گره تیروئید؛ آیا هر ندول یا توده تیروئید خطرناک است؟ دکتر علی جمشیدی‌فرد، فوق تخصص غدد و متابولیسم

Finding a thyroid nodule on an exam or ultrasound can be a cause for concern; but is every thyroid lump cancerous? What features are important on an ultrasound? When is a fine needle aspiration biopsy necessary, and do benign nodules also require treatment or surgery? In this interview with Dr. Ali Jamshidifard, a subspecialist in endocrinology and metabolism at Erfan Niayesh Hospital, we discuss the causes, diagnostic methods, sampling criteria, and follow-up of thyroid nodules. What is a thyroid nodule? A thyroid nodule is a discrete area of ​​thyroid tissue that may be solid, cystic, or a combination. A person may have one or more nodules. Many nodules are small and asymptomatic and are found during imaging or examination. Are every thyroid nodule dangerous? No. Most thyroid nodules are benign, and many only require follow-up. However, the appearance of the neck or the feeling of a lump alone cannot determine whether it is benign or malignant. Risk assessment is based on medical history, examination, TSH test, ultrasound features, and, if necessary, biopsy. The size of the nodule alone does not determine the risk of cancer. Some small nodules may have suspicious features, and some large nodules may be benign. Also, normal thyroid tests do not completely rule out cancer, because many people with thyroid cancer have normal TSH and thyroid hormones. What are the symptoms of a thyroid nodule? Most nodules do not cause any symptoms. Larger nodules may appear as a lump in the front of the neck or may cause a feeling of pressure, difficulty swallowing, shortness of breath, coughing, or hoarseness. Some active nodules also produce thyroid hormone and may cause palpitations, tremors, sweating, anxiety, or weight loss. A lump that is rapidly enlarging, hard or firm, persistent hoarseness, difficulty swallowing or breathing, enlarged lymph nodes in the neck, a history of radiation therapy to the head and neck, or a family history of some thyroid cancers require more detailed and prompt evaluation. What information does a thyroid ultrasound provide? Ultrasound is the primary tool for evaluating thyroid nodules. It assesses the number and size of the nodules, whether they are solid or cystic, and features such as margins, shape, degree of opacification, calcium deposits, and relationship to surrounding tissues. Lymph nodes in the neck are also examined. Ultrasound can estimate the level of risk, but alone does not always provide a definitive diagnosis of cancer. TI-RADS classifies nodules into risk groups based on their ultrasound appearance. A higher number indicates a need for further evaluation, not a definitive diagnosis of cancer. The decision to biopsy depends on the risk group, size of the nodule, and the patient's condition. What is the role of the TSH test? TSH is ordered to check thyroid function. If TSH is low, your doctor may recommend a thyroid scan to see if the nodule is active or “hot.” ​​Active nodules are usually less likely to be malignant, but they may need treatment because they are producing excess hormone. If TSH is normal or high, the decision is made based on the ultrasound and the criteria for biopsy. When is a biopsy needed? A fine needle aspiration, or FNA, is usually done under ultrasound guidance. In this procedure, a fine needle is used to remove a few cells from the nodule and send them to a pathologist for examination. Not all nodules require a biopsy; the size, along with the ultrasound features and risk factors, determines whether an FNA is done or the nodule is simply observed. The biopsy result may be benign, malignant, suspicious, indeterminate, or inconclusive. An indeterminate or inconclusive result does not necessarily mean cancer and may require further investigation. How are benign nodules monitored? Many benign nodules are monitored with periodic examinations and ultrasounds. The follow-up interval is not the same for everyone and depends on the ultrasound appearance, size, biopsy results, and subsequent changes. A nodule growth is also not always a sign of cancer, but it should be reevaluated. When is surgery necessary? Surgery may be recommended for a malignant or highly suspicious nodule, a mass that is causing pressure symptoms, some indeterminate biopsy results, an active nodule, or a nodule that changes with concern on follow-up. Not all nodules, even large nodules, necessarily require surgery, and the decision should be individualized. If you have a lump in your neck that you can feel, your ultrasound shows a thyroid nodule, or you have persistent hoarseness, difficulty swallowing, or breathing, see your doctor for evaluation. Significant shortness of breath or a rapidly enlarging mass requires immediate evaluation. This video was produced with the presence of Dr. Ali Jamshidifard, a specialist in endocrinology and metabolism, at Erfan Niayesh Hospital. This program is to raise public awareness and is not a substitute for examination, diag...