Thyroid Nodules - Causes, Symptoms and Treatments

so you have a thyroid nodule what now welcome to talking with docs I'm Dr Brad and I'm Dr Paul zel I'm Dr Amy meini Dr amini is an ear nose and throat surgeon who's going to help us with this topic in full disclosure you saved my life really did remember a few years ago quite a few years ago I had a real bad infection in my throat was fairly reluctant to seek medical attention which is a mistake and then my surgical assistant with me actually put me in a headlock which made it harder to breathe took me to emerge you saw me and put me in the ICU this is not a joke he actually really would not go see the doctor yeah I think I went from work to ICU in like a world record time yes but I put you on steroids so you have to blame me for your hip replacement in a few side effects of steroids luck I have not had any but you did save my life so I owe you a coffee okay so when it comes to thyroid nodules these are very very common let's start at the beginning what is our thyroid what does it do why do we have it so thyroid is an organ and it produces your your thyroid hormone which helps with your metabolism and how everything functions in your body okay and just lives in the front of her throat just in the front part of the neck but sometimes it's not as obvious here it's usually lower down in this area so the bump you see there is that the thyroid or is it just below the bump no so the bump you see here what you call the atam Apple that's actually your thyroid cartilage but it sits below that all right okay so how would someone know if they have a hot thyroid nodule they don't always know so it's actually someone else that some times identifies it right so if you had a really big one someone might see it or feel it and then the other way apparently is with other investigations that are done for other reasons so if you had like a neck CT scan for some other problem someone says hey we noticed that you have a nodule on your thyroid now we have to talk up with this yes and that's a little different than a goer right people always say goer goers just means that it's a big thyroid big thyroid yeah as opposed to a nodule per so you have a nodule whether it's symptomatic or not you're at your family doctor what do we do then how do how do we work through the history and the physical examin mintion of a thyroid nodule so normally The Family Doctor once it's identified um they'll order actually blood work so looking at your thyroid hormone level so you it's a TSH that they order thyroid stimulating hormone they order T3 T4 and they also look at calcium um and magnesium because there's glands just behind it that are called parathyroid glands that actually control it but they don't rely on the thyroid itself it's kind of cool cuz you're looking at in the blood of a hormone that stimulates the thyroid and then you're looking at hormones that the thyroid produces and depending on those levels you can actually determine if the thyroid is working properly or if it's not working properly if it's getting a signal to do something and it's not doing it or if it's doing something without the signal so you can get a lot of cool information from those uh blood levels and when you're thinking about the thyroid nodules there are certain things that increase people's risk of having an issue or a thyroid no that's more important that fair to say like when it comes to gender age yes iodine exposure not sorry radiation exposure or iodine deficiency would those be the four categories primarily uh I would say so yes okay and what what would we say about gender so gender so men will men don't normally have thyroid nodules as often as women do and they say for women it's because of our estrogen levels okay so if you were to Ultrasound um a woman and you saw that their nodul is there as long as they're a certain size or smaller you just follow them but in men um you do start to worry earlier uh regarding that and also from an age point of view for men it's over the age of 45 and when there's an a higher risk than below that okay and we don't mean to offend anyone with our gender discussions but in medicine often it's important to know if someone is XX chromosome or XY chromosome because it predisposes you to certain diseases and determines your treatment options so that's why we often say things like when men this happens and women that happens but we are sensitive to the various gender discussion question that are going on right now okay so you've done the history you've done the physical examination like you said often if they're small you actually can't feel them um what is the gold standard test for diagnosing a thyroid naul so an ultrasound is a gold standard so even though it's been identified by accident with an MRI or a CAT scan the best Imaging is an ultrasound of the neck and the purpose of the ultrasound is to identify not only the size but whether it's fluid filled what its borders are like that kind of thing yes okay ultrasound so useful so ultrasound is a nice non constructive way of looking at tissue right it's just sound WS we bounce off to look at Contours and shapes and things like that and it's safe test there's no radiation involved with ultrasound and you can't hear it it's Ultra that's right so now so now you got a nodule now what are we going to do how do we find out Beyond just what we have so far whether or not the nodule is something that we need to do something else about so on the ultrasound they will look at different features so uh one of it is the size of course the other one is if it's solid or if there's a mix of solid and fluid or if it's only fluid filled uh the third thing is whether there's little spots of calcium deposits either within it or around it which is not necessarily a good thing like that increases the risk of that Legion it does uh so my the teaching was um it increases your risk of uh for thyroid cancer about 40% if you see calcifications in and that's basically what we're worried about here right if you got nodules we're worried that you might have cancer in your thyroid right is that the idea it is but you can also have a nodule that what we call hot so if it's overactive then you could have Graves disease which is hyper thyroidism but that's usually identified through blood work though okay so not all nodules are cancerous but that's one thing that the surgeon or the doctor or your Healthcare profess is going to try and rule out