Not all thyroid nodules need surgery. The factors which determine which if a person needs surgery are
a)Is the gland, or a portion of it, so large that it is stretching, compressing, or invading nearby structures in the neck? – in case of such nodules causing compressive symptoms surgery is advised.
b)Is the gland producing excess thyroid hormones? (hyperthyroidism)? Overactive thyroid nodules not amenable to other forms of treatment like medicines or radioactive iodine therapy may be considered for surgery.
c)Is the goiter or thyroid nodule due to malignancy? Fortunately, most patients with a goiter or thyroid nodule do not have thyroid cancer. By doing an ultrasound and fine needle aspiration cytology (FNAC), we can find out if a nodule has a high probability of being cancerous. All thyroid nodules that are found to contain thyroid cancer, or that are highly suspicious of a cancer, should be removed surgically by an experienced thyroid surgeon.
A careful examination of the patient, relevant blood investigations, an ultrasound and a fine needle aspiration cytology can help the endocrinologist decide to operate or just follow up the patient.