Thyroid Nodules: When To Worry, Causes, and How To React

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Thyroid Nodules: When To Worry, Causes, and How To React

3 Reasons to Pay Attention to Thyroid Nodules

Key Takeaways:

  • The majority of thyroid nodules are benign and not a cause for concern.
  • A thyroid nodule may be worth a closer look if it’s larger than 1 cm or painful, or if you’re also experiencing symptoms related to hypo- or hyperthyroidism.
  • If your thyroid nodule is benign, you can address it via the gut-thyroid axis (the foundational relationship between your thyroid and gut).
  • Improving your gut health with an anti-inflammatory diet and probiotics, and optimizing your iodine levels, can often reduce the size of thyroid nodules.

If you’ve been diagnosed with a thyroid nodule, it’s normal to feel anxious. But in most cases, there’s little to worry about. The majority of thyroid nodules are benign, don’t cause symptoms, and don’t require surgery. In fact, you may be able to resolve your thyroid nodules with simple treatment and lifestyle options. 

That said, there are three main reasons to pay closer attention to a thyroid nodule:

  1. You have a thyroid nodule that is larger than 1 cm or is growing.
  2. Your thyroid nodule is painful.
  3. You have signs or symptoms of hyperthyroidism or hypothyroidism.

We’ll discuss each of these possibilities. But first, we’ll review what thyroid nodules are.

What Are Thyroid Nodules?

Thyroid nodules are lumps within the thyroid gland, a butterfly-shaped organ located at the front of the neck above the collar bone. They can sometimes be confused with swollen lymph nodes, which are part of the body’s immune system. Swollen lymph nodes in the neck are very common and happen in many conditions. While swollen lymph nodes can potentially point to thyroid issues, they are not a part of the endocrine (hormone) system and are more likely signaling something else.

According to the American Thyroid Association, roughly half of the population will have a thyroid nodule by age 60. And the majority of thyroid nodules don’t cause symptoms unless they are very large nodules. 

Depending on the type of thyroid nodule, it can be solid or filled with fluid, in which case it’s called a thyroid cyst. If small nodules are less than 1 cm or filled with fluid, they are almost always benign. However, if a thyroid cyst continues to expand it may require treatment.

If your entire thyroid is swollen enough to be visible, then it’s a goiter and may also require treatment. However, it is possible to have nodules in addition to a goiter, making it a multinodular goiter. It’s best to consult your doctor for the treatment of a goiter.

Thyroid Nodules: When To Take a Closer Look

If your doctor finds a nodule in your thyroid, it’s a sign of an underlying health condition that deserves attention. However, most nodules aren’t a serious concern. Here’s when you should pay attention to a thyroid nodule:

  • Solid nodules larger than 1 cm: These should be evaluated by an endocrinologist, via thyroid ultrasound or fine needle aspiration biopsy (FNA) to rule out thyroid cancer. It makes sense to get it tested for cancer for your own peace of mind, but only 7-15% of thyroid nodules contain cancer cells. [1
  • Thyroid pain: It’s especially important to have your thyroid gland or thyroid nodule assessed if you experience any thyroid pain. Thyroid cancer is one of the few thyroid conditions that cause pain.
  • Unexplained symptoms: In most cases, benign nodules aren’t an emergency, but pay attention to if they are accompanied by any new symptoms. Some symptoms may be early warning signs of hyperthyroidism or hypothyroidism and will require action.
  • Difficulty swallowing, hoarseness, or shortness of breath: Alongside large thyroid nodules, these symptoms may indicate the nodule is affecting your windpipe or esophagus. In this case, you should seek immediate medical attention.
  • Nodules on top of a goiter: While thyroid nodules with a goiter are often benign, there may be a chance of a toxic multinodular goiter, which can cause an overactive thyroid. Your doctor can run tests to check thyroid function and make sure you aren’t dealing with undiagnosed thyroid disease.

What Causes Thyroid Nodules?

