When Should you Worry About Thyroid Nodules? 6 Signs to Watch For

When Should You Worry About Thyroid Nodules? Look For These Signs

Is your thyroid nodule actually thyroid cancer in disguise?

This is the question that most people ask themselves and it's the question we are going to explore today. 

The good news is that most nodules are NOT cancerous and there are certain signs and symptoms, if present, do increase the chance that your nodule may be harboring cancer. 

More...

Signs your Thyroid Nodule May be Something More

The biggest fear that most people have when it comes to thyroid nodules is whether or not they should worry about it. 

And this makes a lot of sense, considering the thing you should be worried about is your risk of cancer. 

Why?

Because each thyroid nodule, regardless of the size, has a small risk of turning into thyroid cancer. 

The good news is that this is actually quite rare. 

If we looked at the population of the world we would find that about 20 to 70% of people (1) have a thyroid nodule!

signs you should be worried about your thyroid nodule

Obviously, thyroid cancer is not nearly as common which means that most people with thyroid nodules do NOT get thyroid cancer

Having said that, there are some people that will, which is what we are going to talk about now. 

If you have a thyroid nodule AND you have any of these other signs or symptoms, then you may be at a slightly higher risk of thyroid cancer:

  • The size of your thyroid nodule is greater than 2.0 cm or 20 mm (a size greater than 1.0 cm or 10 mm may also be worrisome as well)
  • Unexpected weight loss
  • Difficulty swallowing
  • Changes to your voice or hoarseness when you talk
  • Pain or discomfort in the neck area
  • Enlargement of the lymph nodes in or around your neck
  • A noticeable or irregular lump in your neck
  • Symptoms of hyperthyroidism (weight loss, heart palpitations, sweating, nervousness, heat intolerance)
  • If you have a thyroid nodule and you are younger than 20 years old or if you have a thyroid nodule and you are older than 70

Let me be clear, though, just having these symptoms does not guarantee that you have thyroid cancer. 

But if you do have these signs/symptoms then it's probably a good idea to get checked out by your doctor with advanced testing such as ultrasound or even a biopsy (more information below). 

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Thyroid Nodules are usually Benign and Not Cancerous

The good news is that most people with thyroid nodules do not and will not get thyroid cancer. 

The bad news is that a thyroid nodule is not normal and may be associated with other conditions of your thyroid gland. 

So, even if you don't have thyroid cancer, you should still have your thyroid nodule evaluated and tested for other conditions which are associated with thyroid nodules. 

Conditions in this category include:

  • Goiter - Conditions such as iodine deficiency can lead to an enlargement of your thyroid gland. This condition may also contribute to the development of nodules. 
  • Thyroid cysts - Thyroid cysts are a type of thyroid nodule but they are filled with fluid. These cysts are often identified very easily with thyroid ultrasound but can present the same way as a thyroid nodule. 
  • Hashimoto's thyroiditis - Hashimoto's thyroiditis is an autoimmune condition of the thyroid gland which also causes hypothyroidism. This condition is very common, especially among women. 
  • Other types of thyroiditis - Infections, trauma, and autoimmune attack can all cause inflammation of the thyroid gland. Inflammation triggers damage to the thyroid gland which may lead to the development of a thyroid nodule. 
  • Hyperthyroidism - Most thyroid nodules do not secrete thyroid hormones but some "hot" nodules can actually secrete thyroid  hormones which may cause the symptoms of hyperthyroidism. If you have hyperthyroid-esque symptoms then your doctor should evaluate for these hot nodules. 
  • Thyroid cancer - Some nodules are associated with thyroid cancer but this is actually quite rare. Only about 5-10% of thyroid nodules are cancerous. 

It's important to realize that many thyroid nodules are just run-of-the-mill nodules which are not associated with thyroid disease of any kind. 

But, in order to be on the safe side, it's ideal that every patient who has a thyroid nodule undergoes certain tests to ensure that this is the case. 

Tests such as a comprehensive history and physical, palpation of the thyroid gland, tests of your thyroid function through blood work, and even an ultrasound may all be warranted. 

Your doctor should be walking you through these steps but you can also ask for them if you are worried. 

How Big is Too Big? 

