What to do in the presence of a thyroid nodule?
In France, starting from 50 years of age, more than half of women are affected by a thyroid nodule.
If formerly the tendency was to operate without any doubts, today the progress of the examinations allows the diagnosis to be made with accuracy, thus limiting the number of surgeries.
Surgical indications are determined by the presence of nodules suspected to be carcinogenic, whether of a doubtful or uncertain nature. The clinical examination is fundamental: any nodule that is hard, irregular, and especially if accompanied by voice disorders (dysphonia) or cervical lymphadenopathy, will be considered very suspicious.
This nodule should lead to a quick surgery after some other tests. Other nodules can also lead to surgery even if they are not too bothersome: bulky compressive nodules causing respiratory or swallowing disorders, large cysts (haematoceles) that reproduce rapidly after evacuation puncture, toxic nodules, a severe psychological impact generated by the presence of the nodule, an aesthetic concern, or uncertainties as to the possibilities or the results of the medical follow-up.
Surgery is still usually recommended when the nodule has a diameter greater than 3-4 cm.
Nodules are often discovered by chance with normal clinical examination without thyroid dysfunction and are benign in 90-95% of the cases. In the presence of a nodule of more than one centimetre, it is recommended to undergo the following examinations:
Ultrasound, which can specify the size and the nature of the nodule (solid or liquid). This ultrasound should be done by a specialist, because precise ultrasound criteria allow, according to an international classification (Bethesda), to already determine if a nodule is suspect;
the dosage of TSH, a hormone produced by the pituitary, which controls the functioning of the thyroid gland;
the aspiration cytology, which consists of taking cells from the nodule with a very fine needle to see if there are cancer cells;
The scintigraphy performed only if the TSH level is too low (hyperthyroidism), to determine if the nodule is responsible (“toxic" or “hot” nodule).
Most of the time, the surgeon removes all the thyroid (total thyroidectomy). In the case of a single nodule, the removal of only one of the two lobes of the thyroid (lobectomy) is sufficient.
If all the thyroid is removed, as it is impossible to live without thyroid hormones, a non-binding life treatment is necessary.
Thyroid surgery is not insignificant. It exposes a person to serious risks such as the damaging of the parathyroid glands, which can lead to a drop in calcium, or to touching the recurrent nerves that control the vocal cords, thus altering the voice. Besides, given the location of the thyroid, the operation is delicate. The experience and the dexterity of the surgeon can make the difference for the success of the operation even at the aesthetic level (more discreet scar).
All these risks, as well as the surgery procedure, will be explained by your surgeon. This operation is only partially covered by social security, which alone cannot cover the clinical fees and the operation. The surgeon will specify the amount of his fees beforehand.