An estimated 42 million individuals in India are affected by thyroid disorders, which are classified as autoimmune conditions that have become increasingly prevalent. The primary contributing factor is believed to be iodine deficiency, often resulting from inadequate dietary intake, leading to conditions such as goiter and hypothyroidism. Furthermore, endocrine disorders are observed to be more prevalent among women.

In a discussion with Lifestyle, Dr. Manjunath Malige, Director of Diabetes and Endocrinology at Sakra World Hospital in Bengaluru, stated, “The thyroid, a butterfly-shaped gland located in the neck just below the Adam's apple, produces thyroxine (T4) and triiodothyronine (T3). These hormones play a vital role in various physiological functions, including digestion, mood regulation, body temperature, heart rate, and metabolism. However, terms such as thyroid cancer and thyroid nodules are becoming increasingly common, making it essential to understand their interconnections.”

Research indicates a gradual increase in the global prevalence of thyroid cancer, while the mortality rate has remained stable. Dr. Manjunath Malige stated, “In India, there are 5.4 cases of thyroid cancer per one hundred thousand individuals. These manifest as small lumps on the thyroid glands. Thyroid nodules can be categorized as: Solitary (a single nodule), Multiple (more than one nodule), Cystic (fluid-filled), and Solid.”

Causes of thyroid nodules

Dr. Manjunath Malige emphasized that several factors contribute to an increased risk of developing thyroid nodules. These include a history of radiation exposure to the head and neck, genetic susceptibility to thyroid nodules or thyroid cancer, advancing age, iron-deficiency anaemia, smoking, obesity, metabolic syndrome, alcohol consumption, elevated levels of insulin-like growth factor-1, and the presence of uterine fibroids. Generally, thyroid nodules are not a cause for alarm. While some thyroid nodules may harbour thyroid cancer, the vast majority are benign.

Most thyroid nodules arise without a clear cause. They can form for various reasons, including:

Colloid nodules, which are benign overgrowths of normal thyroid tissue, are the most common type. These nodules do not metastasize beyond the thyroid gland, even if they grow large. 

Thyroid cysts are characterized by a combination of solid and fluid-filled components. The likelihood of malignancy in cystic nodules is minimal.

Inflammatory nodules develop as a result of chronic inflammation of the thyroid gland, and these growths are often painless.

A multinodular goitre consists of multiple nodules, the majority of which are benign.

Excess thyroid hormone production from these nodules can lead to hyperthyroidism.

Thyroid cancer is found in less than 6.5 per cent of thyroid nodules, making it a rare occurrence.

Symptoms of thyroid nodules

Thyroid nodules generally do not present any noticeable symptoms. However, if an individual has multiple nodules or if they are particularly large, it may be possible to detect their presence. In rare cases, these nodules can grow sufficiently to cause changes in the voice, such as hoarseness, as well as difficulties in swallowing or breathing, neck discomfort, and the development of a goitre, which is an enlargement of the thyroid gland.

Types of thyroid cancer

1. Papillary thyroid cancer accounts for the majority of cases (80%), characterized by its slow growth and high curability. Certain variants, such as tall cell and columnar types, exhibit more rapid growth and may necessitate more aggressive treatment approaches.

2. Follicular thyroid cancer has the potential to metastasize to the lungs or bones; however, it generally has a favourable prognosis and is often linked to iodine deficiency.

3. Oncocytic carcinoma is a rarer form of thyroid cancer (3%) that poses challenges in both detection and treatment.

4. Medullary thyroid cancer (MTC) originates from C cells and produces calcitonin, with the possibility of metastasis occurring before diagnosis.

5. Anaplastic thyroid cancer constitutes 2% of cases and is known for its aggressive nature, often arising from previously differentiated tumours.

6. Sarcoma, squamous cell carcinoma (SCC), and thyroid lymphoma are rare and distinct from other types of thyroid cancers.

7. Parathyroid cancer, an uncommon malignancy of the parathyroid glands, leads to elevated calcium levels, which can manifest as symptoms such as kidney stones, bone pain, and fatigue. Surgical intervention is the primary treatment method.

Symptoms of thyroid cancer may include a growing lump in the neck, neck pain or swelling, hoarseness or difficulty speaking, challenges with swallowing or breathing, and a persistent cough unrelated to respiratory infections.

Diagnosis and management

Dr. Manjunath Malige stated that physicians may suggest an ultrasound if they detect any tumours or irregularities in the thyroid during a physical examination to assist in diagnosis. This imaging method can help ascertain whether a nodule is solid or contains fluid. Additionally, the condition of the thyroid can be evaluated through blood tests.

He further stated that a method known as fine-needle aspiration biopsy (FNAB) is utilized to extract cells from a nodule for microscopic examination. Available treatment options include thyroid hormone therapy, radioactive iodine therapy, and surgical intervention. In more advanced cases, external radiation or targeted therapy may be considered.

Prevention and regular screening

Dr Manjunath Malige stated, “While it is not always possible to prevent thyroid nodules and cancer, early detection and intervention can be supported by maintaining a diet rich in iodine, minimizing unnecessary radiation exposure, and undergoing regular medical checkups. The increasing incidence of thyroid conditions can be attributed to factors such as decreased intake of white salt and a preference for alternative salts, like pink salt, which are low in iodine.”

Read Also: Hormones and Cancer: What Every Woman and Man Should Know

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