Thyroid nodules are lumps that form within the gland. A nodule is an abnormal growth of thyroid tissue or a fluid-filled cyst within the thyroid gland. Thyroid nodules are common and are benign rather than cancerous. Many people develop thyroid nodules without knowing. They are often found during a physical examination or on a scan done for another reason.Â
The majority of thyroid nodules (more than 90% of detected nodules) are benign. Finding one rarely means cancer, but a small proportion can be cancerous. Risk factors include a family history of thyroid cancer, thyroid disorders and radiation exposure. The risk of thyroid cancer is low for most nodules, but evaluation for endocrine cancers by an ENT specialist in Singapore helps identify the minority of cases that need treatment.
The most common types of thyroid cancer, papillary and follicular, are typically less aggressive than other thyroid cancers like hurthle, medullary and poorly differentiated/anaplastic thyroid cancers.
Thyroid nodules can be single or multiple, solid or cystic, and benign or malignant. Bilateral thyroid nodules are part of a multinodular goitre. Nodules can be normal thyroid tissue overgrowth (colloid nodules), inflammatory nodules, a thyroid cyst, hormone-producing nodules, or, less commonly, malignant nodules.Â
The management of thyroid nodules depends on the type: small, asymptomatic ones are often monitored. Hyperfunctioning thyroid nodules, or ‘hot’ nodules, cause hyperthyroidism. Solid nodules and suspicious nodules may need biopsy or surgery, with thyroid ultrasound features guiding suspicion. Types of thyroid nodules include:
Benign tissue growths are usually monitored unless they cause compressive symptoms.
Hormone-secreting adenomas causing hyperthyroidism; malignancy is very rare (1-8%).
Fluid-filled; pure cysts are typically benign and do not require treatment.
Any thyroid enlargement, caused by Hashimoto’s or iodine deficiency. Treated only if causing compressive or hyperthyroid symptoms.
Enlarged thyroid gland with multiple thyroid nodules, all usually benign. Treated only if symptomatic or if a nodule is suspicious for cancer.
Forms from cancerous cells through abnormal cell growth. Papillary cancer and follicular types of cancer are typically less aggressive than others.
Most thyroid nodules do not cause symptoms and are found incidentally. In some cases, larger or more active nodules can cause a visible neck lump, difficulty swallowing, or thyroid hormone-related problems. When symptoms do occur, they may include a swelling at the lower front of the neck, difficulty swallowing, a choking sensation, shortness of breath, or a change in the voice.
If a nodule makes too much thyroid hormone, symptoms of hyperthyroidism can follow, such as palpitations, unexplained weight loss, sweating, tremor, anxiety, increased appetite, diarrhoea and trouble sleeping. Thyroid disease associated with nodules may also be linked to low hormone levels, which can cause tiredness, constipation, unexplained weight gain and a general feeling of cold.
Pain is less typical, which is why a painful thyroid nodule or a rapidly enlarging lump deserves proper attention, as should rapid enlargement, voice changes, difficulty swallowing, and noisy breathing, as they may be warning signs of cancer or significant pressure effects.
When to See an ENT Specialist
If you notice a thyroid lump, develop pressure symptoms, or have red-flag features such as a voice change or a rapidly growing swelling, that is when to worry about thyroid nodules. Even though most neck lumps are not serious, it is sensible to have one checked, especially if it affects swallowing or breathing. Persistent hoarseness is particularly important because this could suggest that the cancer affects the nerve that supplies the vocal cords. See an ENT specialist immediately.Â
An ENT head and neck surgeon assesses thyroid nodules because the thyroid sits in the central neck, close to the airway, swallowing passage and voice box. If a nodule is causing a visible lump, airway pressure, voice change, or a concern about thyroid disease or cancer, a specialist review will help clarify what the lump is and whether you need monitoring, a biopsy, or surgery.
The diagnosis of thyroid nodules usually involves a physical examination, a thyroid ultrasound, thyroid function tests, and, when indicated, a fine needle biopsy. A consultation begins with a careful history and neck examination. If the lump moves when you swallow, that can support a thyroid origin. A blood test for thyroid-stimulating hormone (TSH) helps assess thyroid function.
