My Doctor Found a Thyroid Nodule – Should I Be Worried?

Beyond the Thyroid – Episode 31:  My Doctor Found a Thyroid Nodule – Should I Be Worried?

In this episode of Beyond the Thyroid, Dr. Dana Gibbs takes you inside one of the most common (and often alarming) thyroid-related diagnoses: thyroid nodules. What happens when your doctor finds a nodule, and how do you know if it’s something to worry about?

Dr. Gibbs breaks down:

• The ultrasound features that matter when evaluating a thyroid nodule
• What TI-RADS categories mean and when a biopsy is recommended
• How a fine needle aspiration (FNA) biopsy is performed
• What the Bethesda Classification tells us about cancer risk
• When surgery is necessary—and when it’s not
• How active surveillance can be a safe option for some thyroid cancers
• What risks and procedures are involved in thyroid surgery

Whether you’ve just been told you need a biopsy or are considering surgery, this episode empowers you to ask the right questions and better understand your options.

Dr. Gibbs also introduces her Thyroid Clarity Checkup program, designed for patients who want deeper answers than the typical TSH blood test provides.

📑 Join the The Thyroid Clarity Checkup Priority List! 

📲 Follow Dr. Dana Gibbs on the Goodself App!

🩺 Interested in a Discovery Call with Dr. Dana? Click here!

📺 Watch on YouTube

🕒 Episode Highlights: 

00:00 – Introduction and Episode Overview
02:34 – Understanding Thyroid Nodules
04:11 – Biopsy and Diagnosis
08:00 – Biopsy Results and Next Steps
11:06 – When Surgery is Necessary
20:06 – Surgical Procedures and Risks
23:08 – Conclusion and Resources

✨ Get clarity, not confusion, when it comes to thyroid nodules. Tune in now!

Let's connect! 🔔
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✉️ Email Dr. Gibbs at drgibbs@DanaGibbsMD.com or visit https://www.danagibbsmd.com/ for more information.


Thank you so much for listening! Tune in on the next episode.


The medical information provided in this episode is intended for informational purposes only and should not be construed as medical advice. Always consult a qualified healthcare provider regarding any medical questions or concerns.

Transcript

dana-gibbs-md--she-_1_06-24-2025_162732: 0:00

Welcome to episode 31. On today's episode, we're gonna discuss a topic that sparks anxiety in a lot of people. What happens when your doctor finds a thyroid nodule, or worse recommends a biopsy or even surgery. It can be a really scary time. You may want it gone, and now, I get it. But the best way to handle a thyroid nodule is usually not a jump right to surgery. In fact, that's often a really bad idea. So we're gonna go over all the things. So listen carefully for a better understanding of what it means if you have a thyroid nodule. How we diagnose these and what we as physicians do with the findings we get from the test. As a thyroid surgeon, I was always looking for ways to keep people from needing surgery, if at all possible. Because so many people feel worse after their thyroid gland is removed, and new advances in thyroid diagnosis and understanding of the natural history of thyroid nodules has really helped that. I'm Dr. Dana Gibbs and I help people who've been told their thyroid tests are normal, but still feel anything but. On this podcast, we go up beyond the basics to help people solve their fatigue, weight gain, hormone imbalances, and more so you can feel like yourself again. So let's get started.

1:30

You're listening to the Beyond the Thyroid podcast. I'm your host, Dr. Dana Gibbs. I'm an ENT surgeon and hormone specialist. For years, I struggled with my own unrecognized thyroid problems before and even after I was regularly performing thyroid surgeries. Then, one day, I learned something that turned my health around and opened my eyes to the limits of mainstream medicine in treating more subtle thyroid abnormalities. I spent the next 20 years fine tuning my hormone expertise in disorders like Hashimoto's disease, perimenopause, and stress related illness. Come join me as I share this new approach to hormones that empowers you to take control of your own thyroid and hormone imbalances. Let's dive in.

