Thyroid Disorders, Nodules & Cancer

The thyroid is a small butterfly-shaped gland in the front of the neck. Using dietary iodine, it produces T4 and T3 hormones that regulate metabolism throughout the body — influencing heart rate, body temperature, energy levels, weight, mood, fertility, bone density, and cognitive function.

Hyperthyroidism occurs when the thyroid produces more hormone than the body needs. The most common cause is Graves’ disease — an autoimmune condition in which antibodies stimulate the thyroid to overproduce hormone. Other causes include toxic multinodular goiter and thyroiditis.

Physical: Unintentional weight loss, rapid or irregular heartbeat, fine hand tremor, muscle weakness, heat intolerance, sweating, fatigue.

Mood and cognitive: Anxiety, irritability, difficulty concentrating, insomnia.

Other: Goiter, thinning hair, changes in menstrual cycle. Graves’ disease can cause proptosis (eye protrusion).

Antithyroid Medications Methimazole · Propylthiouracil (PTU)

Block thyroid hormone synthesis. Effective in 40–50% of Graves’ patients long-term.

Radioactive Iodine (RAI)

Destroys thyroid tissue. Highly effective. Results in hypothyroidism in most patients, requiring lifelong levothyroxine.

Surgery (Thyroidectomy)

Rapid and definitive. Preferred when the thyroid is very large, when suspicious nodules are present, or when the patient prefers surgery.

Hypothyroidism occurs when the thyroid produces insufficient hormone. The most common cause is Hashimoto’s thyroiditis — an autoimmune condition in which the immune system gradually destroys thyroid tissue. Other causes include previous RAI treatment, thyroid surgery, and certain medications.

Physical: Fatigue, weight gain, feeling cold, dry skin and hair, hair loss, constipation, slowed heart rate.

Cognitive and mood: Depression, poor memory, “brain fog.”

Other: Irregular or heavy menstrual periods, fertility difficulties, muscle aches, elevated cholesterol.

The standard treatment is daily oral levothyroxine (synthetic T4). Dosing is individualized — there is no formula. Most patients notice improvement within two weeks, though full symptom resolution may take 2–3 months.

A subset of patients may genuinely benefit from T3 addition or natural desiccated thyroid (NDT, e.g., Armour Thyroid). We prescribe NDT when clinically appropriate.

Almost certainly not — but it warrants proper evaluation. Up to 75% of the population will have a nodule detected on imaging, and the vast majority are entirely benign. The purpose of evaluation is to identify the small minority that harbor cancer.

Thyroid Ultrasound: The essential first step. We perform high-resolution ultrasound in-office.

Fine-Needle Aspiration (FNA) Biopsy: For nodules meeting size and sonographic criteria. Performed in-office with ultrasound guidance. Results classified using the Bethesda system.

Molecular Testing: For indeterminate biopsies, molecular markers (ThyroSeq, Afirma) can further stratify cancer risk.

RFA is a minimally invasive outpatient procedure that shrinks benign nodules using heat energy delivered through a small electrode under ultrasound guidance. No incision, no general anesthesia, no hypothyroidism in most cases.

A thyroid cancer diagnosis is understandably frightening — but the great majority carry an excellent prognosis. Papillary thyroid cancer (~85%) has a 10-year survival rate exceeding 95%. Our role is to coordinate your care with an expert thyroid surgeon and guide post-surgical management and long-term monitoring.