Active Surveillance for Thyroid Nodules
At the Russell Center for Endocrine Health, we understand that being told you have a thyroid nodule can be concerning. However, not all thyroid nodules require immediate surgery or aggressive treatment. In many cases, active surveillance—carefully watching the nodule over time—is the safest and most effective approach. Whatever option you choose, the Russell Center has more options available to consider, making sure that you receive the treatment and outcome the best matches your priorities.
What is Active Surveillance?
Active surveillance means monitoring your thyroid nodule regularly with ultrasounds and physical exams, rather than removing it right away. If there are any signs the nodule is changing in a concerning way, we can take action quickly.
Why Choose Active Surveillance?
- Most nodules are not cancerous. Over 90% of thyroid nodules are benign (non-cancerous), and even when they are cancerous, many thyroid cancers grow so slowly that they never cause harm.
- Low-risk thyroid cancers behave very differently from aggressive cancers. For example, small papillary thyroid cancers (the most common type) often grow so slowly that they pose no real danger. In some studies, many of these cancers never grew or caused symptoms over 10+ years of monitoring.
- Avoid unnecessary surgery. Thyroid surgery carries risks like damage to vocal cords or lifelong need for thyroid hormone replacement. If the nodule is unlikely to cause harm, it may be better to avoid surgery.
What Does the Science Say?
- Studies from Japan and the U.S. have shown that careful monitoring of small, low-risk thyroid cancers (under 1 cm) is just as safe as immediate surgery. HOWEVER, this does not apply to all patients, and there are multiple reasons that a person may not be eligible or that these results might not apply.
- In long-term studies, only a small percentage of nodules grow or change over time—and if they do, surgery is still effective at that point.
- Active surveillance is especially safe when:
- The nodule is small
- It’s not causing symptoms
- There’s no evidence it’s spreading
- You’re comfortable with close follow-up
It's also important to note that early recognition of changes in the nodule, the development of new nodules, or growth of nearby lymph nodes all could result in the need for surgery. Usually, that surgery would be similar to the surgery that you would have had in the first place.
How We Monitor You
If we recommend active surveillance, here’s what to expect:
- Regular ultrasound exams, often every 6–12 months at first
- Thorough physical exams and blood work
- A customized plan based on your personal health and risk factors
We’ll keep you informed every step of the way, and if anything changes, we’ll discuss all your options.
What makes us different at the Russell Center is that we are able to offer an unbiased review of all of the options: active surveillance, scarless surgery, radiofrequency ablation, or even traditional thyroid surgery. Each of these offers distinct advantages and disadvantages. But for most people with small cancers, any of those options would be safe and acceptable. So make sure that you review all of the options and make the choice that is best and safest for you!
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