dana-gibbs-md--she-_6_06-24-2025_163409: 2:24

Hello. Hello, friend and welcome back. If you are new here, I'm happy to have you. If you like what you hear, please don't forget to subscribe, so you won't miss new episodes as they come out. Today we're talking about thyroid nodules, biopsies and surgery. So let's start with the basics. Thyroid nodules are extremely common. In fact, studies have shown that up to 70% of people have at least one thyroid nodule by the time they're in their 70s and the likelihood is even higher in patients with Hashimoto's thyroiditis. Fortunately, the vast majority of these nodules are benign and actually a sign that your thyroid is trying to heal itself, and even the ones that turn out to be cancerous often grow slowly, especially in older adults. So today, we're gonna walk through exactly what to expect if a biopsy is recommended. What the results mean and how to know if you need surgery. I'll also share what's changed in how we approach small thyroid cancers and how to make confident decisions about your thyroid care. So really, really basics. Here we go. A thyroid nodule is a lump in your thyroid gland. Many people are surprised to learn that they even have one because they're often found by accident during imaging or CT scans for something else. Like a spine problem or a carotid ultrasound. If you've been diagnosed with Hashimoto's disease, your chances of having a nodule are even higher. The chronic inflammation and regeneration cycles of Hashimoto's disease can lead to growths of nodular feeling tissue within your thyroid gland. So, when do we think about a biopsy? Well, if you find a thyroid nodule that's larger than a centimeter, and that's about as big around as the end of a woman's pinky finger. If it's larger than a centimeter and you get an ultrasound and it has some suspicious features on it, then they might recommend a biopsy. What kind of suspicious features? Well, like irregular margins or calcifications or increased blood flow or something called hypoechoic, which means that it's actually more dense than the surrounding tissue. If you find one of those things on a sonogram, your doctor might suggest a fine needle biopsy. The goal being to determine whether the piece of tissue that's there is benign or malignant, or somewhere in between. So generally a nodule that is smaller than one centimeter, it's not even possible to do a biopsy on it, and so the recommended option for that is to check it again in six months with another sonogram. You know, and first I ought to probably go back and talk about what a sonogram is because a sonogram is a little wand that they put some cool gooey gel on and they just run it over your neck. There's no pain involved. It does not have radiation to it, and so there's very little risk to having a thyroid sonogram. Sometimes people with autoimmune thyroid disease will have a red skin over their thyroid gland if you handle it a lot. But usually that goes away within a few minutes to an hour. But a sonogram is a really easy and fairly inexpensive test that we can do to assess your thyroid gland and your thyroid nodules, and we can find out an awful lot about a thyroid nodule using a sonogram. The radiologists use category. The radiologists who do sonograms use a category called the TI-RADS category to assess the features and the size and the shape of thyroid nodules. And they give you a grade and can go from a grade one to a grade five. And anything three or below is generally considered benign and they are not gonna recommend any biopsy be done. So when would a biopsy be recommended? Well, if you had a TI-RADS four nodule that was greater than a centimeter, they're probably gonna recommend it. So what happens during a biopsy? Well, a biopsy is done with a very tiny needle. It's called a fine needle aspiration biopsy, and it is not required that you have any kind of anesthesia except maybe a little bit of lump numbing medicine on the skin. That small needle is passed using the ultrasound wand into the nodule where a small sample of the cells that are in there are drawn out and put on a slide. This is tolerated very well. There's no significant recovery from this, and the risks are mostly just a little bit of bruising. Most people could go right back to work if they needed to. I don't think I necessarily would'cause I kind of stress when people are sticking me with a needle, so I might wanna go home afterwards and relax. But it is not something that you need anesthetic for or general anesthetic or sedation. Now let's talk results. So the most common system that is used to categorize biopsy findings is called the Bethesda Classification System. And it goes from grade one to grade six. Grade one means the specimen was inadequate, and that can happen sometimes if there is just fluid in the specimen and not any cells. Bethesda Class two is benign. That's the most common result by far. And it carries less than 3% risk of cancer. Then you can have atypia of undetermined significance and we'll talk a little bit more about what that means in a minute. And then you can have a follicular neoplasm, which means. There are follicular cells with an atypical pattern and architecture, and then class five suspicious for malignancy. And then class six, definitely malignant. Now, when I send people for a fine needle biopsy, I always have the biopsy physician draw extra cells and put those aside for a second and later test if we need it. That test is called either Affirma, A-F-I-R-M-A or ThyroSeq and those can help us look at the tissue that comes back in those three and four class. Undetermined cell types. Those look for genetic mutations or molecular markers that can really give us a really, really specific idea of whether there's cancer risk present or not. So let's pause here and talk about hurthle cells. And that's spelled H-U-R-T-H-L-E. And that is a specific type of thyroid cell that can show up either in benign or malignant lesions is especially common in people who have Hashimoto's disease. hurthle cells have lots of mitochondria in them, so they stain a really intense pink color, and they tend to be a bit larger than regular thyroid cells. So