Thyroid Lumps
Nodules or swelling in the thyroid gland, most of which are benign.
Last revised
Key takeaways
- Most thyroid nodules: benign
- Assessment: examination, thyroid blood tests and ultrasound
- Most useful single change: See your doctor about any new neck lump.
- Commonest mistake: Waiting to see whether a neck lump goes away.
- See a doctor if any of the signs under "When to get help" below apply to you.
Why it matters
The great majority are harmless, and the small number that are not are found by assessing all of them.
The numbers, in one place
| Measure | Figure |
|---|---|
| Most thyroid nodules | benign |
| Assessment | examination, thyroid blood tests and ultrasound |
| Further testing | fine needle aspiration biopsy if ultrasound features are suspicious |
| Concerning features | rapid growth, hoarseness, difficulty swallowing, a hard fixed lump |
What helps
- See your doctor about any new neck lump
- Mention any hoarseness or difficulty swallowing
- Mention previous radiation to the head or neck, or a family history of thyroid cancer
- Attend the ultrasound and any follow-up offered
What to avoid
- Waiting to see whether a neck lump goes away
- Assuming a lump is fine because thyroid blood tests are normal
- Ignoring a change in your voice
In depth
Thyroid nodules are extremely common, and they become more common as people get older. Many are too small to feel and are found by chance on a scan done for something else, such as a CT of the chest or an ultrasound of the neck arteries. Most are benign: fluid-filled cysts, overgrowths of normal thyroid tissue, or noncancerous growths called adenomas. A goiter is a general enlargement of the gland, which may be smooth or contain several nodules.
Because cancer is the exception rather than the rule, the aim of assessment is to find the small number of nodules that need attention without subjecting everyone to surgery. Ultrasound is the key tool. Features such as a solid structure, darker appearance, irregular edges, tiny bright calcium spots, or a shape that is taller than it is wide raise suspicion, while purely fluid-filled or spongy nodules are reassuring. Size and features together decide whether a needle biopsy is recommended.
When thyroid cancer is found, the most common type, papillary cancer, usually grows slowly and is highly treatable. That has led US specialists to be more selective about biopsying very small nodules, because finding tiny cancers that would never cause harm can lead to treatment that brings more risk than benefit. A plan of watching some nodules with periodic ultrasound is therefore a deliberate, evidence-based choice rather than a sign of neglect.
Signs and symptoms
- A lump in the front of the neck that moves up when you swallow
- No symptoms at all, with the nodule found on a scan for something else
- A feeling of pressure or tightness, or difficulty swallowing with larger nodules
- Hoarseness or a change in your voice
- Palpitations, weight loss or tremor if a nodule makes excess hormone
- Enlarged lymph nodes at the side of the neck
Causes and risk factors
- Getting older, which makes nodules more common
- Being female
- Hashimoto's thyroiditis and other thyroid inflammation
- Radiation to the head or neck, especially in childhood
- A family history of thyroid cancer or certain inherited syndromes
- Iodine deficiency, which is uncommon in the US
How it is checked
Your doctor will examine your neck and check TSH. If TSH is low, a radioactive iodine scan may show whether the nodule is producing hormone; these hot nodules are very rarely cancerous and usually do not need a biopsy. If TSH is normal or high, a thyroid ultrasound is done to measure the nodule and describe its features, and many centers grade it using a standard risk scoring system.
If size and features meet the threshold, a fine needle aspiration biopsy is done, usually in an office with ultrasound guidance and only a few minutes of discomfort. Results are reported as benign, suspicious or malignant, or indeterminate. Indeterminate results are common; your doctor may suggest molecular testing on the sample, a repeat biopsy, or surgery to remove part of the gland for a definite answer.
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Where to go next
- Thyroid Lumps: A Practical Checklist
- Popular Beliefs About Thyroid Lumps, and What Is Actually Published
- Thyroid and Hormones: The Complete Guide
- The Evidence on Polycystic Ovary Syndrome, Without the Hype
- The Evidence on Hormones and Mood, Without the Hype
When to get help
See your doctor promptly for any new neck lump, and urgently for a lump with hoarseness that does not go away, difficulty swallowing, a rapidly enlarging lump, or a hard fixed lump. Call 911 for difficulty breathing or noisy, high-pitched breathing.
Where this comes from
- American Thyroid Association — Thyroid Nodules
- National Cancer Institute — Thyroid Cancer Treatment (PDQ)
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.