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Do I need surgery for benign thyroid nodule?

Q: I am a 35 years old housewife weighing 84 kg. Recently, when I visited India my father noticed a swelling in my neck. Immediately I went to see a general physician who suggested me to undergo a neck scan. Findings of real time ultrasonography thyroid - both lobes of thyroid are normal in size. Right lobe – a well defined 19 x 12 x 14 mm hypoechoic nodule with thin rim is seen in upper pole of right lobe. No evidence of calcification / cystic change within. Peripheral and central vascularity noted within the lesion. Left lobe and isthmus are normal. Reactive appearing bilateral level II, III nodes are seen, largest at level II to measure 9 x 4 mm. Then we consulted another doctor who suggested radioactive scan, which showed both lobes of the thyroid gland are not delineated due to significantly reduced tracer uptake. Salivary gland and oral activity are normal. Background tracer activity is normal. After that the doctor suggested thyroid hormone levels, antibody anti-thyroid test and FNAC, which showed T3 - 1.05 ng/ml, T4 - 7.60 ug/dl and TSH - 1.11 ulU/ml. Then I underwent thyroid tumour scintigraphy. After reviewing all these reports, my endocrinologist suggested me surgery within 6 months. Do I need to undergo surgery? Is there any option except surgery? I have read that it might be an indication of breast cancer and kidney cancer. Is it true? Once I get operated what are the post-surgery complications?

A:This question is regarding the treatment of benign thyroid nodule. The diagnosis is benign thyroid nodule. It is not thyroid cancer. The treatment options are observation only, surgery or medical treatment. For first option you need to get your USG thyroid gland every 6 months or so and if there is increase in size than one can go for surgery or medical treatment. Second option is surgery which can be done if this is increasing in size, for cosmetic reasons or there is sudden change in size / pain or too much discomfort in neck. Third option is medical treatment in which we give thyroid hormone to suppress TSH to <0.1 so that there is no further increase in size and there may be slight reduction in size but please note that this is like artificially inducing hyperthyroidism which can induce bone loss, heart enlargement or irregular heartbeats. But these side effects are usually mild. The newer options include ethanol injection in the nodule, laser treatment. The choice remains with you. My personal opinion would be not to undergo surgery now and observe or medical treatment. Option of surgery is always there and can be postponed. There are no chances of similar swellings in other parts of body. You should not worry much about development of cancer. If any time surgery decision is taken an experienced surgeon (thyroid surgery) is suggested.

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