When it comes to thyroid nodules, the size matters quite a bit. 

Studies have shown time and time again that larger thyroid nodules tend to turn into thyroid cancer at a higher rate compared to smaller thyroid nodules. 

The magic number in terms of size is 1 cm or 10mm. 

But size isn't the only thing that matters. 

For instance:

It has been shown that even small thyroid nodules can be cancerous if they have certain and specific findings on thyroid ultrasound. 

“The number of nodules and their size are not predictive of malignancy, as a nodule smaller than 1 cm is as likely as a larger nodule to harbor neoplastic cells in the presence of suspicious US features.”


For this reason, you never want to judge the risk of thyroid cancer based on the size of your nodule alone. 

You will notice that while the size is certainly a risk factor, you should also look at other risk factors including whether or not the nodule is causing symptoms, your age, and what the nodule looks like on ultrasound. 

As a patient, though, you can use the size of your nodule as a quick and dirty way to assess whether or not you should be worried. 

Thyroid Nodules and Thyroid Cancer

The biggest concern on most people's mind is probably whether or not their thyroid nodule is actually cancer in disguise. 

As I mentioned previously, most thyroid nodules (about 90% or so) are benign. 

But that leaves another 5-10% which can be cancerous and should be evaluated. 

There are some factors which have been evaluated which can help you understand your risk of thyroid cancer. 

The risk of thyroid cancers increases with these risk factors:

thyroid cancer risk by age
  • Age - The younger you are or the older you are, the more likely your nodule is to be cancerous. This is true if you have a thyroid nodule are you are younger than 30 or older than 60. 
  • Gender - Women tend to get thyroid cancer more often than men but thyroid cancers in men tend to be more aggressive. 
  • Genetics (family history) - Do you have a family history of thyroid cancers or thyroid nodules? If so, this may increase your risk.
  • Size of the nodule - The bigger the nodule the greater your risk of cancer. 
  • History of radiation exposure - Radiation exposure from things such as X-rays and CT scans may increase your lifetime risk of developing thyroid cancer. If you undergo these types of tests ensure that your thyroid gland is protected with a lead shield. 
  • History of other cancers - Do you have a history of other cancers? Especially endocrine (hormone) cancers such as MEN (3), MTC, or PTC? If so, your risk for developing thyroid cancer is increased. 
  • How fast the nodule is growing - Most thyroid cancers are actually slow growing. This is why doctors recommend that you get frequent ultrasound testing of your thyroid nodule every 6 to 18 months (4). 
  • Symptoms which are associated with your nodule - Symptoms such as a chronic cough, pain in the neck, and lymph node enlargement are all suspicious symptoms. 

Ultrasound Testing & Manual Exams

There are really three different ways to test or evaluate your thyroid nodule. 

The first is with a manual exam, usually performed by your doctor. 

This is an easy way to test whether or not you need further testing. 

Your doctor can do this when you visit him/her in the office. 

This test is usually done by manually feeling or palpating the thyroid gland while the patient (you) is taking a drink of water. 

evaluation and treatment of thyroid nodules

The second is with ultrasound testing, usually performed by an ultrasound technician and read by a radiologist. 

Ultrasound testing can help you to understand if your thyroid nodule looks suspicious or not. 

There are certain factors, or characteristics, which, if present, may increase your risk of having thyroid cancer. 

These factors include: 

  • The presence of absence of calcification - Microcalcifications (5) found within thyroid nodules may suggest the presence of thyroid cancer. 
  • The shape of the nodule - If your thyroid nodule is taller than it is wide (6) then that is a risk factor for thyroid cancer. 
  • The vascularity of the nodule - The presence of vascularity by Doppler ultrasound (7) is also suspicious for thyroid cancer. 
  • The margins of the nodule - Nodules which have irregular borders, which look 'infiltrative' (8), or which have speculated margins are all suspicious. 

Your ultrasound report should include this information and you can request this information from your primary care doctor or your radiologist. 

But, even if you request the information, you should have your doctor also evaluate this information to help you understand it. 

You can also technically evaluate thyroid nodules with other tests such as MRI and CT scan but these are not often recommended. 

The third is with a biopsy, usually guided by an ultrasound. 

