Thyroid Nodules Surgery in Singapore

Common Causes of Thyroid Nodules

Several conditions can cause nodules to develop within your thyroid gland, and these can include:

• Overgrowth of normal thyroid tissue: Also known as thyroid adenoma, it is unclear why the thyroid tissue becomes enlarged. This condition is usually not serious unless it causes uncomfortable symptoms due to its size.
• Thyroid cyst: Degenerating thyroid adenomas can result in fluid-filled cavities (cysts) developing in the thyroid. While these cysts are usually benign, they may occasionally contain cancerous solid components.
• Inflammation of the thyroid: Hashimoto’s disease is a thyroid disorder that causes long-term thyroid gland inflammation, resulting in enlarged nodules.
• Goitre: The enlargement of the thyroid gland, also known as goitre, is often caused by iodine deficiency or a thyroid disorder. Some goitres have multiple distinct nodules within the goitre itself.
• Thyroid cancer: A large or hard nodule that causes pain or discomfort can be an indication of something more serious. Thus, it is recommended that you consult with your doctor or a thyroid nodule specialist on your condition.

Risk Factors for Developing Thyroid Nodules

You are more at risk of developing thyroid nodules if you had X-rays performed on your thyroid in your childhood or have a pre-existing thyroid condition like Hashimoto. People who have a family history of thyroid disorders or nodules may have a higher risk of developing thyroid nodules. Furthermore, thyroid nodules are more common in women as compared to men.

Signs & Symptoms of Thyroid Nodules

Most thyroid nodules do not have noticeable symptoms, however if the nodule gets large enough, you may experience:

• Pain at the base of your neck
• Difficulty swallowing
• Breathing difficulty
• Hoarse voice

Hyperthyroidism happens in patients with thyroid nodules producing excess thyroid hormones. Thus, they may develop hyperthyroidism symptoms such as:

• Irregular and rapid heartbeat
• Unexplained weight loss
• Difficulty sleeping
• Increased nervousness/anxiety

On the other hand, Hashimoto’s thyroiditis patients with thyroid nodules have an underactive thyroid gland — and do not produce enough thyroid hormones (hypothyroidism). Thus, they may experience hypothyroidism symptoms such as:

• Persistent fatigue
• Unexplained weight gain
• Constipation
• Increased sensitivity to cold
• Dry skin and hair

How Are Thyroid Nodules Diagnosed?

Thyroid nodules vary in size; some may be palpable and easily felt, while others might only be identified during a medical examination. If a nodule is detected, your healthcare provider, such as a thyroid nodule specialist, might recommend further evaluation to understand its nature.

The evaluation process for thyroid nodules typically encompasses a comprehensive ENT, head and neck history and physical examination. This may be accompanied by blood tests to assess thyroid hormone levels alongside imaging techniques, most commonly an ultrasound scan, to visualise the nodule. In some instances, a fine needle aspiration and cytology (FNAC — Figure 4) procedure may be performed on the thyroid nodule to gather more detailed information.

When Should You Consider Thyroid Surgery

Treatment options for thyroid nodules in Singapore are determined based on the size and type of nodule. If your thyroid nodule is not cancerous or causing any problems, your doctor or specialist may decide that no immediate treatment is necessary. Instead, they will closely monitor your condition by getting you to do regular checks and ultrasound scans to monitor the nodule’s status.

Non-cancerous nodules may require surgery if they become too large, causing the patient discomfort, such as difficulty swallowing or breathing. ENT specialists in Singapore may also recommend surgery for individuals with large multinodular goitres. Additionally, nodules deemed suspicious upon biopsy analysis might require surgical intervention.

Surgical Options for Thyroid Nodules

The primary surgical procedures performed by a thyroid nodule specialist include:

• Total thyroidectomy: Removal of the entire thyroid gland. This is typically done for known or highly suspected thyroid cancer.
• Lobectomy or hemithyroidectomy: Removal of only one lobe (half) of the thyroid gland. This may be done for benign nodules confined to one side.
• Near-total thyroidectomy: Removal of nearly all thyroid tissue, leaving only small amounts behind.
• Isthmusectomy: Removal of the narrow bridge of tissue (isthmus) connecting the two thyroid lobes.

