Thyroid nodules and swellings: when to worry

Thyroid lumps are very common but only about 5 in every 100 are cancer and most thyroid cancers are curable. Always see a doctor for any lump or swelling in your neck without delay.

The thyroid gland lies at the front of your neck just below the Adam’s apple. It has 2 lobes connected by a bridge of thyroid tissue, in shape of butterfly. Each lobe is about the size of a plum cut in half, with the whole gland weighing just 15 to 30 grams. It makes 2 hormones called thyroxine (T4) and triiodothyronine (T3) which influence metabolism. The hormones play a vital role in regulation of body weight, body temperature, energy levels, heart rate, menstrual cycle, appetite, digestion, mood, skin, hair, nails, and even eyesight.

There are 2 main things that can go wrong with the thyroid gland. Hyperthyroidism, or overactive thyroid, is where the body produces too much thyroxine. You might experience any combination of unexplained weight loss, heat intolerance, a fast or irregular heartbeat, anxiety or irritability, difficulty sleeping, twitching or trembling, a lump in your neck, and dry or irritated eyes.

Hypothyroidism, or underactive thyroid, is where the body does not make enough thyroxine. You might experience fatigue, drowsiness, weight gain, memory loss, depression or low mood, feeling cold, dry skin and hair, and muscle aches and pains.

Neck lumps are very common, but only about 5% of thyroid lumps are caused by cancer. As many as 90% of women aged over 70 will have small lumps in their thyroid gland, called nodules. An enlarged, swollen thyroid gland is also called a goitre. It is usually a smooth swelling at the front of the neck that moves up and down when swallowing. Dr Hitesh Bodani, a private GP at Northway Clinic, says “you should always have any neck lump checked by a doctor, especially if you find a new lump, or a lump you had checked in the past gets bigger”.

There are several causes of a goitre, including hypothyroidism and hyperthyroidism, hormone changes during puberty, menopause, and pregnancy, some medicines like lithium and amiodarone, and rarely cancer. Another one is iodine deficiency but this is rare in the UK. Iodine is used by the body to make thyroid hormones. Most people will get all the iodine they need from their diet. Good sources are fish and shellfish and it is also found in cereals and grains. People who follow a strict vegan diet may not get enough iodine in their food and might wish to consider taking a supplement, or buying products like plant-based milk fortified with iodine.

Dr Bodani shared his thoughts on how to diagnose and treat goitre, who is at risk of thyroid disease, and how to reduce the risk.

– How is thyroid disease diagnosed?

– A doctor should always suspect thyroid disease in any patient who presents with a mixture of symptoms related to metabolism, or a new or changing lump in their neck. A private GP will take blood tests to measure the amount of thyroid hormones in your body and how well the thyroid gland is functioning and will perform an examination of your neck, which will usually include an ultrasound scan and might involve a biopsy or tissue sample.

– Will I always have a goitre if I have thyroid disease?

– The size of a goitre varies from person to person. In many cases, the swelling is small and does not cause any symptoms. In more severe cases, goitre can cause coughing, a tight feeling in the throat, a hoarse voice, difficulty swallowing or difficulty breathing.

Most people will notice other symptoms of thyroid disease like weight change, mood changes, sensitivity to temperature, and fast or irregular heart beat before they notice any lump or swelling in their neck.

– What are the complications of thyroid disease?

If thyroid disease is left untreated, it can lead to complications like heart disease, eye problems, and pregnancy complications like pre-eclampsia or miscarriage. There are also life-threatening complications of severe thyroid disease called a thyroid storm and myxoedema coma.

– Cardiologists may often suspect thyroid dysfunction

– According to Dr Dushyant Maradia, a cardiologist at Northway Clinic, heart palpitations or heart rhythm disorders referred for investigation by a cardiologist will often turn out to be caused by thyroid disorders. Dr Maradia says “Cardiology and thyroid problems are linked. Basically, whenever we have different types of arrhythmias, we must rule out thyroid problems as a possible cause. In the case of thyrotoxicosis (a very overactive thyroid gland), the thyroid gland releases too much thyroxine, which stimulates metabolism. Excess thyroxine causes the heart to beat faster, causing pathological arrhythmias”. According to Dr Maradia, thyroid dysfunction can also be provoked by cardiology treatments, such as medicines like amiodarone given to treat arrhythmias. “Once they are prescribed, we must always warn the patient that regular thyroid hormone tests are needed. These medicines can cause thyrotoxicosis and, in rare cases, hypothyroidism. That’s why it is always important to monitor any side effects prescribed medication can have.”  

– How is a goitre treated?

– Depending on the underlying cause, treatment can involve medication, radioiodine therapy, or surgery. You will usually have to have regular blood tests to monitor the effects of treatment and you may have to take medication for the rest of your life.

– Who is most at risk of thyroid disease?

– Thyroid disease can affect anyone, but it is more common in women than in men. Especially hyperthyroidism, which is about 10 times more common in women than in men and is usually diagnosed between age 20 and 40. A family history of thyroid disease, having an autoimmune disease like Type 1 Diabetes, or having had previous treatment for thyroid conditions, or previous radiotherapy to the neck or upper chest can increase the risk of developing thyroid disease.

– The cause of most thyroid cancer is unknown, but there are some things that might increase your risk of developing it. A family history of thyroid disease, radiation exposure, obesity, diabetes, having had cancer before, having Systemic Lupus Erythematosus (SLE) or Autoimmune Thyroiditis can all increase your risk of thyroid cancer.

– How common is thyroid disease?

– It is common. It is thought that about 1 in 20 people will experience some kind of thyroid disorder in their life which can be either temporary or permanent. Thyroid cancer is rare, it accounts for less than 1% of all cancer diagnoses in the UK each year: about 2,700 people are diagnosed with thyroid cancer annually. It is most common in people aged 35 to 39, or over 70 and women are 2 to 3 times more likely to develop thyroid cancer than men.

– Is there effective prevention to protect against thyroid dysfunction?

– Because most cases of thyroid disease are caused by the immune system attacking the thyroid gland, there is not much you can do to reduce your risk of developing thyroid disease.

Eating a healthy, balanced diet is the best way to reduce your risk of getting thyroid cancer, and in fact all other types of cancer. This means a low-fat, high-fibre diet that includes plenty of fresh fruit and vegetables and whole grains.

Early diagnosis is key, so if you would like to book a private GP appointment at our modern Clinic in Canning Town, East London (5min from Canary Wharf) please call us on 020 3405 0860 or book it online HERE.