. “They’re managed by endocrinologists and typically don’t involve chemotherapy or external radiation.”
How risk is measured: The TIRADS score
Ultrasound is a key tool for assessing thyroid nodules. Every nodule gets a TIRADS score from 1 (lowest risk) to 5 (highest risk) that helps inform us of the next step.
- TIRADS 1 → Normal thyroid
- TIRADS 2 → 0.9% risk of cancer; biopsy if > 2.5cm
- TIRADS 3 → 2.9% risk of cancer; biopsy if > 2cm
- TIRADS 4 → 38.1% risk of cancer; biopsy if > 1.5cm
- TIRADS 5 → 86% risk of cancer; biopsy if > 1cm
“As the score goes up, so does the likelihood of cancer,” Dr. VanDyke explains. “We use that score, the size, and your personal risk factors to decide if a biopsy is needed.”
What we do about thyroid nodules
Not all nodules require treatment. In fact, many are simply monitored over time.
Observation:
- Best for small, low-risk nodules (often cysts)
- Regular ultrasounds track size and structure changes
- Concerning changes include rapid growth, irregular shape, or new speckled appearance inside
“It’s if they change how they grow that we get concerned,” says Dr. VanDyke. “A smooth, round nodule that suddenly looks irregular or speckled raises a red flag.”
Treatment Options:
- Surgery
• Removes part or all of the thyroid
• Allows full tissue examination for a definitive diagnosis
• May require lifelong thyroid hormone replacement - Radiofrequency Ablation (RFA)
• Minimally invasive procedure that heats and shrinks the nodule from the inside
• Works well for solid nodules and some hormone-producing nodules - Ethanol Ablation
• Used for fluid-filled cysts
• Alcohol scars the inside to prevent new fluid buildup - Radioactive Iodine Therapy
• For functional nodules, ones that produce excess thyroid hormone on their own
• Slows or stops hormone production
What doesn’t work:
“There’s no medication or supplement that will shrink a thyroid nodule,” Dr. VanDyke clarifies. “The old idea of giving thyroid hormone to fix them has been proven ineffective.”
Bottom line
Thyroid nodules are extremely common, and most are harmless. The key to managing them is accurate diagnosis, appropriate monitoring, and choosing the right treatment when needed.
“Whether a nodule needs nothing more than observation or a procedure like RFA, the decision is based on its size, ultrasound features, your symptoms, and your personal risk factors,” says Dr. VanDyke. “It’s about tailoring the plan to the patient, not just the nodule.”
If you’ve been told you have a thyroid nodule
Don’t panic, the majority are benign. Talk with your endocrinologist about your risk factors, get the right imaging, and discuss the best monitoring or treatment plan for you.
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