Risks of Thyroid Surgery

• Voice Changes or Hoarseness: The thyroid gland is located close to the vocal cords and the nerves controlling them. During surgery, these nerves may be unintentionally damaged, leading to temporary or, in rare cases, permanent changes in voice quality or hoarseness.
• Hypoparathyroidism: The parathyroid glands, which regulate calcium levels in the body, are often located near the thyroid gland. In some cases, surgery can inadvertently damage or remove these glands, resulting in a condition known as hypoparathyroidism. This can lead to low calcium levels in the blood, causing symptoms such as muscle cramps, tingling sensations, and fatigue.
• Bleeding and Infection: As with any surgical procedure, there is a risk of bleeding and infection at the surgical site. Surgeons take precautions to minimise these risks but can still occur, necessitating further treatment or a return to the operating room.
• Scarring: Thyroid surgery may leave a visible scar on the neck. The size and appearance of the scar can vary depending on the type of thyroidectomy performed. While efforts are made to make the scar as inconspicuous as possible, some scarring is inevitable.

It’s important to note that the risks associated with thyroid surgery can vary depending on the specific procedure, the surgeon’s experience, and the individual patient’s health. Before undergoing surgery, patients should have a thorough discussion with their doctor to understand these risks and the benefits of the procedure.

Post-Operative Care for Thyroid Surgery

• Pain Management: Your surgeon will prescribe pain medication to manage any discomfort or pain after the surgery. Take the medication as directed and report any severe or persistent pain to your healthcare team.
• Wound Care and Scar Management: Keep the surgical incision site clean and dry. Follow your surgeon’s instructions regarding when and how to clean the wound. It’s essential to protect the incision from excessive sunlight to minimise scarring.
• Activity and Rest: Balance rest and light activity during the recovery period. Avoid strenuous activities and heavy lifting for several weeks following surgery. Gradually increase your activity level as advised by your surgeon.
• Diet and Medication: Follow any dietary restrictions or modifications recommended by your surgeon, especially if there are changes to your thyroid hormone medication. It’s important to maintain a stable thyroid hormone level, and your medication may need to be adjusted after surgery.
• Monitoring for Complications: Keep an eye out for signs of potential complications, such as infection (fever, increasing pain, redness, or swelling at the incision site), difficulty breathing, changes in voice quality, or symptoms of low calcium (tingling in the fingers or around the mouth). Report any unusual symptoms promptly to your healthcare provider.

How Doctors in Singapore Treat Thyroid Problems

Doctors in Singapore commonly adopt a patient-specific approach when managing thyroid issues, including nodules that contribute to hyperthyroidism. The treatment options frequently recommended encompass radioactive iodine therapy, which is absorbed by the thyroid gland to reduce nodule size. Additionally, thyroid-blocking medications may be prescribed as an alternative strategy to surgery. These medications aim to manage the condition by preventing the thyroid from producing excess hormones. In certain cases, where medication and radioactive treatment are not viable or sufficient, thyroid surgery is considered to address the underlying problem directly.

Frequently Asked Questions About Thyroid Nodules

Are thyroid nodules cancerous?

Most thyroid nodules are benign (non-cancerous). However, a small percentage can be malignant. Diagnosis typically requires assessment by a specialist using an ultrasound and often a fine needle aspiration biopsy.

Can thyroid nodules affect thyroid function?

Yes, some nodules (“hot” nodules) can overproduce hormones, causing hyperthyroidism, while others (“cold” nodules) may be associated with underproduction, causing hypothyroidism.

When should I see a doctor for thyroid nodules?

You should see a doctor if you feel a lump in your neck, have unexplained voice changes, experience difficulty swallowing, or notice symptoms of hyper- or hypothyroidism.

Meet Our ENT Thyroid Nodule Doctor

Dr Gan is a specialist with vast experience in the Ear, Nose, and Throat (ENT) field. He is renowned for his in-depth expertise and dedicated approach to addressing complex ear, nose, and throat conditions providing sinusitis cure and sensitive nose remedy amongst other treatments related to snoring and Obstructive Sleep Apnea (OSA). With a keen specialisation in thyroid nodules, Dr Gan employs the latest diagnostic techniques and treatment strategies to manage these issues effectively. His commitment to patient care is evident in his personalised treatment plans, aimed at alleviating symptoms and addressing the root causes of thyroid-related concerns. Through his extensive experience, Dr Gan ensures that patients receive comprehensive support and guidance throughout their journey to wellness.

Common Ear, Nose, and Throat Conditions