If your nodule is not cancer and is not causing problems, your doctor may watch your nodule closely. If your thyroid nodule is causing hyperthyroidism, your doctor may recommend a dose of radioactive iodine, which usually comes in a pill that you swallow. Your doctor may have you take medicine (antithyroid pills) for a few weeks to slow down the hormone production. Your thyroid hormone level needs to be normal before you can be treated with radioactive iodine.
If your nodule is cancer or is so large that it causes problems with swallowing or breathing, you'll need surgery to remove the nodule. You may also need treatment with radioactive iodine to destroy any left over cancer cells. After surgery, you may need to take thyroid medicine for the rest of your life.
Thyroid Nodule Surgery: The extent of your thyroid nodule or tumor surgical removal will be determined by your doctor after evaluation your health history and diagnostic tests, family history and other factors.But in general either a partial or complete thyroidectomy (thyroid removal surgery), is recommended for:
- Thyroid cancer or indeterminate lesions that cannot be classified from a fine needle aspiration biopsy.
- Large thyroid nodules that cause obstructive symptoms, such as problems breathing or swallowing.
- Thyroid nodules that cause pain.
- Cosmetic reasons, to remove large visible thyroid nodules.
Radioactive Iodine: Iodine-131 concentrates in the thyroid tissue and cause tissue destruction. I-131 can be administered as a capsule or in liquid form.
- I-131 can be used to treat multinodular goiters with nodules that are producing extra thyroid hormone. Such cases are indicated by a low TSH level and elevated thyroid hormone level in the blood or a "hot" nodule on radionuclide thyroid scan.
- After I-131 destroys the thyroid, the patient develops an underactive thyroid (hypothyroidism) and requires thyroid hormone replacement for life to maintain a normal level of thyroid hormones in the blood. Thyroid hormone replacement consists of simply a pill taken once daily by mouth, which is safe, easily tolerated, and relatively inexpensive.
Thyroid Hormone Suppression: There is controversy regarding whether physician-supervised administration of thyroid hormone may shrink the size of thyroid nodules. Many doctors believe that thyroid hormone does not effectively shrink nodules. Furthermore, there is the risk of high blood levels of thyroid hormone in patients with multiple thyroid nodules (multinodular goiter). However, clinical trials have shown that suppressive therapy may be successful in shrinking some thyroid nodules. Doctors may make this decision on a case-by-case basis and studies are still ongoing to determine the efficacy of this type of treatment. It is important to discuss the pros and cons of suppressive thyroid hormone therapy with your doctor.