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Table of Contents
Causes
Symptoms
Treatment
Life After Treatment
Thyroid Cancer Outlook
Ahypoechoicnodule is an area of swelling or abnormal cell growth on the thyroid gland. There’s a better chance that a solid nodule is cancer than with other types of nodules.However, the risk ofthyroid canceris still low, and a hypoechoic nodule is still likely to be benign.
The term “hypoechoic” refers to the way the nodule appears on an ultrasound: dark.When a nodule appears hypoechoic rather than “anechoic” (more likely fluid-filled or cystic), radiologists know it’s likely solid. Your healthcare provider will likely order more tests to diagnose it.
This article explains what a hypoechoic thyroid nodule is and what its symptoms and possible causes are. It also discusses how a hypoechoic thyroid nodule is diagnosed and treated.
Some causes of thyroid nodules include:
Thyroid nodules are not uncommon and affect about 6% of females and 2% of males.They’re more likely to occur in older people but when present in younger people, they’re more likely to be malignant.
Researchers continue to explore the causes of thyroid nodules and any related conditions, with genetic changes an increasingly important evaluation in determining treatment.
In some cases, healthcare providers can identify the cause of thyroid nodules. For example:
Are Hypoechoic Thyroid Nodules Cancerous?
Less than 5% of thyroid nodules are cancerous.However, a hypoechoic thyroid nodule may be more likely to be cancer than other nodules are.
The American Thyroid Association guidelines call for a biopsy of all solid hypoechoic nodules measuring 1 centimeter or larger.A modified definition that identifies nodules as “markedly hypoechoic” is reported to improve accuracy in diagnosis.
What Percentage of Hypoechoic Nodules Are Malignant?A 2022 study of thyroid nodules in nearly 5,000 people found that markedly hypoechoic nodules were cancerous in 18.7% of cases; they occurred in benign nodules just 2.5% of the time. Moderate hypoechoic features were present in 31.2% of malignant thyroid nodules but 8.1% of benign tumors.Other features likecalcification, however, are important to an accurate diagnosis.
What Percentage of Hypoechoic Nodules Are Malignant?
A 2022 study of thyroid nodules in nearly 5,000 people found that markedly hypoechoic nodules were cancerous in 18.7% of cases; they occurred in benign nodules just 2.5% of the time. Moderate hypoechoic features were present in 31.2% of malignant thyroid nodules but 8.1% of benign tumors.Other features likecalcification, however, are important to an accurate diagnosis.
People with thyroid nodules often have no symptoms.That’s why thyroid nodules are frequently detected during medical imaging that has nothing to do with the nodule but has to do with another health concern. In about a third of cases, people detect a thyroid nodule themselves.
When someone discovers their own thyroid nodule, it may be because it is pressing on thewindpipe(trachea) or voicebox (larynx) and making it difficult to breathe or swallow. A large thyroid nodule can also lead to vocal changes or hoarseness.
In some cases, a person will be able to feel a thyroid nodule at the front of their throat (just be sure you’re not confusing the nodule for yourAdam’s apple).
More generally, symptoms of thyroid cancer include:
Thyroid Nodules and Hyperthyroidism
In other cases, a thyroid nodule can secrete thyroid hormones, pushing thyroid levels abnormally high. This is known as an active—or toxic—nodule.Active nodules can lead tohyperthyroidism, which has symptoms including:
Once an ultrasound shows a hypoechoic thyroid nodule, your healthcare provider will likely do follow-up testing. Although the risks of cancer are relatively low, a proper diagnosis and understanding of your thyroid nodule are key to assuring the treatment that will be right for you.
Your practitioner will likely conduct a physical exam, feeling your thyroid nodule. This can give the provider an idea of the size and position of the nodule.
For proper diagnosis, you’ll need to undergo follow-up tests for your hypoechoic thyroid nodule. These include:
Fine Needle Aspiration Biopsy
During afine needle aspiration biopsy (FNA or FNAB), a healthcare provider:
A healthcare provider may offer a local anesthetic during this minimally invasive procedure, but that might not be necessary. There’s no special preparation for a biopsy, and most people have no recovery time.
If a biopsy finds malignant cells, the type of cells will help your healthcare provider to define the type of thyroid cancer. If a biopsy cannot provide a definitive answer about whether or not a thyroid nodule is cancerous, your healthcare provider will discuss the best course of action, which may involve surgery.
Determining If a Nodule Is CancerousA fine needle aspiration biopsy is considered the gold standard for hypoechoic thyroid nodule diagnosis. Yet the results are inconclusive in up to 30% of cases and further testing is still needed. Molecular testing for specificgenetic changeshas become a valuable tool in both the diagnosis and management of thyroid cancer.