Getting a Biopsy (Fine Needle Aspiration)

A biopsy, often referred to as a fine needle aspiration or FNA, is the most conclusive way to test your thyroid nodule. 

This procedure can also be done on enlarged lymph nodes in your neck which may be a better way to diagnose thyroid cancer. 

The only problem is that it is also the most invasive procedure out of all three methods. 

It's really cheap and easy to check your thyroid gland manually at a regular visit with your doctor. 

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It's also fairly easy to get an ultrasound of your thyroid gland. 

Even though getting a biopsy is not technically difficult (it's easy to find a nodule and stick a needle in it), you don't necessarily want to get a biopsy of every thyroid nodule that you see (9). 

Why?

While a biopsy is conclusive if your thyroid nodule contains cancer cells, there are many times when the results come back as "inconclusive". 

If you get an inconclusive result then you are stuck in a position where you simply need to monitor the thyroid gland and potentially get a repeat biopsy after some period of time. 

signs your nodule should be biopsied

The waiting game can cause unneeded stress and anxiety to you the patient as you wait. 

Furthermore, you don't really want to get a biopsy unless absolutely necessary because there are small risks involved (10) with any medical procedure. 

The risk of bleeding or infection are small, but they are still real and present. 

For these reasons, you really don't want to get a biopsy unless absolutely necessary based on the size of your nodule or based on the features your nodule has on ultrasound testing. 

Most recommendations suggest getting a biopsy if your nodule is greater than 1.0 cm by itself. 

Conclusion

Most thyroid nodules are not cancerous and are not something that you should be worried about. 

Even though this is true, it's still a good idea to get properly evaluated by your doctor to ensure that your thyroid nodule is completely benign. 

When you get your nodule tested, be sure to also look for other thyroid conditions which are frequently associated with thyroid nodules. 

These conditions, if not treated, can lead to quality of life problems such as fatigue, weight gain, and so on. 

Now I want to hear from you:

Do you have a thyroid nodule?

Are you showing signs which are concerning?

Have you had your nodule tested yet?

What did you find?

Leave your comments or questions below! 

References (Click to Expand)

when to worry about thyroid nodules

Dr. Westin Childs

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 45,000+ people have used them over the last 4.5 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

31 thoughts on “When Should You Worry About Thyroid Nodules? Look For These Signs”

  1. I had the left side of my thyroid gland removed in 1996 due to a nodule. It contained a pepper grain size capillary cancer so when the nodule on the right side doubled in size the doctor recommended removal a year later. I am now 68 and have experienced accelerated arthritis resulting in total knee replacement in 2003 and 2004 plus a hip replacement in 2016. I am convinced that the removal of my thyroid is the cause of my arthritis. Can you confirm this?
    I’ve been on Synthroid until 2017 when in desperation to feel better I found some information regarding natural thyroid. It’s been stressful finding there is a shortage so whenever I need an adjustment in my meds I have to search for it. I’m very interested in your research and encouraged that someone is actually giving this problem some much needed attention. I’m currently 70 lbs over weight and have a doctor who is doing her best to work with me but she needs to be reminded that I’m not the same as her other patients who have a gland. I’m looking for direction. Can you help?

    Reply
      • I had a few tests done. And at first they found one 5mm nodule on left side of thyroid. Few months later they found the 5mm was now 1 3cm and I had two more. One 3mm a d the other 4mm. And they also found two nodules on lower left and one on the upper right lobes. What’s the chances it’s anticancer?

        Reply
  2. I was told after an Ultrasound that I have a 6 mm benign nodule on my Thyroid. I am 45 in extremely good health but have a sensation when I swallow. No history in the family at all and I have a good balanced diet. Should I worry or not?

    Reply
  3. Further to my last message. Although I train like mad and eat relatively small but balanced diet I find it difficult to lose weight and I feel exhausted all the time. I usually put the muscle pain and exhaustion down to having Glandular Fever leading to CFS / ME and training. But could this be due to my Thyroid? I have been told from bloods my Thyroid is normal.

