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.
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.
​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
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.
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:
Your doctor will advise you on appropriate management based on the test results.
Ultrasound-guided fine needle biopsy of a thyroid nodule
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.
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.
