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Treatment for a thyroid mass is dependent on the results of a doctor's examination and any test results. Thyroid masses may be either benign, meaning non-cancerous, or malignant, meaning cancerous. A benign enlarged thyroid mass is called a goiter and 90 percent of the time is caused by an iodine deficiency. Sometimes, benign cysts or nodules may form on the thyroid, causing it to appear enlarged. A malignant thyroid mass will usually be surgically treated and may or may not be followed by radiation therapy.
Before starting any treatment, a physician will perform a physical examination to determine the nature of the thyroid mass and discern if the mass is encroaching on other structures, like the larynx or trachea. If it is, the patient may be experiencing difficulty breathing or have a raspy voice. A physician may administer several tests to determine whether the thyroid mass is cancerous. A fine-needle biopsy is safe and fairly painless and can screen for abnormal cells. If necessary, a CT (computed tomography) scan, MRI (magnetic resonance imaging), or ultrasound may be ordered. A doctor may also check for elevated blood levels of serum calcitonin or serum thyroglobulin, either of which may indicate thyroid cancer.
A patient who has a non-cancerous goiter or thyroid cyst may be tested to determine whether the thyroid is making enough thyroid hormone. Many patients with goiters have normal levels of thyroid hormone. Yet many are either making too little thyroid hormone, in which case they have hypothyroidism, or are making too much, as with hyperthyroidism. In these cases, hormone therapy can correct levels of thyroid stimulating hormone (TSH) in the blood.
If cancer is suspected or if a benign thyroid mass is putting pressure on the esophagus or trachea, a doctor may recommend surgery to remove all or part of the thyroid or just the thyroid mass. Surgery may be indicated in a rapidly growing thyroid mass. During surgery, the lymph nodes may be removed either to prevent the spread of cancer or to contain a thyroid cancer that may have already spread.
After surgery, a patient may undergo radiation therapy or take oral radioactive iodine to prevent the spread of cancer or shrink any tumor not removed during surgery. Chemotherapy is rarely used for thyroid cancer patients. Patients who have had all or part of the thyroid gland removed will need to take replacement thyroid hormone for the rest of their lives to maintain regular thyroid function.
Oh, the joys of the fine needle aspiration biopsy! The radiologist who did mine on my thyroid nodule did six passes with six separate needles. Yes, they had me numbed up, but it was still intensely uncomfortable, and then I went back to work looking like I had a giant hickey on my neck from the bruising! Gah.
Anyway, thank the Lord, my nodule was benign, but it did necessitate the removal of the right lobe of my thyroid. And that's the treatment of choice, really, because it can be darn difficult to tell what kind of structure you're dealing with, just from an ultrasound, or even from an FNA.
Remember to get a referral to a surgeon who does a *lot* of these surgeries. My incision is about two inches long and is hardly visible, now, almost three years down the road.