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What is a Hypoechoic Nodule?

By J.M. Willhite
Updated Mar 03, 2024
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A hypoechoic nodule is a fluid-filled or solid mass that casts limited, weakened echoes compared to the surrounding tissue during the administration of an ultrasound, or sonogram. Though this type of mass may be found in any part of the body, it is most frequently detected in the thyroid. Due to the characteristics of its composition, suspicion of malignancy may arise upon the discovery of a hypoechoic nodule prompting additional testing and biopsy. Treatment for a hypoechoic thyroid nodule is dependent on its type, composition, and the overall health of the individual.

The thyroid gland is responsible for regulating metabolism. Intricately involved in the metabolic regulation process are two hormones produced by the thyroid gland: triiodothyronine (T3) and thyroxine (T4). Fueled by the absorption of iodine provided by one’s diet, the thyroid employs T3 and T4 to aid with regulating several body systems, including heart rate and protein production. Although it is unknown what causes the formation of thyroid nodules, there are several factors that may contribute to their development.

Individuals who develop a diet-induced iodine deficiency may be at an increased risk for developing a thyroid nodule. Certain autoimmune disorders, such as Hashimoto’s disease, cause an inflammation of the thyroid that impairs its functionality. Additional elements that may contribute to thyroid dysfunction may include radiation exposure and genetics. It is very rare for a thyroid mass to manifest as a malignant hypoechoic nodule. There is no known, single cause for the abnormal cell development associated with thyroid cancer, and those who develop this rare disease may experience diverse, aggressive symptoms.

Not everyone who develops a thyroid nodule may experience symptoms. Nodules that progress rapidly, and increase in size, may become noticeable and cause swelling around the base of one’s neck. Additional signs may include unintended weight loss, anxiety, and heart arrhythmia. Individuals who experience symptoms that include a nodule that rapidly increases in size, swollen lymph nodes in the neck and jaw, or changes to his or her voice should seek immediate medical attention. Nodules that are malignant in composition may induce the development of these types of aggressive symptoms.

A variety of tests may be administered to determine the composition of a thyroid nodule. Imaging testing, including ultrasound and magnetic resonance imaging (MRI), are usually employed to obtain a clear picture of a suspected mass in the thyroid gland. The presentation of the nodule is generally used as a basis on which to preliminarily determine suspected malignancy. In order to evaluate whether a mass is benign or malignant, radiologists look for specific characteristics associated with abnormal cell development, such as shape and associated blood flow.

Nodules that possess an ill-defined shape and are densely shadowed are considered to have hypoechoic characteristics. Compared to surrounding tissue, a hypoechoic nodule casts fewer and weaker shadows during ultrasound that may be interpreted to indicate malignancy. Upon discovery of a hypoechoic nodule, a fine-needle biopsy may be conducted to determine the nodule's composition. Individuals diagnosed with a malignant hypoechoic nodule may undergo treatment that includes surgery, hormone replacement therapy, and chemo and radiation therapies. Treatment approach for thyroid cancer is dependent on the size, staging, and extent of the tumor and the overall health of the individual.

Initial treatment for a malignant nodule usually involves the surgical removal of the thyroid gland and any affected lymph nodes. During the procedure, an incision is made at the base of the individual’s neck through which the gland is removed. As with any surgical procedure, there are risks associated with thyroid removal and may include damage to surrounding tissues and glands, nerve damage, and infection.

Following the removal of the thyroid gland, the individual may be placed on hormone replacement therapy to compensate for the resulting hormone deficiency. In order to eliminate any remaining thyroid tissue, radioactive iodine may be orally administered. Individuals who are given radioactive iodine may experience a variety of side effects that may include impaired taste or smell, nausea, and dry mouth. Once the iodine is expelled through urination, side effects generally subside.

Chemo and radiation therapies may also be utilized to eradicate any remaining cancerous cells. Those given chemotherapy drug treatment, either orally or intravenously, may experience side effects that include nausea, loss of appetite, and fatigue. Radiation therapy employs highly concentrated doses of energy focused directly on the affected area to eliminate cancerous cells. Side effects associated with radiation therapy may include redness and irritation at the administration site and fatigue.

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Discussion Comments

By anon995774 — On May 24, 2016

My son aged 12 developed swelling along his right ear moving down towards the lower end of his jaw where there was formation of some lumpish material. He was shown to ENT specialist who advised admission in hospital for investigation and treatment. After spending about a week there and having under gone x-ray and ultra-sound procedures, the report suggested "Right cervical lymphadenopathy." The ultrasound report read as follows:

"Few hypoechoic modular masses are seen anterior to right upper sternomastoid along the angle of manible, measuring 1.2cm in greatest dimension."

What does all this mean and what action should follow this finding?

By amypollick — On Sep 16, 2012

@puppylover: I had a nodule on my thyroid over a year ago. My doctor found it at a routine exam. I don't recall if it was hypoechoic or not.

However, I had an ultrasound in September 2010. My doctor referred me to a thyroid specialist and I had a second ultrasound and fine needle biopsy aspiration to the nodule in January 2011. The right lobe of my thyroid was removed in March 2011. Thank the Lord, it was *not* malignant, but I have had no further problems, except getting my thyroid levels regulated, which is not an uncommon occurrence.

Personally, I would recommend you see an endocrinologist, who might be more aggressive in the treatment of this nodule. An endocrinologist may have more experience in dealing with thyroid issues, and that can only be helpful in your case. Good luck.

By anon291702 — On Sep 16, 2012

I have been diagnosed with a hypoechoic thyroid nodule, per an ultrasound that was done last month. They want to do another ultrasound in six months. I also have lymph nodes under my jaw on the left side only. My doctor referred me to ENT specialist about my lymph nodes, and I am confused.

I am not understanding why they want to do another ultrasound in six months. Meanwhile I have some pain on the left side of throat and do not understand if all of this is connected or not. Could you give me ideas on what I need to do? --puppylover

By abundancer — On Feb 03, 2011

@ artlover - I have been trying a few different diets to strengthen my thyroid and it seems to be working. Try to incorporate iodine rich foods like fresh fish and sea salt. Also, exercise is very important. Any one else have other ideas?

By artlover — On Feb 02, 2011

Having a hypo-echoic nodule diagnosis sounds scary. I have heard that adrenal fatigue can be another factor along with a diet deficient in iodine. Does anyone have any ideas on how to decrease these risk factors?

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