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Thyroid Diseases

Risk of Thyroid Cancer in Hypothryoid Male

06/12/2006

Question:

My Husband has been treated for hypothyroidism for over 6 years and takes Levoxyl 150 MCB 1x daily. He was just told to take an extra tablet once a week last week as his blood work came back a little off. At a recent physical, his doctor noticed that his thyroid seemed large. He was ordered to have an ultrasound that determined he has two nodules that are not fluid filled. His doctor has asked him to get a biopsy in 3 weeks or less.

I have heard that his risk of cancer is higher as he is a male and these are not cysts, but instead nodules. How high is the risk of cancer, and is it common for a patient with hypothyroidism to have nodules?

Also, his father, mother, grandmother and sister all died of or were treaterd for various forms of cancer -- lung, falopian tube, ovarian, and breast, respectivly.

Answer:

The current recommendation is that nodules found on thyroid ultrasound that are over 1 centimeter in size should undergo fine needle aspiration biopsy. 

The risk of a nodule being a cancer is higher in men than in women, but this is because thyroid nodules in general are more common in women than in men, and the majority of these are benign.  In absolute terms, thyroid cancer is more common in women than in men.

The risk of cancer in a thyroid nodule is only about 5-10%.  Even if one of these nodules turns out to ba a cancer, most thyroid cancers respond exceptionally well to treatment.  Your husband should have the biopsies, but should not agonize over this.

I don't have any information comparing the number of thyroid cysts in hypothyroid patients compared with normal patients.  However, it is not uncommon to find thyroid nodules - both cystic and solid - when ultrasound is used to examine the thyroid.  In one study of 253 random individuals aged 19-50, at least one thyroid nodule was found in 27.3% of the ultrasounds.  70% of these nodules were under 1 centimeter in size.

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Response by:

Thomas A Murphy, MD, FACP, FACE Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University