    Reply
  4. How often should a thyroid nodule be biopsied? I have a large solid hypervascular nodule – just one – it is over 2.6 cm wide and 1.4 cm high. It has been biopsied two times with “favored benign” results. I just had another ultrasound, it has stayed the same size – no other changes. I have Hashimotos and take both levothyroxin and cytomel. Is it appropriate to biopsy again? Or just watch… Thank you for your advice.

    Reply
    • Hi Natalie,

      It really depends but if it’s not enlarging or growing or changing on ultrasound then the frequency with which you need a biopsy is very low.

      Reply
  5. I am a 68 year old female diagnosed with Hashimoto’s with all the classic symptoms. My quality of life is continually suffering. I’ve had nodules on my thyroid for a number of years. I have just recently switched endocrinologists & this new doctor is doing a biopsy tomorrow. I don’t think there is reason to worry but this us the first time being biopsied. If the result is inconclusive should I get a second opinion?

    Reply
  6. I have 5 nodules one that was biopsied [1cm] 5 years ago. Several ultrasounds 3 yrs ago showed no change. I have since found I have the genetic CHEK2 variant with increased risk of thyroid cancer. I have a maternal aunt and cousin w/ papillary thyroid cancer. My Dr does not seem concerned, though did order ultrasound at my insistance. Is this something I should worry about or not?

    Reply
  7. I’m a 62 year old woman with subclinical Graves disease–little to no symptoms but suppressed TSH. Ultrasound shows that I have a 2.5 cm nodule that has been reported to me as being “highly suspicious”. It is solid, hypoechoic, has irregular borders and some microcalcifications. It’s wider than tall. An FNA has been suggested ou and is scheduled and I am a nervous wreck! Would you be worried given this information?

    Reply
  8. I am 66 yrs. old. I just had bloodwork done and my TSH is elevated (4.87). An ultrasound showed 3 nodules, one that is 1.0 cm and meets the criteria for biopsy (solid, very hypoechoic, wider than tall, lobulated or irregular). A radiology consult has been ordered. Also, the report stated prominent left-sided lymph nodes but none pathologically enlarged. The other 2 nodules are 0.7, 0.9 cm in size. Do you recommend the biopsy of the largest? What about the 2 following closely in size?

    Reply
  9. I am 66 years old and have a nodule on the right side. It was discovered about 6 years ago? and is now 5.5cm. The Afirma FNA indicated it was suspicious. I was told to have surgery within the next 6 months or sooner and to “prepare my loved ones”. A surgeon had already called me before I even got home from my appoint re: the biopsy results. The second surgeon said that there was a 49% chance it was malignant. 49%??? I have asthma, I am terrified at the idea of someone “cutting my throat”, and feel that there have to be other options. These same doctors including my primary who just refers me to other doctors, have not even referred me to the lab for a full thyroid panel…just a TSH, or the very minimal. Any suggestions? Someone else referred me to Dr. Clayman’s Thyroid Cancer Center in Tampa, FL.

    Reply
  10. I am 77 yrs old.
    I have hypoechoic, ill defined isocehoic/ hypoechic nodule. right side:
    4.9x2x2cm. 1.8×1.3×1.2 was 0.8×0.8×0.08. 1.1×2.1×0.8cm was0.7×0.6×0.6 additional one 0.6×0.5×0.5cm thyroid isthmus measures 3 mm. right side:lesion with punctate densities measuring 1.3.finding could represent microcalification witin nodule. left side: 5.7×1.9×2.6cm 2.3×1.1×1.8cm 1.2×0.9×0.9 no microcalification or internal vascularity identified. these are partially calcified 1.2×0.9×0.9. no increased vascularity. nodule without vascularity thrroiss ishmus no evidence of thickening. color doppler appearance. I have F.A.P., and men1 thyroid cancer in family. What do you recommend?

    Reply
  11. My doctors nurse called me with results from an ultrasound that was done on my thyroid.. she said the doctor said I have three lesions and a cyst but that they were to small to biopsy and that was it… my concern which I called the doctor back is this… I am a breast cancer survivor 2014 had my treatment and bilateral so I am concerned that these may be cancerous… should I be worried… I feel very sickly and tired all the time.. what should I do because I have yet to hear back from the doctor and it’s been two days…

    Reply
  12. I am 39 and noticed a rather large lump in my neck about 2 months ago now. Looking back at photos of myself it seems to have first started appearing in September of last year and is about 5 cm in size as I measure it. As a result of the size the Doctor referred me for an ultrasound which came back ‘suspicious’ but the Doctor has advised that cancer is not likely. Now I am awaiting a biopsy. Other than the lump though I have no other thyroid symptoms and am wondering if that should be a concerning factor since it looks to have been growing for about 10 months now.

