An experienced physician should be able to distinguish a normal thyroid gland from a goitrous or nodular thyroid. This distinction helps direct the next step and may eliminate the need for further tests. Physicians who are inexperienced in dealing with thyroid gland conditions should refer patients to an endocrinologist. Endocrinologists, or internal medicine specialist, focus on the ears, nose, and throat. Endocrine surgeons possess the skills to evaluate thyroid nodules.
A physician considers the patient’s history and conducts a physical examination to help determine whether there is a malignant growth. Physicians also consider other factors in reaching a decision on further testing and management including the history of growth, the presence of pain or other symptoms, age, sex, history of exposure to irradiation, physical characteristics of the gland, and laboratory studies. However, these initial procedures produce generally nonspecific results. At this point, as needed, a physician may employ procedures such as a thyroid function test, a thyroid scan, a thyroid ultrasound, and an FNA biopsy to establish a diagnosis.
If the test performed (most likely the FNA biopsy) shows a benign nodule, the physician may simply watch your condition to record changes. To suppress the growth of additional nodules, your physician may prescribe thyroid hormones. If the nodule grows larger, the physician may perform another biopsy. If the biopsy is inconclusive or indeterminate, the physician repeats the biopsy.
Thyroid cancer is statistically a minor health problem. It only accounts for 0.4 percent of all cancer deaths and is fatal in only eight in 1 million people per year in the United States. In the rare case that a physician detects a malignant growth, surgery is the favored way to remove the nodule. Afterward, the doctor prescribes thyroid hormone tablets to replace hormones made by your removed thyroid. Thereafter, a physician closely monitors the patient, preferably with TSH testing. The physician may also administer radioactive iodine to destroy any remaining cancerous tissue. If a physician’s diagnosis reveals a malignant growth, other family members should be tested because some forms of thyroid cancer are hereditary.