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Thyroid Nodules in Singapore

Overview of Thyroid Nodules

The thyroid is a butterfly-shaped gland located in the lower front of the neck, just below the voice box (larynx). Its primary function is to produce hormones that regulate metabolism, body temperature, and heart rate. These hormones include Thyroxine (T4) and Triiodothyronine (T3), both of which influence how the body uses energy.

Thyroid nodules are growths or lumps that can develop within the thyroid gland. They are quite common, and in many cases, they do not cause symptoms or health problems. Most nodules are harmless, but a small number may require further medical review to rule out conditions such as thyroid dysfunction or, more rarely, thyroid cancer.

Prevalence studies indicate that many people may have thyroid nodules without being aware of them, as they often do not exhibit noticeable symptoms. Because of this, evaluation by a thyroid specialist in Singapore can be crucial for determining which nodules are benign and which ones may require monitoring or treatment.

What are the symptoms of Thyroid Nodules?

Most thyroid nodules are non-cancerous, do not cause symptoms, and do not need treatment. However, when nodules are larger or located in certain areas, they may produce symptoms that require further evaluation. The nodules are often discovered incidentally during check-ups or imaging tests, but some people may notice changes themselves.

Noticeable lump in the neck

Some patients discover a lump while looking in a mirror, buttoning a shirt collar, or fastening a necklace. This is often the first sign that leads to medical review.

Difficulty swallowing or breathing

Larger nodules can press on the windpipe or oesophagus, leading to a “tickle in the throat,” trouble swallowing solid food, or a sensation of shortness of breath.

Hoarseness or voice changes

Rarely, if a nodule affects the nerve that controls the vocal cords, it may cause changes in voice quality or persistent hoarseness.

Neck discomfort or swelling

Some people may experience a feeling of pressure, fullness, or discomfort in the neck area. In uncommon cases, pain may extend to the jaw or ear.

Note: Most thyroid nodules are found incidentally during physical examinations or imaging studies for unrelated reasons. Evaluation by a doctor familiar with thyroid conditions in Singapore helps to distinguish harmless nodules from those that may require monitoring or treatment.

What Causes Thyroid Nodules and Who Is at Risk?

Thyroid nodules can form for several reasons. In most cases, the exact cause is not known, but certain conditions and risk factors are associated with their development. According to sources such as the World Health Organization (WHO), the Singapore Ministry of Health (MOH), and the Endocrine Society, nodules are common and usually benign.

Causes

A lack of iodine in the diet can lead to thyroid swelling and nodule formation. This is uncommon in Singapore due to adequate iodine intake.

Inflammation of the thyroid caused by autoimmune conditions may result in nodules forming over time.

Fluid-filled cysts or long-standing goitres (enlarged thyroid glands) can develop nodular changes.

Risk Factors

Having close relatives with thyroid nodules, goitre, or thyroid cancer increases the likelihood of developing nodules.

Thyroid nodules are more commonly detected in women than in men.

The chance of developing nodules rises with age, even if they remain symptomless.

Prior exposure of the head or neck to radiation, especially during childhood, may increase risk.

How are Thyroid Nodules diagnosed in Singapore?

Doctors may use physical examination, blood tests, imaging, and biopsy to assess nodules. The choice of test depends on symptoms, clinical findings, and the appearance of the thyroid gland.

A doctor may feel the neck for lumps, check for swelling, and ask about symptoms such as difficulty swallowing or voice changes. Questions about any personal or family history of thyroid disease are also typically included.

  • Thyroid Function Tests (TFTs): Measure levels of thyroid hormones to determine if the gland is overactive or underactive.
  • Thyroid antibodies: May be checked to evaluate for autoimmune conditions such as Hashimoto’s thyroiditis or Graves’ disease.
  • Ultrasound: Provides detailed images of the thyroid, showing whether a nodule is solid, cystic (fluid-filled), or mixed. Features such as size, shape, and borders are also evaluated.
  • Thyroid uptake scan: Uses a small amount of radioactive material to identify whether a nodule is “hot” (producing hormone) or “cold” (not producing hormone).

A thin needle is used to take a small sample of cells from the nodule, which is then examined under a microscope by a pathologist. This is often considered a reliable method for assessing whether a nodule is benign or suspicious.

An ENT thyroid surgeon in Singapore may recommend further testing if results are unclear or if the nodule shows features that warrant closer examination.

Possible FNA Results

Benign (Non-cancerous)

  • This result occurs in up to 80% of biopsies.
  • The chance of overlooking a cancer with a benign report is generally less than 3%.
  • Benign nodules usually do not require removal unless they cause symptoms such as choking or difficulty swallowing.
  • Follow-up ultrasound scans are important, and a repeat biopsy may be needed if the nodule grows over time.

Malignant (Cancerous)

  • About 5% of biopsies reveal a malignant result, most often due to papillary thyroid cancer (the most common thyroid cancer).
  • A “suspicious for malignancy” result carries a 50–75% chance of cancer.
  • These findings typically require surgical removal of the thyroid.

