Thyroid Nodules

A thyroid nodule is a lump within the thyroid gland, the butterfly-shaped gland at the base of the neck. Nodules form when thyroid cells grow in a small cluster. They may be discovered when a patient or physician feels a lump, or incidentally on imaging done for another reason. Most are found to be harmless, but each deserves a careful, systematic evaluation.

Cystic nodules are filled partly or entirely with fluid. Purely cystic nodules are almost always benign, though large ones can cause pressure symptoms.

Solid nodules are made up of thyroid tissue. Most solid nodules are still benign, but they carry a somewhat higher likelihood of needing a biopsy to be certain.

Mixed (complex) nodules contain both solid and fluid components and are evaluated according to the characteristics of their solid portion.

Ultrasound allows us to see these features directly and to assign a risk category that guides whether a biopsy is recommended.

This is the question most patients worry about, so we address it directly: the large majority of thyroid nodules — roughly 90–95% — are benign. When thyroid cancer is found, it is most often a well-differentiated type that is highly treatable and carries an excellent prognosis. Certain ultrasound features (such as microcalcifications, irregular margins, or a taller-than-wide shape) raise the suspicion for cancer and prompt a fine-needle aspiration biopsy. The goal of evaluation is to identify the small number of nodules that need attention without subjecting the rest to unnecessary procedures.

Most nodules cause no symptoms at all. When they do, it is usually because of their size or their effect on thyroid hormone levels. Possible symptoms include a visible lump in the neck, a sensation of pressure or fullness, difficulty swallowing, a hoarse voice, or — if a nodule overproduces thyroid hormone — symptoms of an overactive thyroid such as palpitations, weight loss, or anxiety. Larger nodules that press on nearby structures are one of the situations where treatment may be warranted even when the nodule is benign.

Dr. Schneider holds the Endocrine Certification in Neck Ultrasound (ECNU) and performs high-resolution thyroid ultrasound in the office. A typical evaluation includes a clinical history and examination, thyroid blood tests, diagnostic neck ultrasound to characterize the nodule and any lymph nodes, and — when indicated — an ultrasound-guided fine-needle aspiration biopsy performed on site. Having this expertise under one roof means most patients get clear answers quickly, without being sent elsewhere for each step.

Many benign nodules simply need periodic monitoring. When a nodule does require treatment — because it is growing, causing symptoms, or overproducing hormone — patients today have options well beyond traditional surgery. We are among the few practices in San Diego to offer minimally invasive, in-office alternatives such as radiofrequency ablation (RFA) and ethanol ablation, which can shrink or eliminate a nodule without surgery, scars, or general anesthesia.