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Thyroid nodules are lumps of thyroid cells within the gland. The American Thyroid Association (ATA) states that around one-half of people have one by age 60, and that over 90% are benign. Assessment typically includes thyroid blood tests and a review of the ultrasound findings. A fine-needle aspiration biopsy is needed only where the ultrasound appearance and the nodule’s size call for one. Endocare’s endocrinologists in Dubai assess thyroid nodules.
- The ATA describes a thyroid nodule as an abnormal growth of thyroid cells that forms a lump within the thyroid gland.
- Most thyroid nodules cause no symptoms. Many come to light by chance, on imaging requested for another reason.
- Whether a biopsy is recommended depends on the ultrasound appearance and the size of the nodule together.
- The 2015 American Thyroid Association guidelines recommend fine-needle aspiration from 1 cm to 2 cm, depending on how suspicious the nodule looks on ultrasound. Your endocrinologist will interpret these cut-offs alongside the appearance of your nodule.
- The ATA reports that up to 70% of biopsies are benign, and that the risk of cancer in that group is typically less than 3%.
- The ATA states that benign nodules generally need removal only if they cause symptoms, such as choking or difficulty swallowing.
- Endocare’s endocrinologists assess thyroid nodules at our Dubai clinic in Dubai Healthcare City. Your endocrinologist will advise whether a biopsy or any treatment is needed.
01 Introduction
A thyroid nodule is a lump of thyroid cells within the thyroid gland. The American Thyroid Association (ATA) states that over 90% of thyroid nodules are benign and that a small proportion contain thyroid cancer. For that reason, your endocrinologist will assess a nodule with blood tests and an ultrasound before advising whether a biopsy is needed. This page covers how nodules are found, how your endocrinologist assesses them, what a biopsy result means, and when a nodule needs treatment rather than monitoring.
02 How thyroid nodules are found
The ATA states that most thyroid nodules do not cause symptoms. Many are found by chance, on a neck scan requested for another reason or during a physical examination. Occasionally, people find a nodule themselves by noticing a lump in the neck. The ATA’s patient brochure reports that by age 60 around one-half of all people have a thyroid nodule that can be found by examination or with imaging.
03 The symptoms a nodule can cause
A nodule that is large enough to press on the windpipe or the oesophagus, or one that produces thyroid hormone, can cause symptoms such as:
- A visible lump or swelling at the front of the neck
- Difficulty swallowing
- Difficulty breathing, or difficulty lying down
- The symptoms of an overactive thyroid, where the nodule produces hormone
The UK National Health Service (NHS) advises seeing a GP for a lump in the neck, or for a hoarse voice or difficulty swallowing that is not getting better. It gives the same advice for pain in the front of the neck, or a feeling that something is pressing against it. It advises asking for an urgent appointment if you have difficulty breathing.
04 How your endocrinologist assesses a thyroid nodule
Thyroid function tests come first
Your endocrinologist will check thyroid-stimulating hormone (TSH) first, because a nodule that produces thyroid hormone needs a different assessment. The ATA states that most thyroid nodules are non-functioning, which means tests such as TSH are normal. It also states that nuclear scanning still has an important role in the evaluation of the rare nodules that cause hyperthyroidism. Our page on treatment for an overactive thyroid covers what follows.
Thyroid ultrasound, and what the appearance means
The ultrasound result guides the decision on a biopsy. The UK National Institute for Health and Care Excellence (NICE) recommends offering ultrasound to image palpable thyroid enlargement or focal nodularity in people with normal thyroid function if malignancy is suspected. The ultrasound measures the nodule and describes its appearance: whether it is solid or fluid-filled, how its edges are defined, whether it contains calcification, and how it reflects sound.
NICE recommends using an established system for grading the ultrasound appearance when deciding whether to offer a biopsy. The grade on your report describes the appearance of the nodule. It is not a diagnosis. More than one grading system is in use internationally. NICE recommends that each ultrasound report specifies which system has been used. In the ATA system, the more suspicious the appearance, the smaller the size at which a biopsy is recommended.
