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When To Worry About Thyroid Nodules

Learn what to expect and when to worry if a thyroid nodule should appear.
When To Worry About Thyroid Nodules
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We have all been conditioned to be alarmed whenever we feel an unexpected lump or bump on our bodies. So, if you or your doctor notices larger nodules or a lump on your thyroid gland, your first reaction may be fear-based. Fortunately, the majority of thyroid nodules are usually treatable--even those that are cancerous. Here is what you should know about thyroid nodules, what to expect and when you should worry if one is to appear. 

Thyroid nodules are common

Patients with thyroid nodules are quite prevalent in the United States. Although nodules can often by asymptomatic and are very small in size, some sources go so far as to say that about half of Americans will have a nodule by the time they are 60 years old. However, a percentage of thyroid nodules will not be able to be felt upon examination by your primary care doctor, requiring an ultrasound to further diagnose. It is important to note that many doctors pick up less than 1 in 10 on physical exams. Therefore, it is possible to have nodules without knowing it.

Nevertheless, it is important to note that the risk of thyroid cancer or cancerous thyroid nodules has a much lower frequency. According to the American Cancer Society, about 2-3 out of 20 nodules have a risk of cancer. While cancerous and some benign nodules will require treatment,  benign nodules can be left alone and watched closely as long as they are not growing or causing symptoms.

Different types of thyroid nodules

Thyroid nodules are small tumors that locate themselves on the thyroid gland. Like many nodules and tumors, they can come in various shapes and sizes and be solid, fluid-filled, or a mix. Here are the different types of cancerous and non-cancerous nodules on the thyroid.

Thyroid adenomas

Thyroid adenomas are benign growths on the thyroid. They can come in various shapes, sizes, and forms and may have different names. More often than not, these nodules do not require treatment unless they are causing symptoms, and they can be monitored closely with ultrasound.

Toxic adenomas

Toxic adenomas are a type of thyroid nodule that makes excess thyroid hormone, causing thyroid conditions such as hyperthyroidism. While these nodules bring unpleasant symptoms of an overactive thyroid, they are almost always benign (with only 1-8% being malignant).

Thyroid cysts

Cysts are usually benign fluid-filled sacs. These cysts may be very small or quite large and sometimes can show up very quickly. If a cyst is large and bothersome, it may be surgically removed to ensure it does not impact other structures in the neck, such as the airway and vocal cords.


A goiter is a term that encompasses any enlargement of the thyroid gland. The most common cause of goiter in the United States is Hashimoto's thyroiditis, an autoimmune condition causing hypothyroidism. A goiter may also occur in other parts of the world or regions with iodine deficiencies. Like benign cysts, goiters do not require treatment unless they infringe on other proximal organs, such as the vocal cords.

Sometimes, goiters may be multinodular, meaning they have multiple nodules on their surface. Again, these nodules are usually benign and only require treatment if they cause hyperthyroidism by excreting excess thyroid hormone or are suspected to be cancerous.

Thyroid cancer

There are several different types of thyroid cancer, including:

  • Papillary
  • Follicular
  • Hurthle
  • Medullary
  • Poorly differentiated, and
  • Anaplastic

Thyroid cancer cells form when genetic changes occur in otherwise normal cells, causing them to grow rapidly. The most common forms of thyroid cancer (papillary and follicular) are usually less aggressive, but all cancers require diligent monitoring and treatment.

Risk factors for nodules

Factors that lead to an increased risk of thyroid nodules (both cancerous and non-cancerous) include:

  • Family history of thyroid cancer or nodules
  • History of radiation to the thyroid
  • Hashimoto's thyroiditis
  • Advancing age
  • Smoking
  • Obesity
  • Metabolic syndrome
  • Iron-deficiency anemia
  • Increased alcohol intake
  • Uterine fibroids

Worrisome signs

We now know that most thyroid nodules are benign and don't warrant significant concern. However, there is always the possibility some nodules will contain cancerous cells. Thyroid cancer can be silent for a long time, with the only telltale sign being a nodule. Therefore, the moment you feel a nodule, you will want to have it looked at by your provider to rule out cancer. The earlier thyroid cancer is detected and treated, the better the outcome.

Because some nodules will secrete excess thyroid hormone, it is important to correct any nodules that create a state where the thyroid is overactive. Too much thyroid hormone can cause symptoms of hyperthyroidism, including a racing heart with palpitations, anxiety, and muscle weakness. If you have symptoms of hyperthyroidism, you don't necessarily need to be worried, but you need to seek treatment to normalize your thyroid hormone levels.

Unexplained weight loss, debilitating fatigue, and generally unwell can also be worrisome signs of something not quite right.

Treating thyroid nodules

Unless nodules are cancerous or causing symptoms, most benign thyroid nodules can be closely monitored without treatment or further intervention. However, any thyroid nodules with cancerous cells, or suspected cancer, need to be surgically removed by an experienced thyroid surgeon. According to the American Thyroid Association, most cancerous thyroid nodules are curable and rarely will cause life-threatening circumstances.

Several tests can be used to determine if a thyroid nodule is cancerous or not. Thyroid ultrasound is one of the first tools to identify abnormal and normal thyroid tissue, followed by needle aspiration biopsy to extract cells from the nodule. Radioactive iodine may also be used to target nodules.

Not knowing whether a lump is cancerous or not can be highly stressful. But, more often than not, most thyroid gland nodules are benign; if they are cancerous, people usually have good outcomes. Rest assured that the sooner you find out what type of lump you have, the less worry you will have, as there will likely be a clear course of action on the next steps in managing any nodules.

A note from Paloma

Keeping your thyroid levels closely managed is crucial for optimal thyroid health. With the Paloma Health at-home thyroid test kit, you can run a full-thyroid panel from the comfort of your own home. 

If you suspect that you may have a nodule or are developing one, we encourage you to schedule an appointment with your healthcare provider for a physical or ultrasound exam.

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Julia Walker, RN, BSN

Clinical Nurse

Julia Walker, RN, BSN, is a clinical nurse specializing in helping patients with thyroid disorders. She holds a Bachelor of Science in Nursing from Regis University in Denver and a Bachelor of Arts in the History of Medicine from the University of Colorado-Boulder. She believes managing chronic illnesses requires a balance of medical interventions and lifestyle adjustments. Her background includes caring for patients in women’s health, critical care, pediatrics, allergy, and immunology.

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