Do thyroid cysts need treatment?

Written by Zhang Li
Endocrinology
Updated on September 16, 2024
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Thyroid cysts generally do not require special treatment, as most thyroid cysts are quite small, and even larger ones usually do not cause significant clinical symptoms. However, treatment may be necessary in some cases, such as when a thyroid cyst becomes large enough to cause compressive symptoms, leading to difficulty breathing or swallowing, in which case puncture or surgery might be considered. On the other hand, if a thyroid cyst is accompanied by abnormalities in thyroid function, it is important to assess whether there is hyperthyroidism or hypothyroidism and treat according to the specific functional state. Additionally, in a small number of cases where a thyroid cyst may have a tendency to worsen, a puncture biopsy is needed to make a diagnosis, and if confirmed, surgery and appropriate treatment should be carried out.

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Symptoms of thyroid cysts

Regarding the symptoms of thyroid cysts, typically, patients with thyroid cysts do not experience any discomfort in the early stages. Often, a neck mass is incidentally discovered during a physical examination, and usually, there are no systemic clinical symptoms. Some patients may experience slight pain. Of course, if the cyst is large or there is bleeding within the cyst, it may lead to symptoms of compression, such as pain, difficulty swallowing, difficulty breathing, or hoarseness. Additionally, some thyroid cysts can affect thyroid function. For instance, if there is hyperthyroidism, symptoms may include heat intolerance, excessive sweating, and weight loss. Conversely, in long-term cases, patients may experience symptoms of hypothyroidism, such as cold intolerance, fatigue, constipation, and poor appetite.

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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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Which department to see for thyroid cysts?

For which department to consult for thyroid cysts, firstly if it is just a routine physical examination and a thyroid ultrasound reveals a thyroid cyst, it is recommended to first consult the endocrinology department. An assessment of thyroid function should be conducted to see if the thyroid is functioning normally or abnormally. If it is confirmed to be simply a thyroid cyst, then the size of the cyst should be considered in deciding the next steps for treatment. If the cyst is not large and thyroid function is normal, it might be advisable to observe it for some time. If the cyst causes symptoms due to compression, surgical treatment in the department of surgery might be necessary, or dealing with the thyroid cyst using techniques such as radiofrequency ablation could be considered. Therefore, it is advised to first visit the endocrinology department and, based on the opinion of the endocrinologist, if surgical intervention is needed, then consult the breast and thyroid surgery department.

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Do thyroid cysts require surgery?

Thyroid cysts are generally benign lesions and are typically classified as below 3B level in thyroid ultrasound grading, which means they are categorized as class 1, 2, or even 3. The decision to perform surgery depends primarily on the size of the thyroid cyst. If the cyst is large enough to cause compressive symptoms, then surgical treatment is necessary at that time. Secondly, if the development of the thyroid cyst is rapid, and fine needle aspiration of the thyroid reveals malignant changes, then surgery is also required. For routine thyroid examinations, if the thyroid cyst is relatively small, classified at a lower level, and there are no associated thyroid functional abnormalities, regular follow-up is generally sufficient without the need for surgical intervention.

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Precautions for Thyroid Cysts

If an ultrasound has confirmed a diagnosis of a thyroid cyst, it's important to manage iodine intake in your diet. You should not consume too much iodine, but also not completely avoid it; a normal, regular diet is sufficient. Secondly, it is important to monitor any changes in the size of the thyroid cyst. Regular ultrasound checks and self-examination can help observe if there's any rapid increase in size locally. If the cyst grows significantly and is accompanied by pain, it might indicate the risk of bleeding within the cyst. Normally, do not massage the thyroid cyst, as massaging will not have any beneficial effects.