Thyroid Lump: What It Could Be and What to Do

How to recognize a thyroid lump

The thyroid is a butterfly-shaped gland that wraps around the front of the windpipe, below the Adam's apple and above the collarbones. A lump in the thyroid:

• is usually in the lower front of the neck, slightly to one side
• moves up with swallowing, because the thyroid is attached to the windpipe
• is often painless
• may be smooth and soft, or firm

Checking your neck

1. Stand in front of a mirror and tilt your head back slightly.
2. Take a sip of water and swallow.
3. Watch the area below the Adam's apple and above the collarbone for a bulge that moves up.
4. Gently feel the area with your fingertips.

This "neck check" is not a substitute for medical examination, and many nodules are too small to see or feel.

What a thyroid lump could be

Lumps in the neck that are not thyroid

A lump that does not move with swallowing is probably not thyroid. Common examples are swollen lymph nodes on the side of the neck, a thyroglossal duct cyst in the midline (which moves when you stick out your tongue), skin cysts and lipomas. See neck mass.

When to worry about a thyroid lump

Most thyroid lumps are harmless, but these features raise concern:

• hard, irregular, or fixed to surrounding tissues
• rapid growth over weeks
• persistent hoarseness or a change in voice
• enlarged, firm lymph nodes in the neck
• trouble swallowing or breathing
• age under 20 or over 70, male sex
• radiation to the head, neck or chest in childhood
• family history of thyroid cancer or certain inherited syndromes

Even when cancer is found, most thyroid cancers are papillary types with an excellent outlook.

Symptoms that can come with a thyroid lump

Most nodules cause no symptoms. When they do:

• From size: a visible bulge, pressure or tightness in the throat, a feeling of something stuck when swallowing, coughing, or shortness of breath lying flat.
• From too much thyroid hormone (hyperthyroidism): weight loss, palpitations, tremor, sweating, anxiety, frequent bowel movements.
• From too little hormone (with Hashimoto's): tiredness, weight gain, feeling cold, constipation, dry skin.
• Pain: usually from bleeding into a cyst or thyroiditis, not cancer.

What happens at the doctor

1. Examination of the neck and lymph nodes, and questions about symptoms, radiation and family history.
2. Blood test for TSH (thyroid-stimulating hormone). A low TSH suggests an overactive "hot" nodule, which is rarely cancerous; a thyroid scan may follow.
3. Thyroid ultrasound to measure the nodule and look at features such as solid content, calcifications and borders. Radiologists rate nodules with a scoring system (TI-RADS).
4. Fine-needle aspiration (FNA) biopsy if the nodule is large enough and has suspicious features. A thin needle takes cells under ultrasound guidance in a few minutes.

For details on biopsy results, treatment and follow-up, see thyroid nodules.

What you can do

• Do not panic: most thyroid lumps are benign.
• Book a doctor's visit rather than waiting to see if it shrinks.
• Note when you first noticed it and any changes in size, voice or swallowing.
• Avoid high-dose iodine or kelp supplements unless advised; they can affect thyroid function.

Frequently asked questions

Is a lump on the thyroid serious?

Usually not. About 90 to 95% of thyroid nodules are benign. A lump should still be checked with a blood test and ultrasound. Rapid growth, hardness, hoarseness, swollen neck glands or trouble swallowing make cancer more likely and need prompt review.

What does a thyroid lump feel like?

A thyroid lump is usually a smooth or firm swelling in the lower front of the neck, slightly to one side, that moves up and down when you swallow. Most are painless. A cyst that bleeds can suddenly become larger and tender.

Can a thyroid lump go away on its own?

Some can. Fluid-filled cysts may shrink or disappear, and swelling from thyroiditis usually settles over weeks to months. Most solid nodules stay the same size or grow slowly over years. Benign nodules are often monitored with periodic ultrasound rather than removed.

What kind of doctor checks a thyroid lump?

Start with your primary care doctor, who will order a TSH blood test and ultrasound. You may then see an endocrinologist (a hormone specialist) for biopsy and follow-up, or an ENT or endocrine surgeon if surgery is needed.

Can stress cause thyroid nodules?

No. Stress does not cause thyroid nodules. Nodules are linked to aging, iodine deficiency, Hashimoto's thyroiditis, radiation exposure and genetics. Stress can, however, worsen symptoms of an overactive or underactive thyroid in people who already have thyroid disease.