Determining If a Nodule Is Cancerous
A fine needle aspiration biopsy is considered the gold standard for hypoechoic thyroid nodule diagnosis. Yet the results are inconclusive in up to 30% of cases and further testing is still needed. Molecular testing for specificgenetic changeshas become a valuable tool in both the diagnosis and management of thyroid cancer.
Going Into a Thyroid Biopsy: What to Expect
Blood Test
Any time your healthcare provider finds a thyroid nodule, including one that is hypoechoic, they’ll likely order blood tests. The tests will measure the amount ofthyroid-stimulating hormone(TSH) in your blood in order to help determine if your thyroid nodule is active or producing hormones.
If your practitioner notes that your nodule is producing hormones, you might breathe a sigh of relief, since most active nodules are not cancerous.However,hyperthyroidismcauses the body’s metabolism to increase, which can have its own health implications.
Thetreatment for hyperthyroidismcan include medication or radioactive iodine treatment to kill off your thyroid orradiofrequency ablation(RFA) of the hyperfunctioning nodule. RFA is also an option for the removal of benign nodules.
Thyroid Test Analyzer: Decode Your Results
Thyroid Scan
Hypoechoic thyroid nodules are detected via ultrasound, so if you’ve been diagnosed with one, you’ve already had an ultrasound scan. However, your healthcare provider might order another ultrasound to:
Ultrasound and biopsies have become so effective they’ve reduced the need for nuclear thyroid scans.Yet in some cases, especially if your thyroid nodule is active or your biopsy was inconclusive, your healthcare provider may still want to conduct a nuclear thyroid scan to get a better picture of the nodule.
The test uses radioactive iodine to look at patterns of function in your thyroid to help determine if your nodule is making hormones.
If you need a nuclear thyroid scan, you’ll take a pill that contains radioactive iodine. Four to six hours after taking the pill, you’ll undergo a scan while lying on a table. Another scan is usually done about 24 hours later.
What Is a Radioactive Iodine Uptake Test?
How Do You Treat Hypoechoic Thyroid Nodules?
After your healthcare providers have a thorough understanding of your hypoechoic thyroid nodule, they’ll be able to recommend a course of treatment. That precise treatment will depend on your specific situation:
The four types of thyroid cancer are:
Common treatments are used for hypoechoic thyroid nodules, including those that are cancerous.
Surgery
In some cases, and especially if your thyroid nodule is cancerous, your healthcare provider will recommend surgery to remove the nodule, part of your thyroid, or the entire thyroid.
Surgery is the first-line treatment for thyroid cancer. It is also recommended if a benign thyroid nodule is interfering with your ability to breathe, speak, or swallow.In some cases, it’s used for people who have hyperthyroidism.
The type of surgery the healthcare provider recommends will depend on the location of your nodule and whether it’s cancerous. Three common types of thyroid surgery are:
What Is a Scarless Thyroid Procedure?
Radioactive Iodine Therapy
Radioactive iodine therapy, or radioiodine therapy, kills the thyroid and any cancerous cells. The thyroid is very sensitive to iodine, while other organs are not. Because of that, radioactive iodine can channel radiation and target it toward the thyroid without harming other organs or exposing them to radiation. If you go this route, you will:
In some cases, you’ll need a second course of treatment.
Radioactive iodine therapy is used to treat thyroid cancer in some cases and also thyroid diseases such asGraves disease.
Radiation SafetyPeople who get radioactive iodine treatment are required to quarantine at home so they don’t risk exposing anyone else to radiation.
Radiation Safety
People who get radioactive iodine treatment are required to quarantine at home so they don’t risk exposing anyone else to radiation.
Radiation
For certain rare types of thyroid cancer, your healthcare provider might recommend radiation, formally known as external beamradiation therapy. Like radioactive iodine, this therapy kills cancer cells using radiation. In this case, a small beam of radiation from outside the body is carefully targeted toward the cancer.
Radiation is used for cancers that can’t be treated with radioactive iodine, including those that have spread beyond the thyroid.Most commonly, those are cancers that don’t uptake iodine. These include:
In some cases, radiation is also used to treat other types of thyroid cancers that have not responded to radioactive iodine therapy.
Chemotherapy
In most cases,chemotherapyis not used to treat thyroid cancer because it is not particularly useful against thyroid cancer, and more effective treatments are available.
However, if you have anaplastic thyroid cancer or papillary/follicular thyroid cancer, your healthcare provider might recommend chemotherapy in combination with radiation.In rare cases, chemotherapy is also used to treat medullary thyroid cancer.
Targeted Drug Therapies
There are many different types of kinase inhibitors, so your healthcare provider will recommend the one that is most effective against your specific type of cancer.
Targeted drug therapies are particularly useful for medullary and anaplastic thyroid cancer since other treatments aren’t very efficient against them. Targeted drug therapies might also be used for other thyroid cancers that haven’t responded to treatment.
