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The yearly incidence of thyroid cancer is increasing, in part due to detection of non-palpable nodules on ultrasound and cross-sectional imaging performed for unrelated issues.   Incidental thyroid nodules are commonly found by radiological studies done for other indications.   On ultrasound done for suspected parathyroid disease, 46% of patients were found to have incidental thyroid nodules.  Similarly, thyroid incidentalomas have been identified in patients with an incidence of 16% for cross-sectional imaging (CT and MRI), 9–13% for carotid ultrasound (US), and 2–3% for PET scans.  The prevalence of incidental thyroid nodules on ultrasound in the general population ranges between 42–67%.

You probably have a friend, mother, sister or a friend of a friend who has had a thyroid nodule discovered on imaging for an unrelated issue, or a health provider who discovered a thyroid nodule on their physical exam for an unrelated visit.  But do not panic!  Thyroid nodules are actually quite common, discovered in 4–7% of the population by palpation and in up to 60% of patients on postmortem examination.

Do not panic!  Although thyroid nodules are very common, thyroid cancer is still fairly rare.  Palpable thyroid nodules have a reported malignancy rate of around 5%.  Malignancy rates of incidentally-discovered thyroid nodules vary, ranging from 8% to 29%.

The key is to have these thyroid nodules appropriately worked-up according to the American Thyroid Association Guidelines.  This entails:

  • getting a lab test
  • a thyroid ultrasound
  • and possibly an ultrasound-guided biopsy of the nodule, if indicated.

This is a simple procedure that can be done in the office and takes about 10 minutes.  There is a good chance that you will never require thyroid surgery, but you will need to have the thyroid nodule(s) followed with yearly ultrasounds.

Teresa Kroeker, M.D., Fellowship-Trained Head & Neck Surgeon
St. David’s Medical Center

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