if your report mentions hurthle cells, it doesn't necessarily mean that there's anything wrong. As a matter of fact,it can mean that you have Hashimoto's disease. But it might raise concern if it obscures the doctors from determining the other findings such as nuclear atypia. That's a particular thing that they're looking for, that suggests malignancy. So what happens next? You get your biopsy back. Now what? If it's clearly benign, then you're just gonna get regular follow-ups with ultrasound to make sure that it's not growing. If you come to a doctor like me, I might actually have you go on a particular regimen of thyroid medicine to keep it from growing. If it's one of the kinds of nodules that tends to try to get bigger. However, if it is highly suspicious or malignant, your doctor may recommend surgery. Now, that is not always the case anymore because our approach to these has really evolved a lot. For example, in Japan, researchers have been following patients with small papillary thyroid cancers, that's one of the four kinds of thyroid cancer, those that are less than a centimeter. And what they found is that only about 8% of them grew more than about three millimeters more over a 10 year period. And very, very few of those spread to lymph nodes. That's why active surveillance are just following with a serial ultrasound is now considered safe and a very reasonable option for some people, particularly older people, because thyroid is kind of one of these interesting thing where the thyroid cancers, the older you get, the less aggressive these very small thyroid cancers are, they may never grow at all and thyroid cancer when it's found in very young people is something that we wanna be more aggressive with. So we also need to consider the possibility that there might be a false positive or a false negative. And so finding a aspiration has a sensitivity of about 98%. That means it misses only generally about 2%, but it has a specificity that is a bit less around 92%, which means it might give you a false positive between 8 and 30% of the time depending on the operator and the particular study. The bigger a thyroid nodule is, the easier it is to miss a cancer because a thyroid nodule might be large, but only a small part of it has cancer in it. So it is perfectly acceptable if you get a result that doesn't make a lot of sense to wait a few months and then go back and have the fine needle biopsy done again. And that's especially if you did not save tissue for the AFFIRMA test the first time, because that AFFIRMA test really gives us a great additional way to confirm. Is this a malignant lesion? Is this not a malignant lesion? Because not every thyroid nodule needs to be removed. But there are some clear situations where surgery is either strongly recommended or just absolutely necessary. And the first one of those is if you have Graves' disease and you've already tried radioactive iodine and you've already tried the suppression medicines and they are not working for you, you're not under control. And you've been trying for quite a while and you're having severe symptoms. So Graves' disease is one of the big reasons why we would take out somebody's whole thyroid or do something called a near total thyroidectomy. The next one would be if you have a what's called a hot nodule? A hot nodule means that the nodule itself is overproducing thyroid hormone and taking normal thyroid suppressing medicines are not working or your TSH is very, very low and it is not stimulating the thing yet you're still overproducing thyroid hormone getting that particular nodule out would be a reasonable thing to do. And the way you decide whether or nodule is hot or not is by doing something called a thyroid uptake scan. This is a bit more of an involved scan. It involves taking a tiny dose of something called radioactive iodine, where you actually swallow that. It goes to your thyroid, it gets taken up. Preferentially by that hot nodule and it shows up right on a particular kind of scan that they do. If you find one of those, then it's probably a reasonable idea to have just that thyroid nodule or just that side of your thyroid gland taken out. Now, the third reason that isn't cancer is if you have a large nodule or a large goiter, which is a goiter can be a series of nodules all bunched together. If it's causing compressive symptoms like it's visually bulging your neck forward. It's causing difficulty swallowing, or difficulty breathing. And it doesn't respond to suppression levels of thyroid medicine to soften it or shrink it. That's pretty rare that it, that they will actually shrink with medicine. And if you have symptoms like that, it is probably a good idea to go ahead and have either the largest side taken out or even sometimes both sides taken out. And then the final reason, of course, is if you have a cancer that looks like it is growing and or there is some concern that it might be the type of cancer that would spread then having your thyroid removed is probably the answer. Now, there are certain kinds of thyroid cancer that can migrate to your lymph nodes without local spread. So in that case, the doctors are gonna recommend that you take radioactive iodine to kill off any thyroid tissue that we missed when we did the surgery. And if you have that kind of thyroid cancer not only are they just gonna take out the one nodule, they're gonna take out your whole thyroid gland and they're gonna take out any of the large lymph nodes that are around your thyroid. Surgery might also be the right move if there's diagnostic uncertainty and the molecular testing didn't help, you know for sure. Is it cancer? Isn't it cancer? And remember, it's not just about removing cancer, it's also about maintaining your quality of life. And so if it's a small nodule and it is cancer and you opt to have it removed, there are situations nowadays where we don't use that I-131 treatment and if we don't, then there is really not a great reason to take the other side out. However, sometimes we don't know before we go in which kind of cancers are gonna be the kind that need I-131 and which kinds aren't. And so in that case, we might recommend