In a majority of cases, thyroid nodules are caused by Hashimoto’s thyroiditis, an autoimmune attack on the thyroid gland that causes scarring. This thyroid tissue damage can lead to underproduction of thyroid hormones, leading to hypothyroid symptoms such as:

  • Fatigue
  • Weight gain
  • Dry skin
  • Depression

In some cases, benign thyroid nodules produce additional thyroxine, a hormone secreted by your thyroid gland. The extra thyroxine can cause too much thyroid hormone to be produced (hyperthyroidism), leading to symptoms such as:

  • Unexplained weight loss
  • Increased sweating
  • Tremor
  • Nervousness
  • Rapid or irregular heartbeat
  • Palpitations
Thyroid Nodules: When To Worry, Causes, and How To React - Hypo vs Hyper Thyroid Symptoms L

If you have a thyroid nodule, your doctor or endocrinologist may follow up with blood tests to check your thyroid-stimulating hormone (TSH) levels for hypothyroidism or hyperthyroidism. To rule out cancer and the need for a thyroidectomy, physical examination, thyroid scans, radioactive iodine uptake testing, fine-needle aspiration biopsy (FNA), or thyroid ultrasound may be used. 

Ways To Improve Thyroid Nodules

If your thyroid nodule is benign, there are two main natural treatment options to improve your thyroid nodules:

  1. Improve your gut health.
  2. Optimize your iodine levels.

Reduce Thyroid Nodules by Improving Gut Health

One of the most common reasons for thyroid nodules is thyroid autoimmunity, especially Hashimoto’s thyroiditis. Research indicates thyroid health is closely connected to your gut health. [2, 3, 4, 5, 6] In several studies, improving gut health by treating infections or supporting digestion improved thyroid lab markers and (in some cases) thyroid antibodies. [7, 8, 9]

Here are two research-backed steps you can take to improve your thyroid health.

Thyroid Nodules: When To Worry, Causes, and How To React - A%20Winning%20Combination Landscape L

1. Eat an Anti-Inflammatory Diet

Research shows an anti-inflammatory diet such as the Paleo diet, gluten-free and dairy-free diets [10, 11, 12], or the Autoimmune Paleo diet [13] may support your thyroid health.

A Paleo diet template is low-carb, dairy-free, and gluten-free, and could be a good place to start. 

2. Take High-Quality Probiotics 

Probiotics are an effective way to balance your gut microbiome with few side effects. [14, 15, 16, 17] One study showed probiotics decreased thyroid symptoms and the needed dose of levothyroxine. [16] For more about how to use probiotics, see our Probiotics Starter Guide.

Reduce Thyroid Nodules by Optimizing Iodine Levels

Thyroid Nodules: When To Worry, Causes, and How To React - Sources%20of%20Iodine Landscape L

Some health care providers recommend iodine supplementation to support thyroid health, sometimes in very high doses. The logic here is that since the thyroid hormone is partly made of iodine, supplementing will help increase thyroid hormone levels. This logic falls apart in light of research that connects excessive iodine with an increase in thyroid autoimmunity, goiter, and hypothyroidism. [18, 19, 20

Though the American Thyroid Association states, “Iodine deficiency, which is very uncommon in the United States, is…known to cause thyroid nodules,” it’s important to only supplement with iodine if you are certain you are deficient. In some cases, you may need to decrease your iodine intake by using a low-iodine diet.

For more on how to assess and optimize your iodine, see How Should I Use Thyroid Supplements?

The Bottom Line

Most thyroid nodules aren’t serious. A good rule of thumb for knowing when to take a closer look is if they are larger than 1 cm or painful. If you have thyroid nodules, you should also be checked for hyperthyroidism or hypothyroidism. By making a few targeted diet and lifestyle changes, including focusing on your gut health and optimizing your iodine levels, you can likely reduce the size of your thyroid nodules (and your worry).