When a fine-needle aspiration biopsy is recommended
Recommendation 8 of the 2015 American Thyroid Association guidelines for adult patients with thyroid nodules and differentiated thyroid cancer sets the size at which a biopsy is recommended for each ultrasound pattern:
| Ultrasound pattern | Size at which a biopsy is recommended |
|---|---|
| High suspicion | 1 cm or above |
| Intermediate suspicion | 1 cm or above |
| Low suspicion | 1.5 cm or above |
| Very low suspicion | Consider at 2 cm or above, with observation also reasonable |
| Benign appearance, including a purely cystic nodule | No biopsy |
Your endocrinologist will interpret these cut-offs alongside the appearance of your nodule. They will monitor a nodule that falls below the threshold for its pattern and explain where yours sits.
05 What a fine-needle aspiration biopsy involves
The ATA describes a fine needle, smaller than those used in most blood draws. The doctor performing the biopsy typically inserts the needle between two and six times, taking samples of cells from different parts of the nodule. A local or topical anaesthetic may be applied first. The ATA states that the procedure typically lasts less than 30 minutes. Where a biopsy is indicated, your endocrinologist will arrange it and will review the result with you.
06 What your biopsy result means
Biopsy results are reported in categories. Each category carries a different risk of cancer and a different next step. The American Thyroid Association gives the following figures for each category:
| Result category | How often it occurs | Risk of cancer | What happens next |
|---|---|---|---|
| Benign | Up to 70% of results | Typically less than 3% | Follow-up ultrasound examinations |
| Malignant | 3% to 7% of results | A 97% to 99% chance of a true cancer | Surgery in almost all cases |
| Suspicious for malignancy | Not stated by the ATA | A 60% to 75% chance of cancer | Typically surgery |
| Atypia or follicular lesion of undetermined significance | Part of the indeterminate group | 5% to 15% | A repeat biopsy, genetic testing, or both |
| Follicular neoplasm | Part of the indeterminate group | 15% to 30% | Genetic testing, or an operation to remove half of the thyroid |
| Non-diagnostic | Not stated by the ATA | Not enough cells in the sample to assess | A repeat biopsy |
Your endocrinologist will explain what your own result means and what happens next.
07 What happens when the result is indeterminate
An indeterminate result means the cells were neither clearly benign nor clearly malignant. The ATA states that a repeat biopsy or genetic testing may be useful for an atypia result, and that genetic testing may be useful for a follicular neoplasm. Molecular tests examine genes within the nodule’s cells and can help show whether the nodule is more likely to be benign or malignant. Your endocrinologist will explain which option applies to your result.
08 How a benign thyroid nodule is followed up
The ATA states that benign thyroid nodules generally do not need to be removed unless they are causing symptoms such as choking or difficulty swallowing. The ATA describes ultrasound follow-up for nodules that are benign or too small to biopsy. How often a benign nodule is re-scanned depends on its ultrasound pattern, its size and any previous biopsy result, and some benign nodules need less frequent imaging. It adds that surgery may still be recommended for a nodule that is benign on biopsy if it continues to grow or develops worrisome features on ultrasound. Your endocrinologist will compare each scan with the previous one to look for any change in size or appearance.
09 When a nodule is treated rather than watched
Nodules that produce too much thyroid hormone
A nodule that produces thyroid hormone can cause an overactive thyroid. The US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists overactive thyroid nodules among the causes of hyperthyroidism. It describes medication, radioactive iodine and thyroid surgery as the treatment options. Your endocrinologist will assess your thyroid function and discuss with you which treatment is appropriate.
Nodules that cause pressure symptoms
A large nodule or a multinodular goitre that presses on the windpipe or the oesophagus may need treatment for that reason alone, regardless of the biopsy result. The ATA lists an enlarged thyroid causing difficulty lying down, swallowing or breathing among the reasons for thyroid surgery.
Ablation techniques, and what they are for
Radiofrequency, microwave and laser ablation deliver heat through a needle, which can shrink selected benign nodules. In 2023 the American Thyroid Association published a statement on the safe performance, training and adoption of ablation techniques for benign thyroid nodules. NICE recommends considering percutaneous thermal ablation, alongside surgery and radioactive iodine, for adults with normal thyroid function whose non-cystic nodule or goitre causes compressive symptoms. Endocare does not provide ablation.
Surgery
The ATA lists the reasons for thyroid surgery as a nodule that is suspicious for thyroid cancer, thyroid cancer, and a goitre causing difficulty lying down, swallowing or breathing. Hyperthyroidism from a nodule or from a condition affecting the whole gland is also on its list. Endocare does not perform thyroid surgery. Where an operation is indicated, your endocrinologist will refer you to a surgeon. Our page on hormone replacement after thyroid surgery covers the care that follows.