BRAF Mutation: Cancer Types, Testing, Treatment
Wait and See
If your hypoechoic thyroid nodule is not cancerous and is not producing enough thyroid hormone to cause hyperthyroidism, your healthcare provider might suggest you take a wait-and-see approach. This is common if you haven’t been experiencing any symptoms.
In this case, you’ll likely undergo frequent thyroid scans and blood tests every six to 12 months. These scans and tests will ensure the nodule isn’t growing or secreting hormones. If it begins to grow or become active, your healthcare provider might advise treatment.
Undergoing your scans as recommended can ensure any progression ofthyroid diseaseand future complications with your thyroid are caught early.
Immunotherapy for Cancer: What Are My Options?
In many cases, treatments for thyroid cancers kill or remove the thyroid. This is good because it gets rid of the cancer. However, it also ruins your body’s ability to naturally produce thyroid hormone. That can leave you with signs ofhypothyroidism, or underactive thyroid. Thesymptoms of hypothyroidismcan include:
To combat these symptoms and keep your metabolism functioning as normal, your healthcare provider will likely prescribe hormone replacement medication that will be taken daily. The most commontreatment for hypothyroidismis the prescription medication levothyroxine.
In order to determine whether you’re on the right dose and that no new symptoms of thyroid disease or cancer are emerging, your healthcare provider will carefully monitor your thyroid health after you’ve been diagnosed with a hypoechoic thyroid nodule. This will involve scans and blood tests to measure your hormone levels once or twice a year.
Do Thyroid Symptoms Ever Fully Go Away?Although thyroid disease and thyroid cancer are conditions that oftentimes have to be managed over a lifetime, it’s entirely possible to live without symptoms once your healthcare provider has you on an effective treatment protocol.
Do Thyroid Symptoms Ever Fully Go Away?
Although thyroid disease and thyroid cancer are conditions that oftentimes have to be managed over a lifetime, it’s entirely possible to live without symptoms once your healthcare provider has you on an effective treatment protocol.
In most cases, thyroid cancer is highly treatable. Your healthcare provider will be able to talk about your specific outlook using the details from your case. However, data from the National Cancer Institute can help you get an idea of your prognosis.
Unlike other cancers, which use stages to signal how the disease has progressed, thyroid cancer is classified using the following designations:
Using these classifications, the National Cancer Institute calculates the five-year survival rate for each of the four types of thyroid cancers.
5-Year Survival RateLocalizedRegionalDistantOverallPapillaryNear 100%99%76%Near 100%FollicularNear 100%97%64%98%MedullaryNear 100%91%38%89%Anaplastic31%10%3%7%It’s important to remember that these are just statistics. Since the data was gathered about five years earlier than they were released, it’s likely that treatments for thyroid cancer have become more effective over that time, and survival rates may have improved. This may be particularly true for hard-to-treat thyroid cancers like anaplastic thyroid cancer since targeted drug therapies are always being improved upon.Speaking with your healthcare provider about your specific case will help you understand your prognosis if you have been diagnosed with thyroid cancer.SummaryA hypoechoic thyroid nodule appears dark on an ultrasound. In most cases, it is a benign growth, but these nodules do have a greater risk of being cancer than other thyroid nodules. Your healthcare provider likely will want to order additional tests, including a biopsy, to confirm a diagnosis.Treatment will depend on the type of thyroid cancer (if present) and how far it has advanced. Surgery, chemotherapy, and targeted drugs all are options. Surgery also may be needed in cases of benign thyroid nodules that nonetheless have grown to interfere with breathing or swallowing.Thyroid cancer is very treatable, and the most common types have a nearly 100% survival rate over five years. Your healthcare provider will discuss your diagnosis and treatment options with you.
It’s important to remember that these are just statistics. Since the data was gathered about five years earlier than they were released, it’s likely that treatments for thyroid cancer have become more effective over that time, and survival rates may have improved. This may be particularly true for hard-to-treat thyroid cancers like anaplastic thyroid cancer since targeted drug therapies are always being improved upon.
Speaking with your healthcare provider about your specific case will help you understand your prognosis if you have been diagnosed with thyroid cancer.
Summary
A hypoechoic thyroid nodule appears dark on an ultrasound. In most cases, it is a benign growth, but these nodules do have a greater risk of being cancer than other thyroid nodules. Your healthcare provider likely will want to order additional tests, including a biopsy, to confirm a diagnosis.
Treatment will depend on the type of thyroid cancer (if present) and how far it has advanced. Surgery, chemotherapy, and targeted drugs all are options. Surgery also may be needed in cases of benign thyroid nodules that nonetheless have grown to interfere with breathing or swallowing.
Thyroid cancer is very treatable, and the most common types have a nearly 100% survival rate over five years. Your healthcare provider will discuss your diagnosis and treatment options with you.
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