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What is Thyroid Disease

The thyroid gland is a butterfly-shaped gland in the neck, found below the Adam’s apple (Fig. 1). this gland secretes hormones to regulate many metabolic processes, including growth and energy expenditure. If the thyroid gland is overactive or sluggish, the body's metabolism will be affected.


Lumps of the thyroid are common, 90% of which are benign conditions, such as colloid disease, cysts, thyroiditis or hyperplasia (increased growth). The thyroid can also be over (hyper) or under (hypo) active, regardless of whether there are lumps in the thyroid. Approximately 10% of thyroid nodules are cancerous.

Diagnosis of benign thyroid diseases versus malignancy would depend on a combination of blood tests and imaging.  
Signs & symptoms
  • Visible lump in your neck
  • Compression on the throat or the food pipe, causing shortness of breath or difficulties swallowing
  • Sudden weight loss in spite of increased or normal appetite
  • Feeling that the environment is warmer than usual
  • Sensation of an irregular heartbeat
  • Tremor
  • Inability to sleep
  • Feeling of restlessness
  • Diarrhoea
Diagnosis and treatment options

Testing and diagnosis

  • Blood Tests
The basic blood test is a thyroid function test (TFT), which checks the level of your thyroid hormone produced by your thyroid (free T3 and free T4) and the Thyroid-Stimulating Hormone (TSH) produced by the pituitary gland. This test will determine if you are hyper- (high) or hypo- (low) thyroid.

  • Ultrasonography
The ultrasonography is a simple test provides information about the features of the thyroid gland. A gel is placed on the skin to help facilitate the transmission of the sound waves, which are emitted from a small hand-held transducer. This test does not involve any radiation, is fast, and painless. Occasionally, the follow-up of a thyroid nodule may require multiple ultrasounds of the thyroid gland.

  • Fine Needle Aspiration Biopsy
A small-sized needle is inserted into the nodule a few times to aspirate cells into a syringe. The cells are then placed onto a microscope slide, stained, and examined by a pathologist. The nodule is then classified as non-diagnostic, benign, suspicious, or malignant.



Low thyroid hormone levels are treated by thyroxin tablets with 6 monthly blood tests. Over-activity of the thyroid gland is treated with drugs that reduce the production of the thyroid hormones. If this is unable to control the thyroid hormone secretion or if the patient is unable to tolerate treatment, the entire thyroid can be removed surgically. Alternatively, the overactive thyroid cells can be killed with radioactive iodine. Your doctor will carry out a complete assessment of your pre-existing condition and your thyroid disorder before recommending the best treatment.
Surgery is recommended for thyroid nodules in some cases. Cancer is treated by surgically removing the thyroid gland. A multi-disciplinary approach to thyroid cancer management involves surgeons, endocrinologists and nuclear medicine physicians working jointly to provide holistic patient care.
A non-cancerous thyroid nodule may also require surgery, if the patient has difficulties breathing or swallowing due to the size of the nodule. Nodules diagnosed as indeterminate or suspicious by the fine needle aspiration biopsy as mentioned above, may also require surgery. Occasionally, the patient may choose to remove the nodule if it is large or unsightly.


Echotherapy is a non-invasive, high intensity ultrasound which delivers energy to destroy and shrink abnormal or enlarged tissues of thyroid nodules, tumours and goitres in the neck region.

The criteria to undergo echotherapy are:

  • The thyroid nodule/tumour/goitre must be benign (non-cancerous)
  • The size of the thyroid nodule must be 1–4cm
  • The doctor has certified/diagnosed that the patient is not fit for surgery

The benefits of echotherapy are:

  • No cuts, wounds or scars
  • Procedure done under sedation without the use of general anaesthesia and its associated risks
  • Preservation of the thyroid gland and its function with no life-long thyroxine replacement medication
  • 45 minutes – 1 hour treatment duration
  • Day procedure with quick return to normal daily life

The risks include:

  • Sedation-related risks
  • Temporary skin redness
  • Recurrence of thyroid nodules (patient can choose to undergo the same procedure again)
  • Small risk of injury to nerves controlling vocal cords
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