10 Thyroid nodules and thyroid cancer
A small proportion of thyroid nodules contain thyroid cancer. The ATA states that most thyroid cancers are curable and rarely cause life-threatening problems. Where a biopsy shows cancer, your endocrinologist will refer you to a surgeon. Your endocrinologist will continue to manage your thyroid care.
11 Which doctors are involved in assessing a thyroid nodule?
Your endocrinologist will assess your thyroid function, review the ultrasound report alongside it and advise whether a biopsy is needed. The ultrasound and the biopsy are often performed by a radiologist. A pathologist examines the cells. A surgeon becomes involved where an operation is needed.
12 Thyroid nodules in the UAE
If you already have a thyroid ultrasound report, your endocrinologist will review it alongside your thyroid function tests, examine your neck, and advise whether anything further is needed.
A study published in F1000Research in 2022 analysed 2,036 cases of thyroid cancer registered with the UAE National Cancer Registry between 2011 and 2017. Around three-quarters of the patients were women. Diagnoses were most frequent at 35 to 39 years of age.
13 What your care at Endocare involves
Specialist thyroid care at Endocare begins with a full medical assessment. Your endocrinologist will assess your symptoms alongside the appropriate thyroid tests to understand what is actually driving them and determine the right treatment. The assessment includes a review of any ultrasound report you already have and an examination of your neck. Where possible, your first appointment takes place in person at Endocare’s Dubai clinic, as the physical examination and body composition analysis cannot be completed remotely.
A nodule that produces thyroid hormone can change how quickly the body uses energy, which can affect body composition as well as weight. At Endocare, body composition analysis is included free of charge at every consultation. Body composition analysis estimates body fat, muscle mass and body water. Repeated measurements help your endocrinologist understand how your body is changing beyond the number on the scale.
Monthly follow-up appointments can be held in person at the clinic or online. Our blood test panels cover the markers involved. Your endocrinologist will arrange any further test your assessment calls for.
14 FAQ
What is the best treatment for thyroid nodules?
Most benign nodules need monitoring rather than treatment. Treatment is considered for a nodule that produces thyroid hormone, a nodule that causes pressure symptoms, or a nodule that a biopsy shows to be malignant or suspicious. Your endocrinologist will explain which applies to your nodule.
What is a level 4 suspicious thyroid nodule?
Ultrasound reports grade a nodule by how suspicious its appearance is. A higher grade lowers the size at which a biopsy is recommended. A grade is not a diagnosis. NICE recommends that the report states which grading system was used for the assessment. We recommend asking your endocrinologist what the grade means for your nodule.
What type of doctor should I see for thyroid nodules?
An endocrinologist is the specialist who assesses thyroid nodules. Your endocrinologist will interpret the ultrasound alongside your thyroid function tests and advise whether a biopsy is indicated. A surgeon becomes involved only where an operation is needed.
Does a thyroid biopsy hurt?
The ATA states that the needle is smaller in diameter than those used in most blood draws. A local or topical anaesthetic may be applied. You may feel some pressure in the neck during the procedure. The ATA states that some discomfort at the biopsy site is expected afterwards. The procedure typically lasts less than 30 minutes.
Will my nodule grow?
A nodule can grow slowly, stay the same size or shrink over time. For a benign nodule, how often it is re-scanned depends on its ultrasound pattern, its size and any previous biopsy result. If a benign nodule keeps growing, surgery may still be recommended.
Our Dubai clinic is located in Building 27, Block B, Unit 504 B, Dubai Healthcare City. Opening hours are Sunday 10:00-20:00, Monday 08:30-18:30, and Tuesday to Thursday 10:00-20:00. The clinic is closed on Fridays. Free parking is available in the building and on the surrounding streets. For patients using public transport, Dubai Healthcare City Metro Station on the Green Line is the nearest stop.
In the UAE, you can see an endocrinologist directly, with no GP referral needed, for concerns related to hormones, weight, metabolism or blood sugar. If you plan to use health insurance, we recommend checking your policy before you book, because some insurers require a referral or pre-approval. To book a consultation with our endocrinologists in Dubai, call +971 4 285 3885 or email contact@endocare-clinic.com. We recommend bringing your ultrasound report and any previous scans to your appointment.
Book Your Consultation
- Specialist consultation
- Personalized Coaching
- Body Composition Analysis