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There are various treatment options for solid thyroid nodules ranging from medication therapy to surgery. The treatment will largely depend upon on the type of thyroid nodule that is found. Treating benign or cancerous nodules usually involves a combination of medication, radiation therapy and surgery. Typically cancerous nodules will require extensive surgery to remove the malignant formations along with the majority of thyroid tissue.
The complete or near-complete removal of thyroid tissue is called a near-total thyroidectomy and is often performed as a treatment option for cancerous solid thyroid nodules. After the surgery is completed, a lifelong thyroid drug will need to be prescribed in order to supply the body with thyroid hormone. Depending on the extent of the malignancy, the lymph nodes located in the neck may have to be removed.
Approximately four to six weeks after surgery radioactive iodine is sometimes given to patients with thyroid cancer. Much like healthy thyroid cells, some cancerous cells retain the ability to absorb and concentrate iodine. Once the cancerous cells absorb the toxic radioactive iodine, the cells are destroyed. In some cases the cancer may spread to other areas of the body necessitating the need for chemotherapy.
Radioactive iodine is also used to treat benign solid thyroid nodules, adenomas and multinodular goiters which can cause hyperthyroidism. Taken in capsule or in liquid form, radioactive iodine will most likely shrink the nodules. Symptoms of hyperthyroidism usually subside within two to three months from the start of radioactive iodine treatment.
Medications are often used to treat benign solid thyroid nodules. Benign nodules that cause hyperthyroidism can be treated with anti-thyroid medications such as methiamazole. Anti-thyroid treatment is usually long-term, which can have serious side effects on the liver. Thyroid nodules that do not cause hyperthyroidism are often treated with a synthetic form of the thyroid hormone. In theory treating benign nodules with additional amounts of synthetic hormone signal the pituitary gland to produce less of the hormone that is responsible for nodule formation.
When formations increase in size or other treatment options have failed, surgery is performed to remove benign solid thyroid nodules. Large benign nodules can hinder breathing or swallowing, by constricting the esophagus and blood vessels. Sometimes failure of radioactive iodine or anti-thyroid therapy will necessitate surgical removal of the benign nodules.
In some cases the best treatment for a benign thyroid nodule is a watch-and-see approach. Regular physical exams and thyroid function tests are often performed to monitor the situation. A biopsy may be required if the nodules grow larger or tests indicate changed thyroid function.
If anyone is looking for a less invasive treatment for thyroid nodules instead of a thyroidectomy, I can share an excellent alternative.
I had a thyroid nodule that put pressure on my trachea, causing coughing, difficulty swallowing and pain. My first endocrinologist immediately recommended thyroid removal surgery, despite blood tests showing normal levels, and ultrasound confirming the nodule was benign. I didn’t get it; if the thyroid worked well, why remove the whole gland? Why not just remove the nodule?
I searched for non-surgical treatments, learned that a more targeted approach, Radiofrequency Ablation, could reduce my thyroid nodule. RF is a non-surgical alternative for thyroid nodules, well known in Asia and Europe, but not in the US. In
Southern California, UCLA Gonda Diabetes Center seemed to have the most advanced and experienced endocrinology team, so I was hopeful I could reduce the nodule as opposed to cutting out my thyroid.
I was pleased with my second opinion at UCLA, specifically Dr. David Geffner (Endocrinology), and Dr. David K Lu (Radiology). They were respectful of my search for an alternative, fully informed, and the option they recommended was the right, conservative next step for me. The procedure was very successful. The pain was minimal, results were immediate - no sign of a nodule now - and my thyroid is still there! It was perfect for me as I never understood why thyroid removal would be a first step in my case, as my previous endocrinologist had recommended.
I've been very impressed with my care under my new endocrinologist and pleased with his referral for my targeted nodule treatment. I had the highest quality care, the most advanced expertise and skill, a sophisticated imaging facility and an excellent support team.
When I was searching for alternatives, reading blog posts led me to RF Ablation and UCLA, so I hope my experience may help someone. Best wishes and good health.