​Thyroid nodules are abnormal lumps (growths) of cells within the thyroid gland. They can appear as solitary nodules (single), or multinodular goitres (multiple), and can be solid, cystic (fluid-filled), or a combination of both. While majority of thyroid nodules are benign (non-cancerous), a small proportion may represent thyroid cancer.

Thyroid nodule in the left lobe of thyroid gland

• There may be visible swelling in the front of the lower neck
  

• If they are large or increasing in size, they can potentially cause:
• Shortness of breath
• Swallowing difficulty
• Voice change (from compression of the windpipe and oesophagus)
  
• Some thyroid nodules are small, hence they cannot be seen or felt. On occasion, they are detected on other forms of medical imaging of the neck. When detected, they will require some form of evaluation.
  

• Thyroid nodules can sometimes be associated with alteration in hormone production by the thyroid gland, leading to:
  
• Change in weight and appetite
• Change in energy levels (e.g. feeling tired or overactive easily)
• Change in bowel habits
• Change in menstrual cycles
• Palpitations
• Hand tremors
  

When detected, a blood test for thyroid function is required, to determine if there is associated abnormality in thyroid hormone production.

There are other tests that help us evaluate if a thyroid nodule is concerning for cancer:

• Ultrasonography: This is a painless, non-invasive test. A gel is applied to the skin which allows sound waves from a hand-held transducer to be transmitted to the neck. This provides a clear picture of the structure of the thyroid gland and features of nodules within it.
• Fine needle biopsy: A very fine needle is used to extract cells from various areas of the thyroid nodule of concern. The cell samples are prepared and sent to the pathologist to be examined. 
  

​Not all thyroid nodules require surgical intervention. Thyroid nodules that are benign may be monitored with surveillance tests, such as ultrasonography.

You may be advised for thyroid surgery in the following instances:

• A large thyroid nodule or gland that causes discomfort, and related symptoms from compression of adjacent structures.
  
• Abnormalities in thyroid function that are not well controlled despite being on medication.
• A nodule that is cancerous or shows features suspicious for cancer. 
  

​The recommended treatment for thyroid cancer is thyroidectomy. This involves removal of a portion or the whole thyroid gland. Certain cancers may also require removal of surrounding lymph nodes in the neck. There may be additional adjuvant treatment after the surgery, such as radioiodine treatment. If you have concerns on a cancerous thyroid nodule or a nodule suspected for cancer, speak to your doctor to find out more about the appropriate treatment.

• A/Prof Thomas Loh Kwok Seng
  
• A/Prof Raymond Tsang
  
• Dr Donovan Eu
• Dr Joshua Tay
• Dr Lim Wei Sian
• Dr Charmaine Tan Si Min