University of Virginia Health System

Any patient who becomes aware of a mass in the neck deserves an immediate and thorough workup. In children congenital abnormalities, infections, lymph node enlargement, as well as involvement of the thyroid can cause such masses. In adults, such masses could arise from either local lymph nodes or the thyroid. In adults, it is easy for the examining physician to determine the difference between a thyroid and a non-thyroid mass by physical exam. A mass in the thyroid moves with swallowing while a mass outside of the thyroid does not.

The majority of thyroid masses are benign. However, a complete workup should be done to evaluate a thyroid mass. The workup of such a thyroid mass usually entails an office visit where laboratory tests, including thyroid function tests are drawn. If these thyroid function tests determine that the mass is causing a state of over-activity of the thyroid gland (hyperthyroidism) then the physician may proceed with a radioactive thyroid scan. The scan will help to determine if the mass in the thyroid is producing an excess amount of thyroid hormone. The primary treatment of an over-functioning thyroid mass or nodule is medical. The physician may place the patient on thyroid suppression medication followed by thyroid scan six months later. These over-functioning nodules are often called autonomous nodules or "hot" nodules. They rarely require surgery.

In the patient who has normal thyroid function tests, an ultrasound of the neck may be performed. This examination is rapid, non-invasive and relatively inexpensive. It gives the examining physician important information about the size, location and consistency of the nodule. If the thyroid mass is cystic, it may be drained by needle aspiration and followed closely. If the mass is solid or indeterminate, the physician may look for additional nodules in the neck or thyroid. At this point in the diagnostic phase, the physician and patient may discuss fine needle aspiration biopsy or surgical removal of part of the thyroid.

Fine needle aspiration biopsy is a procedure where a very thin needle is placed into the thyroid mass. This procedure may be done by direct placement of the needle or with the use of ultrasound guidance. A benign diagnosis, such as a colloid nodule or adenoma, cannot be completely confirmed by fine needle aspiration. However, a diagnosis of papillary or medullary cancer can be made with virtually 100% accuracy. In our practice at the University of Virginia, we use fine needle aspiration when the patient requests further information about the thyroid nodule. If a patient has a thyroid nodule or mass that is causing symptoms or if the patient is concerned about cancer, we suggest consideration of surgery.

Our goal, within the Endocrine Surgical Group, is to work with the patient, the primary care physician and /or the endocrinologist to provide the best possible care. When the Endocrine Surgical Group sees patients in consultation, a discussion concerning the proposed procedure, risks, and benefits will occur.