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NURSED TO HEALTH: Thyroid nodules can be harmless

Tiffani N. Mickens, MSN, RN, Assistant Clinical Professor of Nursing in JU’s Keigwin School of Nursing

“Could the lump in my neck be cancer? Are all thyroid nodules cancerous?”

The thyroid gland is a butterfly-shaped endocrine gland in the lower front portion of the neck, below the Adam’s apple. Its function is to make thyroid hormones, which are secreted into the blood and carried to other tissues in the body. It also regulates metabolism of how the body uses energy, and assists in the function of the brain, muscles, heart and other organs.

Thyroid nodules are common findings on routine physical examinations or imaging studies. They are growths or lumps in the thyroid gland. Typically, these nodules do not cause any symptoms or problems and are not cancer. Many don’t require any additional treatment. An increased incidence of thyroid nodules is contributed to a deficiency of iodine, which is needed for the production of thyroid hormone; overgrowth of normal thyroid tissue; thyroid cyst; inflammation of the thyroid (thyroiditis); multinodular goiter; or thyroid cancer.

There are three different types of thyroid nodules: solid nodules, cystic nodules that are fluid-filled, and partially cystic nodules. You can have one or several nodules (multi-nodular goiter). You can also have a combination of each nodule. Thyroid nodules do not affect the gland’s ability to function, but sometimes a noncancerous nodule can cause hyperthyroidism (overactive) or hypothyroidism (underactive) functioning.

The following patient was observed and her case addressed by JU’s Keigwin School of Nursing faculty and students:

LYNN

Lynn, a 29-year-old Hispanic female, complained of neck swelling and fullness. “I noticed a lump in my throat when looking in the mirror, while getting dressed for work.”

For several years, she has attributed the fullness in her neck to a weight gain of about 10 pounds over the past three years.

“I’ve always been told when I’ve had physical examinations that I have a large thyroid,” she said.

She recalled that two aunts on her father’s side of the family had the same “neck fullness,” and believed that her aunts may have had a thyroid problem. Lynn had no previous medical history and was otherwise healthy, and her physical examination did reveal a goiter, which is an enlarged thyroid gland.

Because of her presentation and family history of thyroid disease, her health care provider ordered a round of testing.The laboratory results were within normal ranges, except that her thyroid ultrasonography revealed three small, solitary nodules. Once she received the report, her health care provider referred her to an endocrinologist, who reviewed her medical history and recent reports.

The endocrinologist scheduled Lynn for a fine-needle aspirate biopsy, in which a small amount of fluid is removed from the nodules. The cells in the fluid are sent for additional cytology to determine if they are cancerous or benign.

Lynn received the cytology report, and the solitary nodules were all benign. Her health care provider assured her that her thyroid would need to be monitored regularly, and no medication or surgical removal, known as a thyroidectomy, was indicated at this time.

Lynn’s healthcare provider advised her to:

• Schedule regular physicals with a thyroid examination

• Report any changes in size and consistency of the thyroid nodules (i.e. abnormalities to include swollen, large, firm, etc.)

• Report suspicious changes (i.e. excessive coughing, hoarseness, problems swallowing, difficulty breathing, neck pain/fullness, etc.)

• Eat a well-balanced diet (refer to MyPlate.gov)

• Limit alcohol consumption, and avoid cigarettes and/or illicit drugs.

• Consult with an endocrinologist who is a specialist in the treatment of thyroid disorders every 6 to 12 months for close monitoring of thyroid nodules. Consultations with other specialists may also be needed.

Nursed to Health is an occasional feature in The Florida Times-Union in which Jacksonville University Keigwin School of Nursing faculty discuss symptoms, diagnoses and treatments based on actual and composites of patient cases handled by instructors, students and alumni of JU’s local training programs. Today’s column is by Tiffani N. Mickens, MSN, RN, an Assistant Clinical Professor of Nursing in JU’s Brooks Rehabilitation College of Healthcare Sciences.

Names and specific medical information in Nursed to Health have been changed to protect private health information, and any similarity is coincidental. For more information about JU’s Keigwin School of Nursing, visit www.ju.edu/chs/nursing. Readers with specific questions regarding their own health concerns should seek the advice of their healthcare provider.