    Reply
  13. Will being vascular always be cancerous? I have a 4.1 vascular nodule. My thyroid levels are all normal expect for my TSH are non existent. I changed my eating 3 years ago, only organic, no processed foods, water & shower filter, removal of mercury fillings, no toxic products, literally everything possible. This past year I did Ozone IVs & UV and high dose Vit C IV to treat for mold exposure. I actually got my period last month after not having one for 4-5 years. A few months before that period I had weight gain, nails grew, swelling in lower extremities and after that period my thyroid has been swelling in the evenings.

    Reply
  14. So. I had an ultrasound in February. I had a spot that was about 1.1 mm. in August I had another ultrasound and that spot grew to 7mm and I have another one that is about 5mm. This was to give perspective on timeline. I have 1 lymph node that is noticeably swollen. Would this be any concern?

    Reply
  15. do i need to worry. I have a goiter which i was diagnosed with when i was a kid. Now at the age of 60 i have 4 nodules on right lobe and 4 on the left lobe and now a new 1 on the Ishimus. They average in size from 10x8x9mm, 12x6x10mm, 6x4x4mm, 15x7x11mm on the right and the left they average 12x7x10mm, 30x21x28mm, 33x23x27mm, 10x8x13mm, and 8x5x7mm. could you tell me if this is normal or something to be concerned about. have been getting these checked for several years and they do keep getting bigger

    Reply
  16. Hi, I’m a 45 yr female. I Hashimoto’s with hyperthyroid. I take 125mg of Synthroid. I had a ultrasound last year 12/2019 and I had 2 nodules. One was a TR4 Solid, hypoechoic, smoothly marginated, wider than tall. 0.4X0.5X0.3. The Second one was a TR3 Soild, isoechoic, wider than tall. 0.6x.07x.07.
    I f/u up this week and the TR4 nodule grew to .07x.06x.07 and 2nd one stay about the same.
    I have a strong family history both side of family. I have 3 1st degree relatives that have had thyroid cancer. Do you think they will do a FNA. Last year they said it was to small even though it was label as moderately suspicious.

    Reply
  17. I recently had an Ultrasound on my Thyroids and the Technician stated the left thyroid was to big to measure and the right was slightly smaller but big as well. The tech also mentioned i would have to see and Endourologist to be properly examined and have an accurate course of action to decrease the size. She mentioned iodine and radiation. My follow up appointment with my pcp in 02/2021…With these new findings should i request an earlier appointment and what should i be looking for?

    Reply
  18. I had a partial thyroidectomy, my right lobe with large nodule. Had multiple benign fine needle biopsies but nodule had grown to over 4 cm. Doctor removed right lobe and nodule as outpatient in hospital setting. I now have insurance wanting me and doctor to justify why it had to be done in hospital setting rather than a surgery center. They are trying to charge me a $1000 copay since it was done in hospital rather than surgery center. My surgeon used a NIM tube (spelling) to help keep nerves safe in my neck. Could you please help explain why this surgery needs to be done in hospital setting vs. surgery center?

    Reply
    • Hi Sonya,

      It’s a complicated issue and has to do with the preference of your doctor, the complexity of your surgery, and other factors including monetary incentives from the doctor. Some doctors own partial ownership in surgery centers so they make money doing surgeries there, others prefer to do it at a hospital because it’s safer even though it’s certainly more expensive.

      Reply
  19. My dentist found a lump in my next, and told me to tell my doctor who ordered an ultrasound.

    The 1st ultrasound 2 years ago they stated it was a calcification. I recently went in early March 2021 and now they stated it is a 1.17 cm nodule. They were borderline on whether I should do a biospy or not. At this time I have scheduled a biopsy on March 29th and wondering if you think there is a need for this or if I should cancel.

    I am not a fan of needles and scared I will not remain still nor swallow.

