Find out more about our Academic Medical Centre and efforts in Academic Medicine
Academic Medicine Executive Committee (AM EXCO)
Find out more about what JOAM do to support AM initiatives
Find out more about the Office of Duke-NUS Affairs and ACP Study Trip to Duke Durham
Guidelines, forms, and templates for Academic Medicine.
The butterfly-shaped thyroid gland, located at the front of the neck, can sometimes swell or develop solid or fluid lumps (cysts); these are called nodules. Multiple nodules which are found within the same thyroid gland have a different medical term - multinodular goitre.
Thyroid nodule symptoms are usually inconspicuous, which is why many of them are usually found incidentally during medical consultations during routine check-ups or investigations (eg. ultrasounds, CT scans or PET scans) for other health problems.
While the detection of these lumps are not urgent causes for concern, it is still crucial for patients to observe and note any changes in the lumps' properties, shape, and so on. As these lumps may cause problems when they enlarge and compress on other structures in the neck, which could make swallowing and breathing difficult.
Plus, some of the lumps may also produce too much thyroid hormones which could cause hyperthyroidism.
There are risks of thyroid cancer associated with thyroid nodules. Thus, closer observation is tantamount.
While symptoms of thyroid nodules are largely unnoticeable, complications such as bleeding into the thyroid cyst or nodule may cause a sudden and painful swelling in the neck.
Patients who have advanced thyroid cancer may also have a hoarse voice and difficulty swallowing.
Most thyroid nodules are a result of the overgrowths of normal thyroid tissues, fluid-containing cysts or the slow growth of benign tumours (adenomas).
While only a small percentage of these nodules are cancerous, the risk of thyroid cancer is higher for patients who have had a history of radiation to the head and neck for other medical conditions. Individuals who have a family history of thyroid cancer may be at risk as well.
Perhaps one of the more common causes of multinodular goitres is iodine deficiency.
That being said, studies have also shown that multinodular goitres may still develop in people who have enough iodine.
Thyroid function tests assess the levels of your thyroid hormones (T4) and thyroid-stimulating hormone (TSH). These tests evaluate the health of your thyroid gland before any further tests are done.
If you have hyperthyroidism and your levels of thyroid hormones are too high, you may experience symptoms such as palpitations, feeling hot easily, irritability, diarrhoea, weight loss, and increased appetite. Read more about hyperthyroidism.
On the other hand, if you have hypothyroidism, meaning your thyroid gland is underactive, you may feel tired and lethargic, gain weight easily, experience constipation, have memory loss, and feel cold easily. Learn more about hypothyroidism here.
Up next comes the ultrasound scan which produces a picture of the thyroid gland and neck structures using sound waves.
The ultrasound scan will:
evaluate the thyroid nodules
indicate possible signs of cancer
look for enlarged lymph nodes in the neck
The scan is painless with no need for ionising radiation. It would show if the nodule is liquid or solid and if there are multiple nodules present.
If your doctor deems necessary, fine needle aspiration biopsy may be required to test if the nodules are cancerous or benign.
The process involves placing a tiny needle into the thyroid nodule to collect cell samples for further analyses. It takes no longer than a few minutes with no side effects. Patients can resume their regular activities after the procedure.
The possible results can be categorised into 3:
Benign: this means the nodules are non-cancerous and can be left alone. But one will still need to monitor them for changes in size with an ultrasound once or twice a year.
Malignant: malignant lymph nodules are cancerous and would need to be removed. Read more under Treatments
Indeterminate: at times, the thyroid may not produce enough cells for doctors to conclude if the nodules are benign or malignant and the results would fall under "Indeterminate". When this happens, patients may need to repeat the procedure
Malignant lymph nodules would need to be removed through thyroid gland removal (thyroidectomy). Some thyroid cancers can spread to the lymph nodes in the neck and your doctor may need to remove some of the lymph nodes in your neck during the operation as well. Click here to read more about thyroidectomy.
Patients who have completed the surgery will be given regular outpatient appointments for further blood tests and scans to check if the cancer recurs. These tests are crucial for timely treatments if the cancer recurs or complications arise.
