Thyroid Nodules Evaluation in Singapore

Thyroid nodules are lumps or growths that develop in the thyroid gland, located in the front of the neck.

While most nodules are harmless and do not cause symptoms, some can lead to thyroid function issues or, in rare cases, be cancerous. Early diagnosis and appropriate treatment are necessary to address potential complications and ensure optimal health outcomes.

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

Symptoms Causes Types Diagnosis Treatment Prevention FAQ

Symptoms of Thyroid Nodules

Thyroid nodules often go unnoticed but can cause specific symptoms when they affect thyroid function or press on nearby structures. These include:

Visible or Palpable Lump in the Neck: A noticeable swelling in the neck that may move when swallowing.
Difficulty Swallowing or Breathing: Larger nodules can compress the oesophagus or windpipe, causing discomfort and breathing issues.
Hoarseness or Voice Changes: Nodules pressing on the recurrent laryngeal nerve may lead to persistent hoarseness or changes in voice quality.
Symptoms of Hyperthyroidism: Overactive nodules may produce excessive thyroid hormones, causing rapid heartbeat, weight loss, and nervousness.
Symptoms of Hypothyroidism: In some cases, nodules may be linked to an underactive thyroid, leading to fatigue, weight gain, and cold intolerance.

Causes and Risk Factors

The development of thyroid nodules is influenced by a combination of dietary, environmental, and genetic factors.

Iodine Deficiency: A lack of dietary iodine can lead to goitre and increase the risk of nodule formation, particularly in iodine-deficient regions.

Age and Gender: Women and older individuals are at higher risk due to hormonal influences and natural gland changes with age.

Family History: A genetic predisposition to thyroid disease or nodules increases the likelihood of their development.

Radiation Exposure: Prior exposure to radiation in the head or neck significantly raises the risk of thyroid nodules and cancer.

Chronic Thyroiditis: Autoimmune conditions like Hashimoto’s thyroiditis can cause inflammation, leading to nodule development.

Types of Thyroid Nodules

Thyroid nodules are classified based on their activity and potential to cause health issues.

Benign Nodules: These non-cancerous growths, including adenomas and cysts, are usually harmless but may require monitoring for growth or symptoms.
Malignant Nodules: These are cancerous nodules, such as papillary, follicular, medullary, or anaplastic thyroid cancers, requiring prompt intervention.
Hot (Hyperfunctioning) Nodules: These nodules produce excess thyroid hormones, often causing hyperthyroidism, and are typically non-cancerous.
Cold (Non-Functioning) Nodules: These do not produce thyroid hormones and are more likely to be malignant, necessitating further investigation.

Diagnosis of Thyroid Nodules

Physical Examination: The neck is examined for visible or palpable lumps, and the size, shape, and texture of any nodules are evaluated. Mobility of the nodules and associated symptoms like difficulty swallowing or breathing are also assessed.
Ultrasound Imaging: An ultrasound uses sound waves to create detailed images of the thyroid gland and any nodules. It aids ENT doctor in determining nodule size, composition (solid or cystic), and potential malignancy markers such as irregular borders or calcifications.
Thyroid Function Tests: Blood tests measure levels of thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH). These results determine whether the thyroid gland is functioning normally or if the nodule is causing hormone imbalances.
Fine-Needle Aspiration (FNA) Biopsy: FNA involves inserting a thin needle into the nodule to collect a sample of cells for laboratory analysis. This test distinguishes between benign and malignant nodules, helping guide treatment decisions.
Additional Imaging Studies: Radioactive iodine scans assess whether nodules are overactive (‘hot’) or underactive (‘cold’), which can indicate a higher risk of cancer. CT or MRI scans are used for large nodules to evaluate their impact on surrounding tissues or structures.

Treatment Options for Thyroid Nodules

Treatment options for thyroid nodules include non-surgical approaches for benign or minimally symptomatic nodules and surgical options for nodules that are malignant, large, or causing significant symptoms. The choice depends on the nodule size, nature, and overall effect on thyroid function.

Non-Surgical Management

Regular Monitoring: Benign and asymptomatic nodules are monitored with ultrasounds and clinical evaluations at intervals of 6 to 12 months. Follow-up focuses on changes in size, symptoms, or imaging features to decide if further evaluation is needed.
Radiofrequency Ablation (RFA): This minimally invasive procedure uses heat to reduce the size of benign nodules causing discomfort or cosmetic concerns. RFA is typically performed on an outpatient basis, allowing patients to avoid more invasive surgery with minimal recovery time.
Ethanol Ablation: Alcohol is injected into cystic nodules to shrink them by destroying the cyst lining. This treatment is specifically suited for fluid-filled nodules that recur or persist after simple drainage.

Surgical Treatment

Lobectomy: Lobectomy involves removing the thyroid lobe containing the nodule. It is recommended for nodules with inconclusive biopsy results, significant symptoms like compression, or suspicion of malignancy limited to one lobe. This procedure often allows the remaining lobe to maintain normal thyroid function, reducing the need for lifelong hormone therapy.
Total Thyroidectomy: Total thyroidectomy involves the complete removal of the thyroid gland. It is performed for malignant nodules, extensive nodular disease, or diffuse thyroid abnormalities affecting the entire gland. Since the thyroid is entirely removed, lifelong thyroid hormone replacement therapy is necessary to support normal metabolism and overall health.

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Prevention and Management

Although thyroid nodules cannot always be prevented, maintaining adequate iodine intake through diet or supplements can reduce the risk. Avoiding unnecessary radiation exposure and undergoing regular check-ups, especially for individuals with a family history or prior radiation exposure, supports early detection. For treated cases, periodic monitoring with thyroid function tests and imaging ensures ongoing management and reduces the risk of recurrence or complications.

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Frequently Asked Questions (FAQ)

Do thyroid nodules cause pain?

Most thyroid nodules are painless, but some can cause discomfort or neck pain if they grow quickly, press on nearby structures, or are associated with inflammation, such as in thyroiditis.

What is the difference between a cystic and a solid thyroid nodule?

A cystic nodule is filled with fluid, while a solid nodule consists of thyroid tissue. Cystic nodules are usually benign, whereas solid nodules may require further investigation for malignancy.

Can thyroid nodules recur after surgery?

Yes, new nodules can develop in the remaining thyroid tissue after a partial thyroidectomy. Regular follow-up care is important to monitor for recurrence.

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.

Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.

2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
2016 – Best Educator Award (Eastern Health Alliance)
2016 – “Wow” Award (Patient Compliment)

2014 – Eastern Health Alliance Caring Award – Silver
2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
2012 – Human Manpower Development Award (Ministry of Health, Singapore)
2007 – Singhealth Best Doctor Award

Qualifications

MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
FAMS – Fellow of the Academy of Medicine Singapore

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