Most benign thyroid nodules require only regular follow-up and no specific treatment. In a few cases, surgery, endocrine therapy, and radioactive iodine (RAI) therapy are options. These are described separately below.
Follow-up interval
The follow-up interval for most benign nodules is 6 to 12 months; the follow-up interval can be shortened for suspected malignant nodules that have not yet received treatment.
Surgery
Surgery may be considered for nodules that show benign on puncture in the following cases:
① Presence of local pressure symptoms clearly associated with the nodule;
②Combined hyperthyroidism and failure of medical therapy;
③The mass is located in the retrosternal or mediastinum;
④ Progressive nodule growth with clinical consideration of malignant tendency, or combined with high risk factors for thyroid cancer.
Patients who strongly request surgery because of excessive cosmetic or ideological concerns that interfere with normal life may also be operated.
The surgeon will try to preserve as much normal thyroid tissue as possible while completely removing the thyroid nodule. Doctors use total/near-total thyroidectomy with caution and generally consider it only if the nodules are diffusely distributed bilaterally in the thyroid and it is difficult to preserve more normal tissue intraoperatively.
If hypothyroidism occurs after surgery, your doctor will promptly put you on levothyroxine tablets to supplement your thyroid hormone. However, this is not usually recommended to prevent recurrence of nodules after surgery for benign thyroid nodules.
Endocrine therapy
Doctors generally do not routinely use endocrine therapy to treat benign thyroid nodules. It may be used in younger patients who are considered to have a nodular goiter and have small nodules.
Radioiodine therapy
RAI is primarily used to treat benign nodules with autonomic uptake and associated hyperthyroidism. For nodules with autonomic uptake but without hyperthyroidism, RAI may be a treatment option.
Treatment with RAI is not recommended for thyroid nodules that present with signs of compression, or are located behind the sternum. Women who are pregnant or breastfeeding should definitely not be treated with RAI.
Likewise, if hypothyroidism occurs after treatment, your doctor will promptly put you on levothyroxine tablets.