A thyroid ultrasound is the key imaging test. It helps show whether the nodule is solid or cystic, whether there is one or several nodules, and whether the ultrasound pattern looks reassuring or suspicious.Â
If the nodule has suspicious features, a fine needle aspiration biopsy is usually the next step. This fine needle biopsy uses a very thin needle to collect cells for laboratory assessment. Results may show benign thyroid nodules, a follicular lesion of undetermined significance, or cancerous cells. If a patient has symptoms of thyroid hormone overproduction, a thyroid uptake scan or a blood test may also be used.
Many thyroid nodules do not require immediate treatment and can be safely monitored. Thyroid nodule treatment depends on the type, size and symptoms. These can be monitored with ultrasound at intervals. This watchful approach is often the right management for nodules when they are not causing discomfort or suspicious findings.
Treatment becomes more active when symptoms or thyroid dysfunction are present. If the nodule is overactive, treatment is directed at the excess hormone using either radioactive iodine or antithyroid medication. After a total thyroidectomy, thyroid hormone replacement therapy with synthetic thyroid hormone is needed. If the biopsy result shows a follicular lesion or is indeterminate, the next step may be a repeat fine-needle biopsy, close observation, or surgery. Radiofrequency ablation can be an option for treating benign thyroid nodules, especially when shrinkage of normal thyroid tissue is desired without formal surgery.
In reality, there is no reliable way to prevent most thyroid nodules. Iodine deficiency can contribute to nodule formation, but it is generally uncommon in Singapore.
Thyroid nodule surgery is considered when a thyroid nodule is suspicious, confirmed to be cancerous, causing pressure symptoms, or producing significant cosmetic or functional problems. The exact operation depends on the nodule’s size and site, biopsy findings, ultrasound appearance, hormone activity, and whether the nodule is confined to one lobe or involves both lobes. If lymph nodes are involved, neck node surgery may also be needed. The two common surgical operations are:
The surgical removal of the entire thyroid gland, a total thyroidectomy, is more often used for larger cancers, toxic goitre or more extensive disease.
The surgical removal of one lobe of the thyroid gland, a hemithyroidectomy, is often used to treat benign nodules or small cancers.
Thyroid Nodule Specialist
Thyroid surgery is usually safe, but patients should understand the recovery process and the main risks before deciding on an operation. Most patients recover well, but every operation carries general risks such as bleeding, infection and anaesthetic complications. Specific thyroid surgery risks include hoarseness from irritation or injury to the recurrent laryngeal nerve, breathing difficulty, low calcium if the parathyroid glands are affected, and the need for thyroid hormone replacement, especially after a total thyroidectomy.
Recovery varies with the extent of surgery. Many patients go home after a short hospital stay, and some may need a temporary drain in the neck. Follow-up usually includes a wound review, a pathology discussion, blood tests, and sometimes repeat scans. In cases of malignant thyroid nodules, further treatment such as radioactive iodine may be recommended, and in almost all cases, long-term surveillance is important.
A thyroid lump should be properly assessed so that patients are treated early. If you have noticed neck swelling, pressure symptoms, a voice change, or a rapidly enlarging lump and have any questions about the best treatment for a benign thyroid nodule, an ENT specialist review can provide clarity and reassurance.
At Barrie Tan ENT Head & Neck Surgery, thyroid nodules are assessed with close attention to symptoms, scan findings, biopsy results, and their impact on your breathing, swallowing, and voice. Whether the nodule appears benign, indeterminate or suspicious, Dr Barrie Tan can guide you through the next steps, including surveillance, biopsy planning and surgery where appropriate. To discuss a thyroid lump or get a second opinion, contact our clinic for a consultation.
MBBS, MRCS (Edinburgh), MMed (Otorhinolaryngology), FAMS
Dr Barrie Tan is an ENT specialist at Gleneagles Hospital, Singapore, with more than 20 years of clinical and surgical experience. He previously served as Head of ENT and Director of the Centre for Hearing and Ear Implants at Singapore General Hospital. The information provided is not intended as medical advice. More about our medical experts.
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