Cystic Thyroid Nodule

Condition Overview

Cystic thyroid nodules are fluid-filled sacs within the thyroid gland. They can be entirely cystic (filled with fluid) or partially cystic with solid components. These nodules are typically benign, though in rare cases, they can harbor malignancy. Cystic thyroid nodules may vary in size and can change over time, sometimes becoming noticeable or symptomatic.

Patients with cystic thyroid nodules may be asymptomatic or present with symptoms such as a palpable lump in the neck, difficulty swallowing, hoarseness, or a sensation of fullness in the throat. Sudden enlargement of the nodule can cause acute pain, usually due to hemorrhage within the cyst.

Diagnosis involves a combination of physical examination, thyroid function tests, and imaging studies such as ultrasound, which helps to characterize the nodule as cystic or solid. Fine-needle aspiration biopsy (FNAB) is often performed to obtain fluid or tissue samples for cytological analysis, helping to rule out malignancy. If the nodule is entirely cystic, it is sometimes common that there will not be enough cells in the sample (the result can be Bethesda I, or non-diagnostic).

Treatment Options

1. Ethanol Ablation
   1. Description: Ethanol ablation is done by first removing the fluid in the cyst with a needle and then refilling the cyst with alcohol. This alcohol can then either be left in place or removed. The purpose of the alcohol is to caus cause scar tissue in the wall of the cyst so that it doesn't return.
      Indication: Simple symptomatic cyst of the thyroid

1. Radiofrequency Ablation (RFA)
2. Description: RFA is a minimally invasive procedure that uses heat generated by radiofrequency energy to destroy nodule tissue. This technique can effectively reduce the size of cystic nodules and alleviate symptoms without the need for open surgery. It is usually used AFTER a trial of ethanol ablation is tested, but can sometimes be used at the same time.
   • Indications: Symptomatic benign cystic nodules, patients seeking non-surgical treatment options.
3. Thyroid Lobectomy
   • Description: This surgical procedure involves the removal of one lobe of the thyroid gland. It may be recommended if the cystic nodule is large, symptomatic, or has suspicious features that warrant further examination.
   • Indications: Large or symptomatic cystic nodules, indeterminate or suspicious cytology, patient preference for definitive treatment.

Management of cystic thyroid nodules requires a multidisciplinary approach involving endocrinologists, radiologists, and surgeons to ensure accurate diagnosis and appropriate treatment planning. The choice of treatment depends on the nodule's size, symptoms, and patient preferences. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your cystic thyroid nodule.