Does nodule size predict compressive symptoms in patients with thyroid nodules?

Thyromegaly and thyroid nodules are known to cause compressive symptoms, but the exact relationship between nodule size and development of compressive symptoms is unclear. We sought to determine whether compressive symptoms are directly related to nodule size.

A retrospective analysis of 99 patients who underwent thyroidectomy by a single surgeon was performed. Patients were placed into one of two cohorts: those who experienced preoperative compressive symptoms (N=51) and those who did not (N=48). Compressive symptoms were defined as experiencing neck fullness, dysphagia, choking, or dyspnea. Nodule size, thyroid lobe size, and the presence of visible thyromegaly were compared between the two groups.

Average nodule size in patients with compressive symptoms was 3.8 versus 2.2 cm in asymptomatic patients (P<0.0001). Average lobe diameter was 6.2 cm in patients with compressive symptoms versus 4.9 cm in asymptomatic patients (P<0.001). Visible thyromegaly was present in 65.2% of patients with compressive symptoms and 15.4% of asymptomatic patients (P<0.0001). The most common symptom was dysphagia, occurring in 80% of patients, followed by neck fullness (69%), choking (49%), and dyspnea (32%). Of patients who underwent surgery for compressive symptoms, 92.7% had improvement in their symptoms postoperatively. Of patients with a thyroid nodule greater than 1.5 cm, 97% showed improvement in symptoms postoperatively.

Thyroid nodule size and lobe size appear to directly correlate with compressive symptoms. Of patients with compressive symptoms and a thyroid nodule >1.5 cm, 97% experienced improvement in symptoms postoperatively.