Surreal illustration of thyroid gland with vines, symbolizing Graves' disease and hidden nodules.

Graves' Disease and Thyroid Nodules: What's the Real Risk?

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"Uncover the Connection Between Thyroid Nodules and Graves' Disease: Frequency, Risks, and What it Means for Your Health"

Graves' disease (GD), an autoimmune disorder affecting the thyroid gland, often brings a host of concerns, and among these, the presence of thyroid nodules takes center stage. The co-occurrence of thyroid nodules in Graves' disease patients is a well-documented phenomenon, with reported rates varying considerably in medical literature, ranging from 2% to as high as 46%. This wide range underscores the complexity of the relationship between GD and thyroid nodules, signaling the need for further investigation.

For individuals diagnosed with both GD and thyroid nodules, concerns about the potential risk of thyroid cancer understandably loom large. Studies suggest that those with GD and coexisting thyroid nodules may face a higher likelihood of thyroid cancer compared to individuals with GD alone. Thyrotropin receptor antibodies (TRAbs), implicated in GD development, have also been linked to thyroid cancer through in vitro studies, further intensifying these concerns.

To shed light on the frequency and malignancy risk of coexistent thyroid nodules in patients with GD, researchers conducted a comprehensive study, delving into the medical records of individuals surgically treated for GD. Their findings offer valuable insights into understanding this complex interplay, empowering both healthcare professionals and patients with evidence-based information to make informed decisions regarding management and care.

Decoding the Nodules: Frequency and Characteristics

Surreal illustration of thyroid gland with vines, symbolizing Graves' disease and hidden nodules.

The study, a retrospective review spanning from 1990 to 2017, scrutinized data from 233 patients with GD who underwent thyroidectomy. The researchers meticulously examined pathology reports, demographic information, nodule sizes, and the results of various diagnostic tests, including ultrasound, 123I scintigraphy, and fine needle aspiration biopsy (FNAB).

Their analysis revealed that 103 out of the 233 patients (44%) had one or more thyroid nodules. Interestingly, a significant portion of these nodules (54 patients, or 52%) were incidentally discovered during pathologic examination, highlighting the importance of thorough assessment even when nodules aren't initially apparent.

Most nodules were found incidentally on pathologic exam (52% of nodule cases).
A substantial number of patients (64%) had at least one nodule larger than 1 cm.
The study confirmed nodules are frequently accompanied by GD.

Nodule sizes ranged from 0.2 cm to 11.5 cm, underscoring the variability in nodule presentation. The research underscores the importance of diligent evaluation to promptly discern the features of thyroid nodules in individuals grappling with GD.

Key Takeaways for Managing Thyroid Health with Graves' Disease

The research emphasizes that while thyroid nodules are frequently observed in individuals with GD, most are discovered incidentally during pathologic examination. However, it also highlights a higher rate of malignancy in patients with GD who have clinically identifiable nodular disease. Vigilant monitoring and thorough evaluation of thyroid nodules are essential in patients with GD to ensure early detection and appropriate management, supporting better health outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.amjsurg.2018.07.011, Alternate LINK

Title: Coexistent Thyroid Nodules In Patients With Graves’ Disease: What Is The Frequency And The Risk Of Malignancy?

Subject: General Medicine

Journal: The American Journal of Surgery

Publisher: Elsevier BV

Authors: Helen H. Shi, Christopher R. Mchenry

Published: 2018-11-01

Everything You Need To Know

What exactly is Graves' disease, and why is it often discussed alongside thyroid nodules?

Graves' disease is an autoimmune disorder where the thyroid gland is affected, often leading to the appearance of thyroid nodules. This connection is significant because the presence of nodules in Graves' disease patients is quite common, with studies showing varying rates. It's important to understand this relationship to properly manage thyroid health and address any concerns related to nodule malignancy.

What are thyroid nodules, and why are people with Graves' disease often concerned about them?

Thyroid nodules are growths or lumps in the thyroid gland. They are significant because, in the context of Graves' disease, their presence can raise concerns about the risk of thyroid cancer. Detecting and evaluating these nodules, especially through methods like ultrasound and fine needle aspiration biopsy (FNAB), is crucial for assessing the need for intervention and ensuring better health outcomes.

What are thyrotropin receptor antibodies (TRAbs), and why are they relevant when discussing thyroid nodules and Graves' disease?

Thyrotropin receptor antibodies (TRAbs) are antibodies that stimulate the TSH receptor. These are involved in the development of Graves' disease. They are also linked to thyroid cancer, based on in vitro studies, which raises concerns about malignancy risks in individuals with both Graves' disease and thyroid nodules. Monitoring TRAb levels and nodule characteristics is essential for managing potential risks.

What is a fine needle aspiration biopsy (FNAB), and when is it necessary for people with Graves' disease who also have thyroid nodules?

Fine needle aspiration biopsy (FNAB) is a diagnostic procedure used to sample cells from a thyroid nodule for examination under a microscope. It is important because it helps determine whether a nodule is benign or malignant. In the context of Graves' disease and thyroid nodules, FNAB plays a vital role in assessing the risk of thyroid cancer and guiding treatment decisions, ensuring timely intervention if necessary.

What is a retrospective review, and how does it help us understand the connection between Graves' disease and thyroid nodules?

A retrospective review is a type of study that looks back at past data. In this setting, researchers examined medical records of individuals surgically treated for Graves' disease between 1990 and 2017. This approach is valuable for understanding long-term trends, frequencies, and characteristics of thyroid nodules in Graves' disease patients, providing insights that help inform management and care strategies.