The difference between thyroid cysts and nodules

Written by Luo Han Ying
Endocrinology
Updated on March 04, 2025
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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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How to treat thyroid cystic tumors?

Thyroid cysts refer to fluid-filled sac-like formations or lumps found in the thyroid, generally round in shape, typically painless or only mildly painful, and move up and down with swallowing. Most are solitary nodules, with multiple nodules being less common. Most thyroid cysts do not exhibit obvious clinical symptoms unless the cyst is large or there is bleeding within the cyst, which may lead to symptoms of compression such as pain, difficulty swallowing, difficulty breathing, and hoarseness. Therefore, the treatment of thyroid cysts primarily involves understanding their nature. If a thyroid cyst is malignant, prompt surgical removal should be undertaken; if benign, generally it is sufficient to monitor the cyst through follow-up observations.

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Written by Luo Juan
Endocrinology
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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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Does thyroid cyst affect pregnancy?

Thyroid cysts generally do not affect pregnancy because they are merely morphological changes, meaning enlarged cystic nodules found in the thyroid. These nodules are typically fluid-filled and often non-functional, so they do not significantly impact pregnancy. However, since the thyroid can develop such cystic nodules or cysts, there might also be some functional manifestations. In other words, there could be both cysts and other thyroid function issues concurrently, which might affect pregnancy. Therefore, when thyroid issues are detected, it is necessary to undergo thyroid function tests before planning a pregnancy to determine whether it is safe to conceive and if there will be any impact on pregnancy.

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Written by Zhang Li
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What causes thyroid cysts?

Thyroid cysts currently have no definitive cause identified. Previously, most believed they were possibly related to iodine deficiency, as such deficiency leads to thyroid hyperplasia and an increase in thyroid cysts. However, it was later discovered that in some high-iodine coastal areas, the incidence of thyroid cysts remains high. This suggests that variations in iodine levels, such as switches from low to high iodine or from high to low iodine, can also lead to the occurrence of thyroid cysts. Additionally, it is currently believed that there might be some connection with radiation and the use of mobile phones and computers, but there is no definitive conclusion. Regardless, once thyroid cysts occur, it is important on one hand to eliminate the possibility of malignant features, ruling out thyroid cancer, and on the other hand to ensure thorough thyroid function tests to understand if there are any abnormalities in function and whether treatment is needed.