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Thyroid Diseases

Possible Diagnosis Of Cancerous Nodule

05/30/2008

Question:

I have had 2 TIA`s and they did a doppler on my neck. Told me that the arteries are clear, but I have a 2cm mass on my thyroid. They told me they aren`t worried about it and that my blood work showed that it was clotting and that was more important. So I am going to a hemotologist and also having a TEE before getting this checked. My question is: How big is the thyroid? Is a 2cm mass on it bad? I am a smoker so I am concerned. Would the doctor know if it was important or not by all the blood work they did?

Answer:

These are good and important questions. What you have is referred to as a "solitary thyroid nodule." Solitary thyroid nodules are common. Some 2-3% of the population have a solitary thyroid nodule large enough for a doctor to feel, and the percentage of people with one or more thyroid nodules can be as high as 66% when doppler ultrasound is used. About 5% (maybe as high as 10%) of these nodules are thyroid cancers, which means that you have a 90-95% chance that this is benign. Also, you should know that thyroid cancers aren't like other cancers, such as lung and breast. They usually grow quite slowly and respond very well to treatment. So there is no extreme urgency to getting this checked out.

On the other hand, if it is a thyroid cancer, you don't want to ignore it either. So sometime within the next few months, you'll want to get it evaluated. You should see an endocrinologist who will probably order a real thyroid ultrasound. The endocrinologist may then put a small needle into the nodule to get some cells out, or the endocrinologist may ask the ultrasound specialist to do it using ultrasound guidance. This is a simple procedure, and is about as painful as having blood drawn. The doctors can't tell from a blood test whether or not this is a cancer. You should stop smoking for about 50 different reasons, but your thyroid nodule is not one of them.

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Response by:

Thomas A Murphy, MD, FACP, FACE Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University