If you want to put a plan together to support your thyroid health, consider taking my thyroid course or reach out to us at the Ruscio Institute.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
  1. Wong R, Farrell SG, Grossmann M. Thyroid nodules: diagnosis and management. Med J Aust. 2018;209(2):92-98.
  2. Konrad P, Chojnacki J, Kaczka A, Pawłowicz M, Rudnicki C, Chojnacki C. Ocena czynności tarczycy u osób z zespołem przerostu bakteryjnego jelita cienkiego [Thyroid dysfunction in patients with small intestinal bacterial overgrowth]. Pol Merkur Lekarski. 2018;44(259):15-18.
  3. Cellini M, Santaguida MG, Virili C, et al. Hashimoto’s Thyroiditis and Autoimmune Gastritis. Front Endocrinol (Lausanne). 2017;8:92. Published 2017 Apr 26. doi:10.3389/fendo.2017.00092
  4. Centanni M, Gargano L, Canettieri G, et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med. 2006;354(17):1787-1795. doi:10.1056/NEJMoa043903
  5. Bugdaci MS, Zuhur SS, Sokmen M, Toksoy B, Bayraktar B, Altuntas Y. The role of Helicobacter pylori in patients with hypothyroidism in whom could not be achieved normal thyrotropin levels despite treatment with high doses of thyroxine [published correction appears in Helicobacter. 2011 Dec;16(6):482. Albayrak, Banu [corrected to Bayraktar, Banu]]. Helicobacter. 2011;16(2):124-130. doi:10.1111/j.1523-5378.2011.00830.x
  6. Bertalot G, Montresor G, Tampieri M, et al. Decrease in thyroid autoantibodies after eradication of Helicobacter pylori infection. Clin Endocrinol (Oxf). 2004;61(5):650-652. doi:10.1111/j.1365-2265.2004.02137.x
  7. Centanni M, Gargano L, Canettieri G, et al. Thyroxine in goiter, Helicobacter pylori infection, and chronic gastritis. N Engl J Med. 2006;354(17):1787-1795. doi:10.1056/NEJMoa043903
  8. Bugdaci MS, Zuhur SS, Sokmen M, Toksoy B, Bayraktar B, Altuntas Y. The role of Helicobacter pylori in patients with hypothyroidism in whom could not be achieved normal thyrotropin levels despite treatment with high doses of thyroxine [published correction appears in Helicobacter. 2011 Dec;16(6):482. Albayrak, Banu [corrected to Bayraktar, Banu]]. Helicobacter. 2011;16(2):124-130. doi:10.1111/j.1523-5378.2011.00830.x
  9. Bertalot G, Montresor G, Tampieri M, et al. Decrease in thyroid autoantibodies after eradication of Helicobacter pylori infection. Clin Endocrinol (Oxf). 2004;61(5):650-652. doi:10.1111/j.1365-2265.2004.02137.x
  10. Krysiak R, Szkróbka W, Okopień B. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Exp Clin Endocrinol Diabetes. 2019;127(7):417-422. doi:10.1055/a-0653-7108
  11. Virili C, Bassotti G, Santaguida MG, et al. Atypical celiac disease as cause of increased need for thyroxine: a systematic study. J Clin Endocrinol Metab. 2012;97(3):E419-E422. doi:10.1210/jc.2011-1851
  12. Asik M, Gunes F, Binnetoglu E, et al. Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine. 2014;46(2):279-284. doi:10.1007/s12020-013-0065-1
  13. Abbott RD, Sadowski A, Alt AG. Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto’s Thyroiditis. Cureus. 2019;11(4):e4556. Published 2019 Apr 27. doi:10.7759/cureus.4556
  14. Sindhu KN, Sowmyanarayanan TV, Paul A, et al. Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2014;58(8):1107-1115. doi:10.1093/cid/ciu065
  15. Dinleyici EC, Eren M, Dogan N, Reyhanioglu S, Yargic ZA, Vandenplas Y. Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitol Res. 2011;108(3):541-545. doi:10.1007/s00436-010-2095-4
  16. Besirbellioglu BA, Ulcay A, Can M, et al. Saccharomyces boulardii and infection due to Giardia lamblia. Scand J Infect Dis. 2006;38(6-7):479-481. doi:10.1080/00365540600561769
  17. Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017;51(4):300-311. doi:10.1097/MCG.0000000000000814
  18. Foley TP Jr. The relationship between autoimmune thyroid disease and iodine intake: a review. Endokrynol Pol. 1992;43 Suppl 1:53-69.
  19. Katagiri R, Yuan X, Kobayashi S, Sasaki S. Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies. PLoS One. 2017;12(3):e0173722. Published 2017 Mar 10. doi:10.1371/journal.pone.0173722
  20. Gaberšček S, Gaberšček B, Zaletel K. Incidence of thyroid disorders in the second decade of adequate iodine supply in Slovenia [published online ahead of print, 2020 May 6]. Wien Klin Wochenschr. 2020;10.1007/s00508-020-01662-5. doi:10.1007/s00508-020-01662-5

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