make sure this isn't a cancer okay so now we're suspicious that it's cancer depending on its features and its size what is the next test that we do to try to identify whether or not it's cancerous or not so if the radiologist uh reports a certain kind of criteria that they have so there's a there's a grading system it's spelled TI i r a d and it ranges from 1 to six if it's 1 to three it's usually you know less suspicious features and so they usually recommend more observation and follow up ultrasounds if it's four to six there's a higher uh risk of having thyroid cancer in it so that's when we would order what we call a fine needle aspiration biopsy okay and what's interesting I learned when I was studying for this is that you guys have agreed on some nomenclature and some language that's used by the radiologist so that it's more useful for everyone saying you have to specifically talk about these things so that we all can understand what you mean if someone else you didn't know your radiologist but you look at the report me same thing to everybody okay so we're on to fine needle aspiration that sounds bad you're going to put a needle in my thyroid FNA FNA and so typically where is this done and how's how's it done so it can be done either by the Radiology Clinic which is where I tend to send my patients to because they're just set up to do them more frequently uh but you can have a surgeon also do that procedure for you or some endocrinologist who is a medicine doctor that specializes in endocrine glands and thyroid is one of them he or she may also do the needle biopsies and this is just under under local anesthetic just under local sometimes it's done without local FNA sounds sounds effing p can't say that when I was when I was training uh one of the uh one of the staff men he'd say that you know it's still going to be a needle in there whether it's frozen or not so so to be honest I kind of say the same thing for the knee cuz you're like are you going to freeze I'm like well I could maybe freeze the top part of the skin but the needle goes so much deeper you can't adequately freeze the whole thing so no but but if you're doing normally we're supposed to do at least three samples separate samples so I don't know I think some times of freezing may help I would agree and the reason that you have to do three samples is imagine if you were putting a needle into an orange there's a and there you hid something maybe hit some dye inside of the orange there's a possibility that you could take samples from three different locations and not get to the dye so that's why we're hoping to get a representative sample and not miss a smaller area of cancer okay okay that's FNA what about the other way to biopsy is there any other biopsies you if you don't do a fine need as would you ever take a significant piece of the thyroid or is that just with the thyroid ectomy that it's a biopsy I think it's a depends on what you're looking for so the gold standard really is spine needle aspiration but if you're say ruling out a lymphoma and you need more chunks of tissue because we need to send it away for different uh analysis then sometimes they will get a Core biopsy done here okay yeah so so once you've done the final aspiration those cells go off and they're looked at under a microscope and then you're told for sure it's not cancer for sure it is cancer or maybe it's cancer or indeterminate is that fair to say I I don't know about for sure radiologist theology will not say that okay highly suspicious versus versus not cancer is that fair to say or not really yes I think that that would be fair it'll say benign right right or it'll say a Tippy of undetermined significance um it may say um suspicious for follicular neoplasm but neoplasm can be cancer and can be non-cancerous uh or suspicious or consistent with a certain type of thyroid cancer okay okay and then based on those results that dictates your next treatment plan I suspect well what I recommend yes right okay okay so then so so how do you go through that so someone's got a nodule they've had to find El aspiration they have some results now they're sitting in your office and you're looking at the report so say you have the benign group what do you tell that person so with the benign group and if really their ultrasound shows that there's not a lot there except for more size and it does recommend more followup then if the patient is comfortable with the idea of repeating the ultrasound somewhere between six to 12 months and if there's some growth there they may need another needle biopsy okay it really just depends on it's very individualized obviously related to it okay and then so what if you're in that group of the the atypical cells group so the atypia so that usually means about a 25 to 30% chance of having cancer in that nodule so I guess I should go back the General risk that we all have without knowing any other information about a nodule is 7 to 11% okay so 25 30% isn't huge but it's still an increase comforable if you really want to know more information about it sometimes well actually usually we do repeat the needle biopsy um in about at least six months later okay to see if we get a different results okay uh but if not uh then you could send a sample a new sample sample to the States and it's called an affirma test is one of the companies that makes it and they do genetic testing on it right it's not 100% um but it can tell you if there's any of the really bad genes in there okay what the risk is for having a cancer in there okay so certain centers not not read not everywhere I guess have the ability to do certain genetic testing to send that but it cost about four grand us okay so it's not something that most people order right yeah okay and then what if you get to the point where like yeah this looks like a looks like an a cancer yes and then is it straight to thyroid ectomy thyroidotomy it is it is a thyroidectomy when I started 18 years ago though if it said that and it was a 1 centimeter thyroid cancer we would automatically take the whole thing out okay but now there's a lot more research in there and and we have a better understanding of how they progress which ones are safe sizewise uh so if there's nothing nothing else on the other side we have to worry about then taking out just the one side is reasonable right yeah and and the reason that we want to do less harm with surgery is particular for thyroid is potentially they can not have