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Dr. Hernan Goldsztein is now a full partner with Pacific ENT Medical Group, Inc.

Dr. Hernan Goldsztein was selected as a Top Doctor in Otolaryngology by his peers in 2017 and 2018 as featured in San Diego Magazine.

Dr. Moses Salgado and Dr. Hernan Goldsztein were featured as “Champions for Health” in San Diego Physician Magazine because of their volunteer work with patients in Project Access San Diego

Pacific ENT of San Diego County's Carlsbad * Treating Sinusitis * Sinus Surgery * Sleep *  Snoring * Sleep Apnea * Allergies * Ear Hearing & Balance * Voice * Head & Neck Surgical Care Allergist ENT Sinus Doctors of San Diego County California

Thyroid Nodules

The thyroid gland is located in the front of the neck, below the Adam's apple and above the collar bones. It is dumb-bell shaped with two lobes on each side, and a narrower isthmus that crosses the windpipe. The thyroid gland produces thyroid hormones that help regulate metabolism.

Thyroid lumps or nodules are relatively common, occurring in approximately 10% of the adult population. They are more commonly found in woman than men. Many nodules can be seen or felt in the neck; others are smaller or deeper and may be noted on ultrasound or imaging studies performed to evaluate other conditions in the neck.

Most nodules are asymptomatic. Some may cause pain, pressure, difficulty in swallowing or hoarseness. Nodules are more likely to be cancerous if you are less than 20 or older than 70 years old. They are more likely to be cancerous in males, than in females. Other risk factors are a history of external irradiation to the neck in childhood, other swollen lymph nodes in the neck, or symptoms of hoarseness, or difficulty in swallowing.

Fortunately, only 5-10% of thyroid nodules are cancerous. The benign nodules are most commonly adenomas, cysts, or Hashimoto’s thyroiditis; a form of inflammation of the thyroid gland. Of the cancerous nodules, most are differentiated and usually are curable with treatment. Papillary, follicular, and mixed papillary-follicular carcinoma account for at least 80% of thyroid cancers.

The evaluation of thyroid nodules includes laboratory (blood) studies to determine if the thyroid gland is functioning normally. Most thyroid nodules do not cause abnormalities in thyroid function.

An ultrasound examination of the gland is used to evaluate the size of the thyroid gland and nodule and whether the nodule is solid or cystic (fluid filled). Most cystic nodules are benign.


A fine needle aspiration (FNA) is performed to obtain a sample of the contents of the nodule. If the nodule is small or cannot be felt on examination of the neck, the ultrasound may be used to help locate the nodule during the biopsy. This procedure is performed in the office or radiology center and is performed under local anesthesia with a small needle. The results of the biopsy may be benign, suspicious, malignant, or non-diagnostic. Most biopsies are found to be benign. 5-10% may be non-diagnostic because there are not enough cells in the biopsy to evaluate. If non-diagnostic, the biopsy is usually repeated in order to obtain more cells. 10% of biopsies are suspicious. Of the suspicious biopsies, 25% are found to be cancerous when the entire nodule is removed. The remainder of the biopsies are either malignant, or contain follicular cells that cannot be interpreted as benign or malignant unless the entire nodule is removed. In some instances, other studies, such as a nuclear medicine scan, may be ordered to determine if the thyroid nodule is hot (producing thyroid hormone) or cold (not producing thyroid hormone). Most hot nodules are benign.

If the results of the fine needle aspiration biopsy are found to be malignant, suspicious, or indeterminate (follicular cells), it is often recommended that the entire nodule be removed. That entails removing the entire lobe of the thyroid that contains the nodule (thyroid lobectomy). If cancer is confirmed within the nodule, the entire thyroid gland and any enlarged lymph nodes adjacent to the thyroid gland may be removed.

Thyroid surgery is performed under general anesthesia. The procedure is performed through an incision in the front of the neck above the collar bones. Most patients may go home the same day of the surgery although others may be observed overnight in the hospital. The major risks of the surgery are bleeding, swelling, injury to the recurrent laryngeal nerve, temporary or permanent hoarseness, and damage to the parathyroid glands, which may result in hypocalcaemia (too low calcium levels). In the case of the latter, calcium supplementation would be necessary. These complications are infrequent and usually occur in less than 2% of thyroid procedures.

Most individuals can return to regular activity in 1-2 days but should not exercise vigorously for at least 10 days following their surgeries.


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