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Tipper Gore has Thyroid Nodule Removed

© Keri

Thyroid disease is in the news once more. Just before the beginning of the new millennium, Tipper Gore, the wife of Vice President Gore of the US, was discovered to have a lump (nodule) on her thyroid. According to news reports, the lump was found during a routine examination. In this case, the media is reporting good news. The nodule was benign (not cancerous) and since they removed only the right lobe of the thyroid, she is not expected to need thyroid replacement.

Tipper is not alone. One in 12 to 15 women develop thyroid nodules as compared to one in 40 to 50 men. The good news is that more than 90 percent of the nodules are benign and some are actually cysts filled with fluid and not thyroid tissue at all. The bad news is that men have a higher rate of cancerous nodules than do women.

Since thyroid nodules usually are not accompanied by symptoms, it is recommended that you do your own self-exam. If you suspect a lump, contact your health care provider for further tests and a referral to an endocrinologist or endocrine surgeon, a specialist who deals with these problems on a regular basis.

Thyroid nodules increase with age and may be present in as many ten percent of the adult population. Thyroid nodules can be "cold" not producing symptoms or absorbing iodine. They show up on a thyroid scan as lighter than the surrounding tissue. Occasionally, a nodule may be "hot" and appear as darker on the scan. These nodules produce thyroid hormone and may be the cause of hyperthyroidism.

Evaluation of a thyroid nodule should include a thorough history and examination.

Some features favor a benign thyroid nodule:

• Family history of Hashimotos thyroiditis
• Family history of benign thyroid nodule or goiter
• Symptoms of hyperthyroidism or hypothyroidism
• Pain or tenderness associated with a nodule
• A soft, smooth, mobile nodule
• Multinodular goiter, lots of nodules
• "hot" nodule on thyroid scan
• simple cyst on ultrasound

Some features increase the suspicion of a cancerous nodule:

• age less than 20 or more than 70
• male gender
• new onset of swallowing difficulties
• new onset of hoarseness
• history of external neck irradiation as a child
• firm, irregular and fixed nodule
• presence of swollen hard lymph glands in the neck
• previous history of thyroid cancer
• "cold" nodule

Thyroid hormone levels are usually normal in the presence of a nodule. Usual blood tests may not be helpful in diagnosing the type of nodule. As discussed above, the nodule will show on a thyroid scan after the ingestion of radioactive iodide. Ultrasound can also show the size of the thyroid gland, the size and shape of the nodule(s), and can identify solid nodules as small as 3 mm or cysts as small as 2 mm. To truly differentiate the type of nodule, a fine needle aspiration may be necessary. In this test, the doctor with the help of ultrasound guides a fine needle into the nodule and removes some tissue from the nodule. The cells are then examined by a pathologist and classified.