What Size Thyroid Nodule Should Be Removed?

Find out about the different factors that affect the decision to remove a thyroid nodule and when surgery may be recommended.

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A thyroid nodule is a growth (lump) in the thyroid gland. The thyroid gland is located in the neck, just above where your collarbones meet in the middle. The thyroid gland makes hormones that help regulate the way your body uses energy.

Most thyroid nodules are benign (noncancerous). But sometimes a biopsy is needed to be sure that a nodule is not cancerous.

If a biopsy shows that a thyroid nodule is cancerous, it will need to be removed with surgery. The size of the nodule helps determine whether just a portion of the thyroid lobe needs to be removed (lobectomy) or the entire lobe and some surrounding tissue need to be removed (near-total or total thyroidectomy).

What is the difference between a benign and malignant thyroid nodule?

A thyroid nodule is a growth of thyroid cells in the thyroid gland. They can be benign (not cancerous) or malignant (cancerous). Benign nodules are usually not a cause for concern. They are often found incidentally on imaging tests performed for other reasons. Most people with benign nodules do not need treatment.

Malignant thyroid nodules are less common. They may grow quickly, be irregular in shape, and feel hard or firm on examination. Sometimes, malignant thyroid nodules can cause symptoms such as difficulty swallowing or shortness of breath if they are large enough to press on the esophagus or windpipe.

The best way to tell if a thyroid nodule is benign or malignant is to have a fine needle biopsy performed. In this procedure, a small needle is inserted into the nodule and cells are removed for examination under a microscope. If the biopsy shows that the cells are cancerous, additional testing will be done to determine the type of cancer and whether it has spread outside of the thyroid gland.

What are the symptoms of a thyroid nodule?

Most thyroid nodules are found incidentally when a person has a scan for another reason. A thyroid nodule is more likely to be talked about when it causes symptoms, such as:
-A feeling of fullness in the throat
-Difficulty swallowing
-Hoarseness or change in voice
-Cough that isn’t due to a cold or other respiratory infection

The vast majority of thyroid nodules are benign, meaning they are not cancerous. However, a small percentage of thyroid nodules can be cancerous, and these need to be treated differently.

How is a thyroid nodule diagnosed?

Diagnosis of a thyroid nodule begins with a consultation with a doctor and a physical exam. To specifically look for evidence of thyroid nodules, the doctor may order one or more of the following tests:
Blood tests. A simple blood test can measure the levels of thyroid-stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland and stimulates thyroid hormone production. If your TSH level is high, it may be an indication that your thyroid gland is not functioning properly, which could be due to a benign or cancerous growth.
-Ultrasound. This imaging test uses sound waves to produce detailed images of your thyroid gland. It can help determine if a nodule is fluid-filled (cystic) or solid, as well as its size, shape and location within the gland.
-Fine needle aspiration biopsy. During this procedure, a thin needle is inserted into the thyroid nodule to remove cells or fluid for laboratory analysis. This can help determine if the nodule is cancerous or noncancerous.

What are the treatment options for a thyroid nodule?

There are several treatment options available for thyroid nodules, and the right option for you will depend on a number of factors, including the size of the nodule, your symptoms, and whether or not the nodule is cancerous.

If the nodule is small (less than 1 cm) and is not causing any symptoms, your doctor may recommend monitoring the nodule with periodic ultrasounds and thyroid hormone level tests. If the nodule grows or begins to cause symptoms (such as hoarseness, difficulty swallowing, or shortness of breath), your doctor may recommend surgery to remove it.

If the nodule is large (greater than 1 cm) or is causing symptoms, your doctor may recommend a fine needle aspiration biopsy to determine if it is cancerous. If the biopsy shows that the nodule is cancerous, surgery to remove all or part of the thyroid gland (thyroidectomy) will be recommended.

In some cases, radioactive iodine therapy may be recommended to treat a large non-cancerous thyroid nodule. Radioactive iodine therapy works by shrinking or destroying the thyroid tissue that contains excess iodine. This treatment option may not be suitable for people with certain medical conditions, such as pregnancy or kidney disease.

Thyroidectomy and radioactive iodine therapy are generally very effective treatments for thyroid nodules and can often lead to a cure. However, it is important to discuss all of your treatment options with your doctor before making a decision.

What are the risks of surgery to remove a thyroid nodule?

There are several risks associated with surgery to remove a thyroid nodule, including:
– Damage to the parathyroid gland, which controls calcium levels in the body
– Injury to the nerves that control the vocal cords, which can cause hoarseness or loss of voice
– Bleeding
– Infection

What are the risks of not treating a thyroid nodule?

If a thyroid nodule is found to be cancerous, it will need to be removed. However, even if a thyroid nodule is not cancerous, there are still risks associated with leaving it untreated. One of the biggest risks is that the nodule could grow larger and eventually cause difficulty swallowing or breathing. Additionally, if the nodule is large enough, it could press against blood vessels in the neck and cause problems with blood flow. Finally, untreated thyroid nodules can also lead to an imbalance in hormone levels, which can cause a variety of symptoms.


After reviewing the evidence, we can say that there is no definitive answer to the question of what size thyroid nodule should be removed. The decision must be made on a case-by-case basis, taking into account the individual patient’s medical history, symptoms, and risk factors.