    Would you have the biopsy with this information?
    Thank you for your assistance!!

    Reply
  20. Could you please give me your opinion of this interpretation?

    US THYROID

    Details

    Study Result

    Impression
    Unremarkable thyroid ultrasound.

    NOTE: Permanent recorded sonographic images were taken.

    Narrative
    CLINICAL DATA: Sensation of lump in throat

    COMPARISON: None

    TECHNIQUE: Multiple sonographic images of the thyroid gland were
    obtained.

    FINDINGS:

    The isthmus measures 1.8 mm. There is a 7 mm hypoechoic nodule.

    The right thyroid lobe measures 4 x 1.2 x 1.1 cm. There is an
    ovoid hyperechoic 8.6 x 3.4 mm nodule. This demonstrates no
    increased Doppler flow.

    The left thyroid lobe measures 3.9 x 0.9 x 1.3 cm. Normal
    echogenicity without mass or nodule.

    No lymphadenopathy or parathyroid nodule identified.

    Reply
  21. Hey there!
    39 year old female recently diagnosed with Hashimotos after seeking treatment and help for diffuse hair loss over 2months.

    Labs showed TPO antibodies were increased (27) but TSH 1.070 and T4 0.93 normal. Ultrasound showed enlarged thyroid mildly heterogenous…left lobe nodule 0.7X0.4cm circumscribed parallel hypoechoic nodule lower pole without punctate echogenic foci.

    Bilateral cervical chain lymph nodes incidentally noted largest on right measuring 2.2cm long axis.
    Impression:small TI-Rads 4 nodule left lobe , heterogeniety of thyroid may reflect chronic thyroiditis. Repeat ultrasound in 1 year.

    Any thoughts?
    Thanks so much for your videos!
    Ashley

    Reply
  22. Hello Dr.
    My Mother was dx at around my age (58) with thyroid cancer (actually she had two different cancer cells in her thyroid. My younger sister also dx thyroid cancer in her 40s.
    Recently during an MRI a nodule was found, and it was suggested by the radiologist to have an US to further study the nodule.
    Findings “High-resolution transducer is utilized for evaluation of the thyroid gland, nonuniform echopenic nodule in the right lobe posteriorly in the mid-portion of the gland measures 11x7mm. The right lobe measures 5.6×1.6×1.0 cm. The left lobe measures 5.1×1.7×1.9 cm, a complex solid nodule in the mid-portion of the gland measures 2.8×2.7×1.8cm, this is better seen on the MRI to compress the trachea. Follow-up thyroid uptake and scan could be useful for further evaluation”
    I just finished the Nuclear Thyroid Uptake this morning, and my Primary Dr office called saying that the results were I had a cold Thyroid and I was being referred to a general surgeon. I am currently in WV and the healthcare is not optimal here, with a lack of specialists and long wait times, etc. My question is this: Should I try to travel out of the area to have an endocrinologist surgeon do the consult/biopsy/procedure/s or is it customary to have a general surgeon handle this case?
    I do have hoarseness, a lump feeling when I swallow, and it grew rather quickly to the size reflected above, as it was not detected in 2017. If I was your family member, what would you suggest? Thank you for your time and this informative article. Kim

    Reply
    • Hi Kimberly,

      I don’t think I’ve ever met an endocrinologist that does his own biopsies. Endo’s spend most of their day seeing patients and writing prescriptions. General surgeons spend most of their days cutting people open! A general surgeon doing a biopsy shouldn’t be an issue. I would personally feel more comfortable with a surgeon over an endo doing that procedure. The only exception would be if you can find a general surgeon that does ONLY thyroid gland procedures.

      Reply
  23. Hello Dr.
    I am a 56 year old male who was diagnosed with bile duct cancer in June of this year. I had surgery on the 28th of July and they removed 20 % of my liver. The doctor ordered a cat scan of my chest and they found a 2.5 cm hypodense left thyroid nodule. What are the chances that it is cancerous since I had bile duct cancer? Should I be concerned and should I ask for a pet scan of my whole body to see if there is anything else to worry about. I start chemo July 31st. Had many chest cat scans and it never showed up on any of them till now.

    Reply

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