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Thyroid Nodules and Cancer

What is the thyroid?

The thyroid gland is a butterfly-shaped organ located in the front of the lower neck. It produces thyroid hormone which is important for the regulation of metabolism in adults. In children, it is important for physical growth and mental development.

What are the symptoms of thyroid disease?

Thyroid problems may present as a neck swelling or lump in the front of the neck. These lumps are usually located near the midline at the lower part of the neck. You may notice that the swelling moves up and down during swallowing. If the thyroid is very large, you may also experience difficulty swallowing, tightness in the neck and throat, or difficulty breathing especially when lying down.

In some cases, the thyroid hormone levels may be affected. If the levels are too high, you may experience symptoms such as increased sweating, increased appetite, weight loss, insomnia, palpitations, and diarrhoea. If the thyroid hormone levels are low, you may experience lethargy, reduced appetite, weight gain, and constipation.

What are thyroid nodules?

​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
Thyroid nodule in the left lobe of thyroid gland

What are the symptoms of thyroid cancer?

Not all thyroid lumps are cancerous. In fact, 90 to 95% of thyroid lumps are benign. Some thyroid cancers may present suspicious symptoms. These include a rapidly enlarging thyroid mass, change in the voice, difficulties in swallowing, noisy breathing, and shortness of breath. If the cancer has spread to the surrounding lymph nodes, it may lead to lumps at either side of the neck.

However, many patients with thyroid cancer simply present as an isolated thyroid lump. There are also patients who have thyroid cancer that is incidentally found when performing general health screening.

Who is at risk of developing thyroid cancer?
Risk factors for thyroid cancer include previous radiation exposure as well as family history of thyroid cancer. Males with thyroid nodules are also more likely to have thyroid cancer than females.
When should I see a doctor for my thyroid problem?
Any adult or child with a lump in the neck should consult an Otolaryngology - Ear Nose and Throat (ENT) doctor. Our specialist doctors are trained in the evaluation and management of all head and neck lumps.
What should I do if I suspect that my child has a thyroid lump?
You should consult an ENT specialist. Thyroid lumps are much less common in children. However, up to 25% of thyroid lumps in children are cancerous. Fortunately, with the appropriate treatment, the prognosis for children with thyroid cancer is generally better than that of adults. There are several paediatric ENT specialists within our department who are trained in the evaluation and management of thyroid lumps in children.
How will my thyroid be evaluated?

Your doctor will first ask you some questions about your medical history and proceed to examine your neck to evaluate the thyroid gland. A few important tests may then be performed:

  1. Nasoendoscopy
    This is an endoscopic evaluation of the upper airway. It is critical in the evaluation of thyroid nodules as thyroid cancers can invade the nerve that controls the voice box, causing reduced movement of the vocal cord. It is a quick and relatively painless procedure that can only be performed by trained doctors at the ENT clinic.

  2. Ultrasound
    This is a non-invasive method of evaluating the thyroid gland. Many of our doctors are trained to perform this procedure by the bedside.

  3. Fine Needle Aspiration Cytology (FNAC)
    A biopsy may be required to evaluate thyroid nodules. A small needle, similar to that used in blood taking, is used to extract some cells. This helps us to evaluate the likelihood that a thyroid lump is cancerous. FNAC is sometimes performed with the help of an ultrasound to guide the needle.

  4. Thyroid Function Test
    A blood test can be used to determine whether your thyroid hormone levels are too high or too low.

Your doctor will advise you on appropriate management based on the test results.

Ultrasound-guided fine needle biopsy of a thyroid nodule
Ultrasound-guided fine needle biopsy of a thyroid nodule

How are thyroid nodules managed?

Benign thyroid lumps that are small and asymptomatic can be left alone. However, as they enlarge (beyond about 4cm), they may cause discomfort, swallowing problems, or breathing difficulties. Surgery can then be performed to remove the part of the thyroid gland that contains these lumps.

Sometimes, fine needle aspiration may show some cells that are not typical of benign nodules. Your doctor may then recommend surgery to remove the entire nodule so that it can be examined to ensure that there are no cancer cells within.

How is thyroid cancer treated?

Cancerous thyroid lumps should be removed surgically also known as a thyroidectomy. Depending on the size, location, and number of nodules, your doctor may recommend removing half of the thyroid gland or the entire thyroid gland. If lymph nodes are involved, a procedure called a neck dissection may be required to remove these lymph nodes in a systematic manner.

The most significant risk of thyroid surgery is injury to the recurrent laryngeal nerve. This nerve controls the movement of the vocal cord which may affect both the voice and breathing. If the entire thyroid gland needs to be removed, calcium levels may also drop after the operation and require replacement.

Post-operatively, radioactive iodine (RAI) may need to be administered. This is a form of targeted radiotherapy which helps to remove any remnant thyroid cells in the body. It is a non-invasive treatment that is administered orally.

After treatment is completed, you will have regular follow-up sessions with a head and neck cancer specialist. The specialist will perform regular examinations, blood tests, and ultrasounds to ensure that the disease is well controlled.

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