Indeterminate / Atypical / Suspicious

  • Seen in up to 20% of cases, where the sample has enough cells but cannot be clearly classified as benign or malignant.
  • Follicular lesion: Cancer risk is around 20–30%. Diagnosis requires surgery, usually the removal of the thyroid lobe containing the nodule. If cancer is found, the rest of the thyroid may need to be removed.
  • Atypia / follicular lesion of undetermined significance: Usually carries a low risk of cancer, but surgical biopsy is often recommended for confirmation.

Inadequate Sample

  • Occurs in fewer than 5% of biopsies when ultrasound is used to guide the procedure.
  • This result means there were not enough cells for diagnosis, which is more common in fluid-filled (cystic) nodules.
  • Repeat biopsy or, in some cases, surgical removal may be required for further assessment.
ENT thyroid surgeon holding a thyroid gland model while explaining

What Complications Can Thyroid Nodules Cause?

Most nodules are harmless, but possible complications include:

Large nodules may press on the windpipe or oesophagus, causing discomfort, trouble swallowing, or a sensation of tightness in the neck.

Some nodules produce excess thyroid hormone, which may lead to symptoms such as rapid heartbeat, weight changes, or heat intolerance.

While most nodules are benign, a small proportion may turn out to be thyroid cancer and require further evaluation.

What Are the Treatment Options for Thyroid Nodules?

Treatment depends on the type and size of the nodule. While many nodules do not require intervention, others may require medication, ablation, or surgery, depending on their features and their impact on health.

Nodules that are benign on Fine Needle Aspiration (FNA) or too small for biopsy are often monitored with regular follow-up. Ultrasound imaging should be performed every 6–12 months to monitor any changes in size or appearance.

Antithyroid drugs may be prescribed if a nodule produces excess thyroid hormone. Beta blockers can be used to control related symptoms such as rapid heartbeat or tremors.

In overactive nodules, radioactive iodine may be used to shrink the nodules and reduce hormone production.

Minimally invasive methods such as Radiofrequency Ablation (RFA), Ethanol Ablation, or High-Intensity Focused Ultrasound may be considered for nodules that are symptomatic but not cancerous.

  • Surgery may be recommended for large nodules, those with suspicious features, or those causing symptoms such as difficulty swallowing or breathing.
  • Hemithyroidectomy (Lobectomy): Removal of one lobe of the thyroid.
  • Total Thyroidectomy: Removal of the entire thyroid gland.
  • Learn more about thyroid surgery, including recovery and follow-up care.

What Are Some Risks Of Thyroid Surgery?

Complications of thyroid surgery are uncommon, and may include:

 

  • Infections of the wound and wound site
  • Bleeding from the wound site and surgical bed
  • Temporary hoarseness and throat discomfort
  • Injury to the surrounding structures such as the windpipe, foodpipe, and large blood vessels in the neck
  • Injury to the nerves supplying the voice box, which may result in a permanently hoarse voice and / or a deepening of the tone of the voice
  • Injury to glands which secrete calcium which are attached to the thyroid gland; this may result in low calcium levels requiring calcium supplementation

FAQs about Thyroid in Singapore

An endocrinologist primarily manages thyroid hormone disorders medically, while an ENT thyroid surgeon is involved when there is a need for surgical assessment or removal of part or all of the thyroid gland.

No. Most thyroid nodules are benign. However, further tests such as an ultrasound and FNA biopsy help determine whether further action is needed.

This depends on how much of the thyroid gland is removed. Some individuals may require long-term thyroid hormone replacement therapy, especially after a total thyroidectomy.

Recovery time varies, but most individuals return to normal activities within 1–2 weeks. Full healing of the surgical site may take several weeks.

Pain is usually mild and well-managed with oral medications. Most patients are discharged within a day or two post-surgery.

Most thyroid nodules do not disappear completely on their own. Some cystic nodules may shrink over time, but most require observation with follow-up scans. Regular monitoring at an ENT clinic helps track changes.

You should consider a medical review if you notice a lump in your neck, develop hoarseness, or have difficulty swallowing. Persistent throat symptoms may also warrant consultation with a throat specialist in Singapore.

Thyroid nodules may be assessed by an endocrinologist or an ENT surgeon. If surgery is needed, an ENT surgeon with a specialisation in throat surgery can perform procedures such as hemithyroidectomy or total thyroidectomy. Children with thyroid conditions may be seen by a paediatric ENT surgeon.

Table Of Content
Conditions We Treat
  • Thyroid nodules 
  • Cancer of the Thyroid
  • Salivary Gland lumps
  • Salivary Gland and/or Salivary Duct Stones
  • Enlarged Cervical Lymph Nodes
  • Cancers of the Head and Neck Region
  • Nasopharyngeal Cancer (NPC)
  • Lesions in the Mouth & Oral Cavity
Our Treatments
  • Hemi / Total Thyroidectomy
  • Salivary gland removal (submandibular / parotid gland)
  • Removal of salivary duct stones
  • Excision of Cervical Lymph Nodes
  • Excision of Mouth & Oral Cavity Lesions

Thyroid Specialist / Thyroid Surgeon in Singapore

If you are experiencing symptoms of thyroid nodules, consider consulting an ENT thyroid doctor for evaluation.
Dr Leslie Koh sees patients at Mount Alvernia Hospital.

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