How common are thyroid nodules?

Very common. How many we find depends on how we look.

• Feeling the neck finds only the larger ones, roughly 1 in 20 people
• Ultrasound finds many more, up to half of adults in some studies
• Nodules are about 4 times more common in women than men, and become more common with age

Why do thyroid nodules develop?

There is no single cause. The thyroid can form nodules through several different processes.

• Colloid / multinodular change — the commonest, and benign
• Follicular neoplasm — a growth that needs closer assessment
• Thyroiditis — inflammation, often autoimmune
• Malignant nodule — thyroid cancer, the minority

What is a goitre, and how is it different from a nodule?

Goitre is the umbrella term for any enlargement of the thyroid gland. It comes in different forms:

• Thyroid nodule — a lump within the gland
• Multinodular goitre — enlarged, with several lumps
• Diffuse goitre — evenly enlarged, often due to Hashimoto's thyroiditis or Graves' disease
• Thyroid function may be normal, overactive or underactive with any of these

Do nodules or goitre cause symptoms?

Often, no symptoms at all. Many are found by chance on a scan done for another reason.

When large, they can cause:

• Visible neck swelling
• Feeling a lump
• Difficulty swallowing
• Pressure or tightness
• Hoarse voice
• Breathing difficulty (large goitres)

How do you diagnose a thyroid nodule?

We never diagnose a nodule just by looking at it or feeling it. The assessment combines:

• History — recent growth, hoarseness, swallowing trouble, previous neck radiation, family history of thyroid cancer
• Examination of the neck and lymph nodes
• Blood tests — TSH first, to check thyroid function
• Ultrasound — the key test for characterising a nodule
• Biopsy — only when the picture says it is needed

What does a thyroid ultrasound actually tell us?

Far more than the size. Ultrasound lets us characterise the nodule and estimate how likely it is to be cancer.

• Composition
• Echogenicity (brightness)
• Shape
• Margins (edges)
• Calcifications
• Blood flow
• Nearby lymph nodes

What makes a nodule look suspicious?

No single feature proves cancer. We look at the combination, using a structured scoring system such as ACR TI-RADS.

• Irregular or spiky edges
• Taller than wide shape
• Microcalcifications — tiny bright specks
• Suspicious lymph nodes, or growth beyond the gland
• Also: marked darkness (hypoechoic) and a solid composition

Does every thyroid nodule need a biopsy?

No. We score each nodule on ultrasound with ACR TI‑RADS, then decide.

• Points for composition, echogenicity, shape, margins and bright spots
• The total gives a TI-RADS level, TR1 to TR5
• TR1–2: mostly ultrasound surveillance, watching for change in size or appearance
• TR3: surveillance or biopsy (FNAC or CNB), depending on size and the clinical picture
• TR4–5: biopsy, by FNAC or core needle biopsy (CNB)

How accurate is a thyroid biopsy?

Very useful, but not perfect. Studies quote an average accuracy of around 95%, and it varies with the situation.

A biopsy result comes back as one of:

• Limitations: too little tissue, cystic nodules, follicular lesions, and sampling the wrong spot

What are the chances a nodule is cancer?

Low. The great majority of thyroid nodules are benign.

In the reference data we use, fewer than 5 in 100 nodules turn out to be cancer.

• The exact risk varies with age, sex, family history, radiation exposure and how the nodule looks
• Our job is not to assume every nodule is cancer, but to find the minority that need more investigation

What is thyroid cancer?

A cancer that starts in thyroid cells. It is not one single disease: the main types behave very differently.

• Papillary — the commonest by far; usually slow-growing with an excellent outlook
• Follicular — less common; also usually treatable
• Medullary — rare; can run in families
• Anaplastic — very rare, aggressive, needs urgent specialist care

How is thyroid cancer treated?

It depends on the type, the size, whether it has spread, and your overall risk.

• Surgery — removing part or all of the thyroid; the main treatment for most
• Radioactive iodine — used selectively after surgery in some papillary and follicular cancers
• Thyroid hormone tablets — to replace what the gland made, and sometimes to keep TSH low
• Active surveillance — careful monitoring instead of immediate surgery, for selected very small, low-risk cancers
• Specialist systemic treatment — for advanced disease

Am I a candidate for RFA?

RFA is considered for selected benign nodules, particularly when they cause:

• Pressure or local symptoms
• Cosmetic concern — a visible lump
• Progressive enlargement
• Or for people who want a minimally invasive alternative to surgery

Is RFA safe? What are the risks?

Minimally invasive, but no procedure is risk-free. The thyroid sits next to important structures.

Safety depends on:

• Careful patient selection
• An experienced operator
• Continuous ultrasound guidance
• Precise electrode positioning
• Protecting surrounding structures
• Proper follow-up

Will the nodule come back after RFA?

The goal is progressive shrinkage, not instant disappearance. The nodule is followed with ultrasound.

• In the study we cite, volume reduction was sustained for up to five years, with reductions of up to 95%
• Smaller nodules respond best
• I never promise a treated nodule can never grow again. Some need a second treatment, so long-term follow-up matters

When should you see a doctor about your thyroid?

Get assessed if you notice:

• A new lump in the neck
• A thyroid swelling that is growing
• Difficulty swallowing
• Difficulty breathing
• Persistent hoarseness
• Abnormal thyroid blood tests
• A nodule found by chance on a scan
• Family history of thyroid cancer
• Previous radiation to the neck