Nodules are fairly common and can appear in places like the thyroid or lungs. This article will discuss various nodules, their causes, symptoms, diagnosis, and treatment.
Nodules can vary in size, number, and location. You may have one or several. Most nodules occur in organs like the lungs, thyroid, and vocal cords, but others may be under or on your skin.
Many nodules are benign and do not cause any symptoms. However, some nodules may indicate an underlying health condition and should be assessed by a doctor. If you notice a lump that is growing or causing symptoms, seek medical attention.
Common places where nodules occur can include:
- lungs
- thyroid
- lymph nodes
- vocal cords
Nodules that appear under or on the skin include rheumatoid arthritis nodules and nodular melanoma, which is a type of skin cancer. Below is more information on the specific types of nodules that can occur and what symptoms they may have.
Lung or pulmonary nodules are small, usually measuring less than 3 centimeters (cm) or about 1.2 inches. They are usually benign. Lung nodules can develop from scar tissue, bacterial or fungal infections, or inflammation.
They appear in up to 50% of adults who have a chest X-ray or CT (computed tomography) scan as a white spot. Small nodules usually do not cause any symptoms, but if they become larger than 3 cm, they can cause pain and/or breathing problems and may indicate malignancy. Less than 5% of lung nodules will be cancerous.
Thyroid nodules are also very common — about half of all adults have these by the age of 60. The majority of thyroid nodules are benign, while between 10%–15% are associated with malignancy.
Some nodules can produce too much thyroid hormone, causing hyperthyroidism. This condition can increase your metabolism, causing unintentional weight loss and a rapid heartbeat.
There are hundreds of lymph nodes scattered throughout your body. These bean-shaped masses filter lymph, a watery fluid that contains white blood cells that attack bacteria and viruses.
Enlarged lymph nodes (lymphadenopathy) with nodules usually mean that you have an infection, but they can also indicate an autoimmune disorder or a malignancy like lymphoma or leukemia. Historically, doctors consider lymph nodes larger than 1 cm in diameter abnormal.
Vocal nodules are growths on the vocal folds inside your larynx, or voice box. The folds vibrate to produce sounds.
These nodules are benign and painless but can often get larger with overusing your voice, smoking, singing, or allergies. People who use their voices a lot, such as singers and teachers, are more prone to developing vocal nodules.
If you have a vocal nodule, you may notice your voice becoming hoarse and raspy. These nodules are common, with 2.29%–16.9% of people getting them.
Rheumatoid arthritis (RA) affects about 1.5 million adults in the United States. It is a chronic, autoimmune inflammatory condition that causes pain and swelling in your joints, especially the hands and feet.
RA nodules are one of the most common signs of this condition and may appear under the skin near a joint, such as the wrist. Up to 35% of people with RA have nodules, and they are more prevalent in people who smoke and those who have severe RA.
RA nodules are benign and usually painless, but they can interfere with joint motion.
Nodular melanoma is a fast-growing, malignant skin cancer that is more common after age 65. It is twice as common in men than women and makes up 15%-30% of all melanoma cases.
If you notice a firm, dome-shaped dark brown or red-brown/black bump on your skin — usually on the head, neck, or trunk — that grows quickly, seek medical attention right away.
Click here to learn more about the warning signs of melanoma.
Fast-growing nodules may indicate cancer. However, some nodules, like thyroid nodules, may have an unknown cause. Your doctor will order tests to determine the underlying cause.
Depending on where your nodule is located and its size, you may have a variety of associated signs and symptoms, including:
- swelling
- pain in the neck, jaw, or ear
- difficulty swallowing
- difficulty breathing
- a tickle in your throat
- feeling of a “lump in your throat”
- rasp or hoarse voice
- shortness of breath
- chest pain
- chronic cough
- coughing up blood
- unintended weight loss
- fatigue
While most nodules are benign, the general rule of thumb is if you are having any symptoms associated with the nodule, or it appears to be getting larger, see a doctor as soon as possible. Additionally, if you have any chest pain, are having difficulty swallowing or breathing, or are coughing up blood, you should seek medical attention right away.
If you notice a change in your voice (e.g., hoarseness) that lasts more than 2 weeks, or you have a fast-growing skin nodule, you should also visit your doctor for a diagnosis. If any of the symptoms listed above suddenly get worse, you should let your doctor know as well.
Diagnosing a nodule will require a trip to a doctor’s office. Your doctor will conduct a physical exam and take your medical history. They will assess the size and location of the nodule and check for additional symptoms.
You may have various blood and imaging tests. If your nodule is found to be potentially malignant after an ultrasound, CT, or PET scan, your doctor may order a biopsy to confirm malignancy. A biopsy takes a small piece of tissue from the nodule to test for cancer.
Your doctor may order imaging tests to get a better look at your nodule. These may include:
- ultrasound
- a chest X-ray
- CT (computed tomography) scan
- PET (positron emission tomography) scan
If you have a lung nodule, your doctor may use a bronchoscope to examine your airways and take a biopsy. A bronchoscope is a long tube with a video camera that is inserted through your mouth or nose and down into your airways and lungs.
Vocal cord nodules are examined using a laryngoscope, a thin tube with a camera, inserted through your mouth or nose and down your throat.
Your doctor may also order blood tests such as:
- a complete blood count (CBC)
- metabolic profile
- thyroid hormone levels
- antibody tests
- hepatitis test
- tests for viruses (e.g., HIV)
- antibody tests for tumor antigens
If your nodule shows indications that it may be potentially malignant after an ultrasound, CT, or PET scan, your doctor may order a biopsy. This will provide information on the nodule’s exact size, location, and constitution.
A tissue sample from the nodule will undergo examination by a pathologist under a microscope. Some nodules, like rheumatoid arthritis nodules and vocal nodules, do not usually require a biopsy unless they are causing pain or nerve compression.
If the results from your imaging test do not indicate a need for a biopsy, your doctor may just monitor your nodule every 6 months to a year to check for growth or changes.
If your nodule is from a medical condition (e.g., infection, allergies, or autoimmune disease), your doctor will treat it and your nodules may resolve over time. However, if you have a large nodule that is causing symptoms, your doctor may recommend surgery.
If your biopsy results show a malignancy, your doctor will discuss the best treatment plan for you. Treatment for malignant nodules may include:
- surgery to remove the nodule and affected tissues
- immunotherapy
- radiation
- chemotherapy
- targeted therapy
A growing nodule, whether it is benign or malignant, can cause complications depending on its size and location. Some of these may include:
- difficulty swallowing or breathing
- pain
- restricted joint movement
- shortness of breath
- voice changes
- swelling
If you have a biopsy, some potential complications include bleeding, infection, numbness around the biopsy site, and needle damage to nearby organs or tissues. All surgeries have potential complications, so it is best to discuss these with your surgeon before your procedure.
Most nodules are benign, so there is no immediate cause for alarm if you have a small nodule that is not growing or causing symptoms. Your doctor will monitor it via imaging tests over time.
If you start to have symptoms or your nodule grows, you should visit your doctor.
Nodules are common and most are benign and painless. However, if you have worsening symptoms or notice your nodule getting bigger, you should visit your doctor. Some nodules can indicate a more serious medical problem and your doctor will help you identify if you need any additional tests.
If you have a benign nodule, your doctor will monitor it over time to make sure that it is not growing or changing. If your nodule is malignant, your treatment will depend on its size and location.
