Do thyroid cysts require surgery?

Written by Chen Xie
Endocrinology
Updated on September 07, 2024
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Thyroid cysts are benign nodules that generally only require follow-up observation. It is recommended to have a re-examination every 6 to 12 months, including thyroid ultrasound and thyroid function tests, to monitor the status of the cyst. If the cyst is large and affects breathing or even swallowing, cyst aspiration drainage can be performed, and nowadays radiofrequency ablation surgery is also an option. However, if the thyroid cyst shows signs of malignancy, a puncture for cytological examination is necessary to determine its benign or malignant nature. If it is malignant, thyroid cancer removal surgery is needed. Therefore, not all thyroid cysts require surgical treatment; it depends on the specific situation.

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Can thyroid cysts become cancerous?

Thyroid cysts can potentially become cancerous. Initially, thyroid cysts may arise from various thyroid diseases such as nodular goiter, Hashimoto's disease, thyroid adenoma, and thyroid follicular cancer, which form through degeneration, liquefaction, and hemorrhage. They are one of the common diseases of the thyroid. In the population, at least 4% of people can feel thyroid nodules larger than one centimeter. Among these nodules, about 5% to 20% are cystic. Statistics show that even benign lesions causing cysts have a 4%-5% chance of becoming cancerous when the diameter of the individual exceeds 4 centimeters. Therefore, thyroid cysts can potentially become cancerous.

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What are the symptoms of thyroid cysts?

Thyroid cysts generally refer to a cystic mass found in the thyroid, typically containing a mixture of fluid or semi-solid fluid. The mass usually has clear boundaries and is painless. It can move up and down with swallowing, which distinguishes it from some subcutaneous nodules. Thyroid cysts generally do not show obvious symptoms or clinical signs and are mostly discovered when looking in the mirror or during a physical examination. However, larger thyroid cysts may cause compression symptoms, such as pressing backward against the trachea or esophagus, leading to symptoms like breathlessness and discomfort swallowing. A small portion may also exhibit signs of thyroid dysfunction, such as hyperthyroidism or hypothyroidism, although this is relatively rare in clinical settings.

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The difference between thyroid cysts and nodules

Thyroid cysts are a benign change in the thyroid, and are generally classified as first or second level in clinical analysis. Thyroid nodules may be solid or may have mixed echogenicity. The biggest difference between a thyroid nodule and a cyst is their composition: cysts usually contain fluid, whereas nodules may contain other substances. Secondly, the vast majority of cysts are benign, classified as sub-level. Nodules, however, may potentially be malignant, and are classified as third, fourth, or even fifth level. If it is a thyroid cyst, there is no need for excessive worry. If it is a thyroid nodule, it is crucial to complete an ultrasound classification and then schedule regular follow-up exams.

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Do thyroid cysts require surgery?

Thyroid cysts are relatively common in clinical practice. Whether surgery is necessary depends on two factors. On one hand, it depends on whether the cyst is malignant. If the ultrasound reveals small calcifications within the cyst, or other signs of malignancy, then a fine needle aspiration of the thyroid should be carried out for a pathological examination. If the cyst is confirmed to be malignant, surgery is generally recommended. However, if the examination indicates that the thyroid cyst is benign with a low malignancy level, surgery is usually not required. However, if the thyroid cyst is large, affects appearance, causes significant swallowing difficulties or hinders neck movement, surgery can also be considered.

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Are thyroid cysts dangerous?

Generally speaking, thyroid cysts are benign lesions and are not dangerous. First, let's understand what thyroid cysts are. A thyroid cyst is a fluid-containing cystic formation found in the thyroid gland. Typically, the lump is round, smooth, painless, or may cause slight pain, and can move up and down with swallowing. Most cysts are solitary nodules, and it is less common to find multiple nodules. Additionally, if the cyst is large or if there is bleeding within the cyst, it can cause symptoms of compression such as pain, difficulty swallowing, difficulty breathing, and hoarseness. We know that about 10% of cystic nodules are malignant, hence, it is important to understand the nature of a thyroid cyst. If it is malignant, surgical removal is necessary. Furthermore, if the nodular cyst is large and causes compression symptoms, surgery is also required. However, most are benign lesions, and thyroid function is within the normal range, so no special treatment is needed, just follow-up observation. Therefore, whether thyroid cysts are dangerous depends on the circumstances.