What Are Pseudonodules? What Are the Symptoms of Pseudonodules?

Pseudonodules, frequently seen on thyroid ultrasounds but a term many people have never even heard of, can lead to unnecessary biopsies and even incorrect surgeries, according to experts. An Endocrine Surgery Specialist emphasized that confusing these formations, which are particularly common in women over 40, with real nodules can lead to both misdiagnoses and high-risk surgical interventions. They stressed that pseudonodules have no relation to cancer whatsoever and stated that the most critical mistake is performing a biopsy on these structures.

What Is a Pseudonodule?

Although thyroid diseases are a very common issue in society, many people are unfamiliar with the term "pseudonodule." An Endocrine Surgery Specialist from Yeditepe University Koşuyolu Hospital highlighted a critical misunderstanding that is frequently confused even among the public and some doctors regarding thyroid nodules. The specialist explained that these formations are seen more often in women over 40 and that mistaking pseudonodules for real nodules is a serious point that should be taken seriously as it paves the way for both misdiagnoses and risky surgical interventions.

• The Critical Difference Between a Real Nodule and a Pseudonodule

The Endocrine Surgery Specialist described the point that distinguishes pseudonodules from real nodules as follows: "A real nodule is a structure within the thyroid gland with clear boundaries, distinctly separate from thyroid tissue. A pseudonodule, however, is a formation without a capsule, without clear real boundaries, which gives the appearance of a nodule on ultrasound but is not actually a real nodule."

Who Gets Pseudonodules?

Our specialist stated that the prevalence of pseudonodules is closely related to thyroid diseases, especially thyroid inflammation, saying, "We most commonly see these structures in women over 40. The female gender and the over-40 age group are the most common demographic for pseudonodules."

They continued, indicating that the biggest factor in the emergence of these formations is Hashimoto's disease: "Hashimoto's is inflammation of the thyroid gland and is very common in women over 40. Inflammatory cells cluster in one area, forming a mass-like structure, and these structures cause the pseudonodule image on ultrasound. This is precisely why pseudonodules are frequently seen in inflammatory diseases like Hashimoto's."

What Are the Symptoms of Pseudonodules?

Our specialist Prof. Dr. AYŞAN, emphasizing that pseudonodules, like real nodules, often show no symptoms at all, continued: "Since they cause no symptoms, they are often detected incidentally. We accidentally detect pseudonodules on ultrasounds performed for Hashimoto's or other thyroid gland diseases."
Noting that these nodules also have no effect on hormone function, our specialist said: "There is no relationship between pseudonodules and thyroid hormone secretion. Whether there are few or many pseudonodules in the thyroid gland does not affect this result. However, the inflammation in the thyroid gland, i.e., the underlying cause, can disrupt hormone secretion."

Are Pseudonodules Dangerous?

Our specialist, emphasizing that the most critical point regarding pseudonodules is unnecessary biopsies, summarized the situation as follows: "Biopsy should absolutely not be performed on pseudonodules. Look, I'm not saying 'biopsy is unnecessary,' I'm saying 'biopsy should absolutely not be performed.' This is very important! Because when a biopsy is performed, inflammatory cells look very similar to tumor cells under the microscope, so the pathologist may interpret this as having a cancer risk. This is exactly where the problem starts. The clinician receiving this report tells the patient, 'You have a cancer risk, you must have surgery.' Thus, a biopsy that should not have been done can bring the patient to the operating room door, unfortunately. Therefore, the correct diagnosis of pseudonodules is a critically important issue."

Pointing out that surgery performed with a misdiagnosis also carries high risks for the patient, our specialist said: "Since the thyroid gland is inflamed, the risk of complications in these surgeries is high. Because inflammation disrupts the surgeon's working plans, limits the field of view, and increases the risk of bleeding. In this case, very important organs and structures like the parathyroid glands and vocal cord nerve can be damaged. Moreover, these can be permanent."

Are Pseudonodules Treated?

"Our specialist, saying 'This point is very important; the goal in a patient with a pseudonodule is not to treat the pseudonodule. The goal should be to treat the underlying disease causing it, i.e., thyroid inflammation,' stated: 'The physician should focus on Hashimoto's disease. However, it's also true that Hashimoto's is a chronic and difficult, even often impossible disease to cure; it may not heal but it can be managed.'"
Our specialist concluded their words with this warning: "The main message I want to emphasize is this: Correctly identifying pseudonodules on ultrasound is the first and most important point. The second important point is that biopsy should absolutely not be performed on these formations. Otherwise, with the misleading report from the pathologist, patients may undergo unnecessary surgery. They may not only lose their thyroid glands unnecessarily but also have to deal with surgery-related complications."