to have thyroid replacement right exactly it's just it all depends also on your age I think too because the the gland over time will weaken right or not I shouldn't say weaken but doesn't produce as much thyroid hormone so I think it's about we all have a 1% chance as we get older that our thyroid will reduce its function and that we might need replacement okay so so now you've had your thyroid out yes what are the what's the prognosis for someone with thyroid cancer So speaking about all cancers obviously some of them are very very serious and have a high chance of even death thyroid cancer actually is a pretty treatable cancer depending on the subtype yes definitely generally speaking Yeah and I know there people will say you know if you're going to have a cancer this is the best type I don't like to say that because once you say cancer no one's comfortable with that idea but if it if it is one of the more um sorry less aggressive uh types then usually just removing it and then just having follow up if you don't especially if you don't remove the other side right is a reasonable course is like Curative almost basically for for most patients yes and then as long as um I actually I always tell them that usually you will die from regular things such as heart disease and stroke then your thyroid cancer but there are certain subtypes that can be very aggressive right okay and then we always talk about risks anytime you have a surgical procedure there are risks what are some of the risks associated with having a thyroid removed so there's two specific things from a thyroidectomy that you have the run the risk of so one is your calcium can drop temporarily or permanently and that's because of those little glands I was talking about earlier parathyroid glands they're about the shape I always tell patients like the shape of a caper so pretty small about half a centimeter less than a centimeter and they sit next to the thyroid but they do not rely on its blood supply with for the thyroid so it's like if you think of oranges and the sections when you separate it it's like that but even if you preserve them if say their blood supply gets stretched a little bit they get stunned somehow um you can have a drop in your calcium after surgery okay so it's really important to keep an eye on plus some collateral damage to the parathyroid hormone which is integral in the balance calcium yes in your body there's one more thing though one is your voice box so the thyroid gland if you kind of think of it as a fat butterfly so that's how I think so it sits on top of your trachea and there's a Groove between the your trachea sorry your trachea and the esophagus where food goes down and the nerve that provides the movement of your vocal cord it actually runs up in that in that space and it goes behind the cartilage called um well it's actually the thyroid membrane so it sits in there so it's very close so that's your recurrent Lal nerve that's your recurrent Lal nerve right and that thing is at risk even when you get intubated for any procedure that can be Dam there's lots of things that can happen with with that nerve so it's a little vulnerable so you can end up with like horseness or lose your voice completely yes so if it's not moving it'll actually not move in and out normally and so that will sometimes the paralysis is most of the time the paralysis is temporary because it's just been stretched not actually damaged but it's if it gets cut right what percent are we talking about here if you you're having a thyroid ectomy the percentage chance of having this recurrent layer on gal nerve either temporarily or permanently damaged is roughly so permanently damaged it's less than 1% okay so very rare and then the temporary part I I hardly see it fortunately so it's not so rare but devastating complication especially if you're talking with docks right we lose the Talking part but you can still be horse even though it's not damaged because of the breathing tube sitting there okay so that's so it's like a mild laryngitis okay yeah temporary temporary yes okay there you go okay and then so after you're all done so so you've had your thyroid out do you have regular follow-up or again it's very individualized depending on the type of cancer and how the surgery went whether or not you'd have to have ongoing followup with your surgeon so most of the time I actually get my referrals from endocrinologists so they're already being followed by them I'm really just a technician okay like I know that feeling but I I follow my patients until if they don't have cancer then I follow them at least a year just to make sure anything potentially related to the surgery that they have issues with I've dealt with and then I always actually my thyroid patients are the only ones that don't need a re-referral if there's something that's there maybe related to the thyroid before or their Endo says you need to see mabini back you know there's a lunk there right yes so endocrinologist those are the docs that sort of measure hormones are are are interested in all those blood levels when they determine if the thyroid is functioning yes and the thyroid for sure is a real team right it's so it's the surgeon the endocrinologist maybe an oncologist maybe a radiation oncologist as well as a whole people yeah they're family doctor everybody's involved with that the primary care is usually who identifies they're the key except for orthopods we don't get not involved with the thyroid okay now you know everything you wanted to know about thyroid nodules and thyroid cancer so if you like this video please like it subscribe to our Channel leave a comment if you had experience with this pathology and remember you are in charge of your own health Dr mbini thank you so much for sharing your expertise we'll see you next time

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Keywords: thyroid nodules, thyroid nodule, thyroid, thyroid nodule treatment, thyroid cancer, thyroid nodule (disease or medical condition), thyroid nodules causes, thyroid nodules cancer, thyroid nodules symptoms, thyroid nodule causes, thyroid nodule symptoms, thyroid nodule biopsy, nodule, nodules on thyroid, about thyroid nodules, thyroid gland, thyroid nodules biopsy, what are thyroid nodules, who gets thyroid nodules, thyroid nodules removed, causes of thyroid nodules

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Length: 17min 46sec (1066 seconds)

Published: Sun Jan 21 2024