HELPING REDUCE UNNECESSARY THYROID BIOPSIES AND SURGERY

Over half of people over 60 have a thyroid nodule. Many of them are referred for a thyroid ultrasound to investigate their nodule, even though most nodules are benign. According to the American Thyroid Association, only 2-12 percent of nodules become cancerous. Most thyroid cancers are curable and rarely cause life-threatening problems.

Because thyroid nodules are so common, thyroid ultrasound reporting guidelines were established to help clarify diagnoses and improve you and your doctor’s ability to make appropriate treatment decisions.

At Mayfair Diagnostics, we follow the American College of Radiology’s Thyroid Imaging, Reporting, and Data System (TI-RADS) for the classification and evaluation of thyroid nodules. Once your thyroid ultrasound is complete, our radiologists will send a detailed report to your doctor. This report will describe the nodule’s features, assess the risk of malignancy, and help determine the next steps, such as the need for surgical consultation, biopsy, or ultrasound follow-up to monitor nodule growth or development of worrisome features.

The goal of TI-RADS is to help you and your doctor balance the benefit of identifying cancers that require treatment against the risk of biopsy and treatment of benign nodules or indolent cancers – cancers that are slow-growing and will almost certainly never be problematic.

The only way to definitively determine if a thyroid nodule is cancerous is to examine its cells under a microscope. The most common method is called fine need aspiration (FNA) biopsy, where a very small needle is inserted into the thyroid nodule and cells are removed for microscopic assessment.

WHAT ARE THE SYMPTOMS OF THYROID NODULES?

The thyroid is a butterfly-shaped endocrine gland located in the lower front of the neck which produces hormones that control your metabolism. Lumps or bumps in this gland are called nodules. What causes them is not known, although iodine deficiency and inflammation of the thyroid can increase the risk of developing thyroid nodules.

Changes in the thyroid may be seen or felt, but most thyroid nodules don’t cause symptoms. They are often discovered during a routine physical exam or via medical imaging, like ultrasound or computed tomography (CT) exams, performed for unrelated reasons. Sometimes the tissue in a nodule makes too much of the thyroid hormones causing hyperthyroidism, which can be seen by performing a thyroid-stimulating hormone (TSH) blood test. However, most thyroid nodules, including those that are cancerous, are non-functioning, meaning tests like TSH are normal.

It’s important to see your doctor if you have:

• Swelling or a lump in the neck.
• Hoarseness or other voice changes.
• Difficulty swallowing or persistent sore throat.
• Difficulty breathing.
• Pain in the front of the neck
• A persistent cough.

WHAT ARE THE RISK FACTORS FOR THYROID CANCER?

According to the Canadian Cancer Society, women are more likely than men to develop thyroid nodules and incidence increases with age. Women are also more frequently diagnosed with thyroid cancer compared to men.

Thyroid nodules and other thyroid conditions, such as goitre (enlarged thyroid) and inflammation of the thyroid, can increase the risk of thyroid cancer. Other risk factors include:

• A history of significant radiation to the neck.
• A personal history of thyroid cancer.
• A family history of thyroid cancer.
• Certain hereditary conditions, such as Multiple Endocrine Neoplasia (MEN) type 2.

HOW DO I GET A THYROID ULTRASOUND?

This exam is covered under your Alberta and Saskatchewan Health Care Insurance Plans and must be requested by a health care practitioner. To determine whether it’s appropriate for you, your doctor will often review your medical and family history, risk factors, how long symptoms have been present, and how they affect daily activities. If a thyroid ultrasound is indicated as a best next course of action, your doctor will provide you with a requisition and the appointment can be booked.

Mayfair has 13 locations in Calgary, one in Cochrane and one in Regina, which offer thyroid ultrasounds. Thyroid biopsies are performed in hospitals or doctors’ offices.

If you would like to receive a copy of your medical imaging report, you will need to wait until that report is completed and sent to your doctor. You may then contact us and arrange to pick up your report, photo identification and your health care card will be required when picking up your images and report. Please note that your results will need to be discussed with your doctor.

American Thyroid Association (2017) “Thyroid Nodules.” www.thyroid.org. Accessed September 1, 2022.

Clayman, G. & Brady, B. (2021) “What Are Thyroid Nodules?” www.endocrineweb.com. Accessed September 1, 2022.

Canadian Cancer Society (2021) “What is thyroid cancer?” www.cancer.ca. Accessed September 1, 2022.

Hu, X. Y., et al (2022) “Improvement in thyroid ultrasound report quality with radiologists’ adherence to 2015 ATA or 2017 TIRADS: a population study.” European Thyroid Journal, 11:3

Vaccarella, S., et al. (2016) “Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis.” New England Journal of Medicine, 375;7: 614-17.