About Cold Thyroid Nodules

Thyroid nodules, or lumps, are very common. They occur in over half of the world’s population, but only five per cent of them are cancerous. Nodules are referred to as either “hot” or “cold,” depending on the amount of radioactive iodine it concentrates, or takes up, when testing for the type of nodule it is.

Signs of Cold Thyroid Nodules

Signs of a problem with the thyroid gland are swelling in the thyroid area of the neck which may or may not be painful. There may also be an enlargement of the thyroid. The doctor will palpate (feel) the throat for swelling or nodules (lumps) on the thyroid gland. Upon scanning the thyroid gland, lumps or nodules could appear which may or may not be cancerous. These nodules can occur in any age group, but most occur in people as they age. The lump may be solid of full of liquid (cystic).

An ultrasound or nuclear imaging is performed to check the thyroid area. A fine needle aspiration (FNA) is a form of biopsy usually performed if a nodule is found to determine if it’s benign or malignant. Radionuclide scanning (using a radioactive isotope given orally to measure the amount of radioactive iodine the nodule concentrates) can also be performed to determine whether the lump is ‘hot’ or ‘cold.’ If a nodule is cold, it will not take up the radioactive material. When scanned, the cold nodule areas will show up lighter than normal tissue or even as totally blank areas. This is due to the decreased activity in that area of the thyroid (it’s hypoactive, or not producing much thyroid hormone). A nodule that is cold is more likely to be a cancerous one, though the majority of them still turn out to be benign.

Symptoms of Cold Thyroid Nodules

Most patients with thyroid nodules will not have symptoms. Most nodules are discovered during a doctor’s examination. Rarely occurring symptoms, such as neck pain in the neck, jaw, or ear may be present. Also hoarseness, if the cold nodule irritates the nerve to the larynx (voice box). There may also be difficulty in swallowing if the nodule is big enough to obstruct part of the throat. Some may suffer from shortness of breath if the lump is pressing against the windpipe. Others may feel as if they have a tickle in the throat, also due to the large size of the nodule.


If the cold nodules are cancerous, they will be treated and cured. If medication doesn’t work to cure the cancer, surgery will be used on most of the thyroid. Radioactive iodine is usually given to the patient to destroy any thyroid tissue that remains. Once a patient’s thyroid gland has been removed or destroyed, thyroid hormone treatment must be continued for life. If the nodules are not cancerous, nor are accompanied by any symptoms, they are usually left alone, unless they are not aesthetically pleasing.