The physician-patient

Last spring, I was at home washing my hands and as I glanced up into the mirror, I noticed something unusual. My bathroom light hit my neck just right as I swallowed and there it was: a prominent lump. I diagnosed myself with a thyroid nodule and wondered how I, a physician, had failed to notice this large protuberance before that moment.

Thyroid nodules are quite common. In some cases, they are noticed by the patient (like me) or are found on exam. In many cases, they are found on accident when someone has an imaging test like a computerized tomography scan, magnetic resonance imaging or ultrasound done for some other reason. The vast majority of thyroid nodules are benign, only 5% or less representing thyroid cancer.

Typically, if a thyroid nodule is found, thyroid labs and a formal thyroid ultrasound will be recommended. The size and characteristics of the nodule on the ultrasound help to guide whether a fine needle aspiration (a type of biopsy) should be performed. Many nodules are fluid filled and small, which we know conveys almost no risk of being cancerous, so those can be watched without biopsy.

In my case the nodule was medium sized, two centimeters in diameter and had slight irregularity, such that it was “mildly suspicious” and did warrant biopsy. As a physician-patient awaiting my procedure, I knew that the data said my nodule was still very low risk of being cancerous, but I still had some anxiety about the worst-case scenario.

My colleague, a surgeon, performed my fine-needle aspiration expertly the next month. The procedure was easy, done in the office with minimal discomfort. She drained out enough fluid that I no longer had a visible neck lump afterward. My results returned benign, a huge relief.

My thyroid nodule story is a typical one and leaves me with the following advice for others. If a nodule is characterized as benign on ultrasound, rest assured, as these guidelines are sound and based in excellent data. If your doctor recommends a biopsy, try not to lose too much sleep; the procedure is very tolerable and still most nodules are benign.

I had the good fortune of knowing that even if my mass turned out to be cancer, most thyroid cancers have excellent cure rates. However, I am oddly grateful to have had a small taste of the health stress my patients deal with daily. I hope it improves my doctoring.

Kelly Evans-Hullinger, M.D. is part of The Prairie Doc  team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc  at http://www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc  a medical Q&A show celebrating its 20th season of truthful, tested and timely medical information streaming live on Facebook most Thursdays at 7 p.m.