a two step surgery process. For example, if your nodule was indeterminate or we thought it was papillary and it turned out it wasn't. We might start with removing one lobe and then maybe there's a 10% chance that we'll have to go back and take out the other side. The reason why we recommend that is that people who have half their thyroid left on average are much healthier than people who have had their whole thyroid taken out, we call that brittle. When you have no thyroid tissue and all the thyroid hormone in your body is coming from a medicine that you take. In general, it seems to be more difficult to handle the hypothyroid patient who has had their whole thyroid taken out. Now, in my office. In my clinical practice, I use some specific mechanisms, some specific techniques, and to stop that so that it doesn't happen. One of those is I make sure that people are taking their thyroid medicine, divide it into two doses. The second one is I make people go to the lab at the same time every time. The same time of day, every time they go to the lab, because your thyroid will go up right after you've taken your pill and it will go down if it's been a while since you had it, and depending on what time of day you had your blood test taken, it can make your thyroid hormone level look too high or look too low. And so those two simple things can help people be less brittle when they've had their whole thyroid out. All right. What to expect from the surgical procedure? Well, thyroid surgery is usually done under general anesthesia and it takes about two hours. The main risk of thyroid surgery, aside from bleeding, thyroid is a very vascular tissue. It has a lot of blood vessels, and so bleeding is a concern. The second largest risk, and actually one that's probably more serious is the risk of damage to what's called your recurrent laryngeal nerve and what that is is the main nerve that works, your vocal cords, and you have one on each side and they run right underneath your thyroid gland. So it's very, very important that your surgeon is really experienced, ideally 25, 50 cases or more of thyroid surgery per year. You want that experience on your side because the more cases they do, the less likely they are to damage your recurrent laryngeal nerve. Most people feel surprisingly well within a few days after thyroid surgery, they do have to stretch and pull the muscles of your neck out of the way in order to do that. And you might be sore, you might have a hard time turning your head easily and your voice might feel a little bit scratch your horse for a while, but most people do not have serious problems after thyroid surgery. There is one other risk that occurs when you're having both sides of your thyroid taken out at a time, and that is risk to damage your parathyroid glands. Parathyroid glands are not thyroid tissue. They are another endocrine gland that secretes something called parathyroid hormone and parathyroid hormone manages your blood calcium levels, and if you don't have any parathyroid hormone, you have a very hard time managing your blood calcium levels. And you would think, oh, calcium's just for bones. No, that is not true. Calcium is involved in the contraction of every muscle tissue in your body, including your heart, including the transport of. Ions and molecules across cell membranes. It's very, very critical. And so if you damage all four of your parathyroid glands during a thyroid surgery, it's a very rough life after that. And so that's another reason why if you don't have to have both sides of your thyroid out, you absolutely should not. And yes, robotic and minimally invasive techniques have come a long way. Some centers now offer robotic thyroidectomy through a small incision near your armpit or under your lip. This is not right for everybody. It's an exciting option for selective cases, I'm not sure I would choose that, if it was me needing to have my thyroid out, I think I would probably go for the direct view because of. Those risks that we talked about. Alright. I hope this episode has helped you feel more informed and empowered about your thyroid care. Whether you're dealing with nodules or navigating a recent biopsy, or trying to decide if thyroid surgery is something you wanna go ahead with, you deserve answers that go beyond the standard TSH. I do have a platform where I answer questions, and so if you are not familiar with the free Good Self app. I answer questions in there every Tuesday at 1230 Central in the free Good Self app on something called a good talk. So if you haven't checked that out download it and go ahead and check it out. Also, if you haven't already subscribe to be on the Thyroid podcast so you don't miss any future episodes. And don't forget to join the wait list for my Thyroid Clarity Checkup Program is designed to help you get the clarity you need about whether or not your thyroid is causing your symptoms, so you can move forward with confidence. Thank you for listening and take care. Until next time.

24:22

Thank you for listening to this episode of Beyond the Thyroid. If you found this information valuable, it would mean so much to me to take a few seconds and give the podcast a five star review. It helps other people who need this information find the show and it's really easy. Just search and click on the name of the show, Beyond the Thyroid, and scroll to the bottom to ratings and reviews. I truly do read and appreciate. Remember, when it comes to hormones, there will always be more to discover, so follow the show so you get the next episode as soon as it's released. And if you or someone you care about needs a caring doctor to help figure out how to heal hormone problems that other doctors have dismissed, check out my website at www. danagibbsmd. com. And if you're not a physician, please keep in mind, while I'm a doctor, I'm not your doctor. The content of this podcast is my opinion and it's for educational and entertainment purposes only. This is not meant to be individual medical advice and you should consult your own physician for any medical issues or diagnoses that you may have. I look forward to continuing this journey with you beyond the thyroid.