If you’ve been diagnosed with a thyroid nodule or are experiencing symptoms such as a neck lump, swallowing discomfort, or voice changes, seeing the right thyroid specialist in Singapore is essential for accurate diagnosis and safe management.
Dr Leslie Koh provides comprehensive evaluation and treatment of thyroid nodules as an ENT thyroid specialist, combining medical expertise in head and neck conditions with a patient-centred, evidence-based approach.
Thyroid Conditions We Treat
Thyroid disorders can affect hormone balance, metabolism, voice, swallowing, and overall well-being. As an ENT thyroid specialist in Singapore, Dr Leslie Koh provides comprehensive assessment and management of a wide range of thyroid conditions, with particular expertise in thyroid nodules and conditions affecting the neck and throat.
Thyroid Nodules
Thyroid nodules are abnormal growths within the thyroid gland and are one of the most common reasons for referral to a thyroid specialist in Singapore. While most nodules are benign, specialist evaluation is essential to assess cancer risk, symptom impact, and the need for monitoring or intervention.
Hyperthyroidism
Hyperthyroidism occurs when the thyroid gland produces excessive thyroid hormones, leading to symptoms such as palpitations, weight loss, heat intolerance, and anxiety. Evaluation focuses on identifying the underlying cause and assessing whether the condition may be contributing to thyroid enlargement or nodules.
Hypothyroidism
Hypothyroidism is characterised by insufficient thyroid hormone production, which may cause fatigue, weight gain, cold intolerance, and cognitive slowing. Thyroid function tests and imaging are used to assess gland structure and function, especially when nodules are present.
Thyroid Cancer
Thyroid cancer refers to malignant growth within the thyroid tissue and includes types such as papillary, follicular, medullary, and anaplastic thyroid cancer. Early diagnosis and appropriate referral for specialist-led management are critical. ENT thyroid specialists play an important role in the surgical treatment of selected thyroid cancers involving the neck.
Thyroiditis
Thyroiditis involves inflammation of the thyroid gland and may result from autoimmune conditions, infections, or other inflammatory processes. Symptoms can vary depending on the stage of inflammation and may overlap with hyperthyroidism or hypothyroidism.
Autoimmune Thyroid Disorders
Autoimmune thyroid conditions such as Graves’ disease and Hashimoto’s thyroiditis occur when the immune system mistakenly targets thyroid tissue. These conditions may cause thyroid enlargement, nodules, or hormonal imbalance, requiring careful specialist evaluation and long-term follow-up.
Common Thyroid Disorder Symptoms
Thyroid disorders may present with a wide range of symptoms depending on whether the thyroid gland is overactive, underactive, inflamed, or structurally abnormal. Because these symptoms often overlap with throat, voice, or neck concerns, assessment by a qualified thyroid specialist in Singapore is important for accurate diagnosis and appropriate management.
Unexplained Weight Changes
Unexpected weight loss may be associated with hyperthyroidism, while unexplained weight gain despite unchanged diet and activity levels may suggest hypothyroidism. These changes often occur gradually and may be overlooked without specialist evaluation.
Changes in Energy Levels
Persistent fatigue, weakness, or reduced stamina may be linked to an underactive thyroid. Conversely, restlessness, nervous energy, or difficulty sleeping can occur when the thyroid gland is overactive.
Sensitivity to Temperature
Increased sensitivity to cold environments may be associated with hypothyroidism, while heat intolerance, excessive sweating, or feeling unusually warm may be seen in hyperthyroidism.
Neck Swelling, Lumps, or Discomfort
Structural thyroid conditions such as nodules or goitre may cause visible swelling in the lower neck, a sensation of pressure, or discomfort when swallowing. In some cases, patients may notice voice changes or a feeling of tightness in the throat, which warrants assessment by an ENT thyroid specialist.
Heart Rate or Palpitation Changes
Thyroid hormone imbalance can affect heart rhythm. Palpitations or a racing heartbeat may occur in hyperthyroidism, while a slower-than-usual heart rate can be seen in hypothyroidism.
Mood, Concentration, and Cognitive Changes
Thyroid dysfunction may affect mental wellbeing. Symptoms can include anxiety, irritability, or nervousness in hyperthyroidism, and low mood, poor concentration, or cognitive slowing in hypothyroidism.
Menstrual or Hormonal Changes
In women, thyroid disorders may contribute to menstrual irregularities, changes in flow, or fertility-related concerns. These symptoms often coexist with other systemic or neck-related signs.
What is a Thyroid Nodule?
Thyroid nodules are abnormal growths or lumps that develop within the thyroid gland, a butterfly-shaped gland located at the base of the neck. These nodules are common and may be:
- Solid or fluid-filled
- Single or multiple
- Small and asymptomatic, or large enough to cause pressure symptoms
While most thyroid nodules are benign, a small percentage may be associated with thyroid cancer. Proper evaluation by a thyroid specialist in Singapore is therefore crucial.
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
Iodine deficiency (rare in Singapore)
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.
Autoimmune thyroid disease (Hashimoto’s, Graves’)
Inflammation of the thyroid caused by autoimmune conditions may result in nodules forming over time.
Thyroid cysts or goitres
Fluid-filled cysts or long-standing goitres (enlarged thyroid glands) can develop nodular changes.
Risk Factors
Family history of thyroid disease
Having close relatives with thyroid nodules, goitre, or thyroid cancer increases the likelihood of developing nodules.
Female gender
Thyroid nodules are more commonly detected in women than in men.
Ageing
The chance of developing nodules rises with age, even if they remain symptomless.
Past radiation exposure
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.
Physical Examination & Patient History
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.
Blood Tests
- 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.
Imaging Studies
- 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).
Fine Needle Aspiration (FNA) Biopsy
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.
What Complications Can Thyroid Nodules Cause?
Most nodules are harmless, but possible complications include:
Difficulty swallowing or breathing (if large)
Large nodules may press on the windpipe or oesophagus, causing discomfort, trouble swallowing, or a sensation of tightness in the neck.
Overactive thyroid (hyperthyroidism)
Some nodules produce excess thyroid hormone, which may lead to symptoms such as rapid heartbeat, weight changes, or heat intolerance.
Rarely, thyroid cancer
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.
Observation / Monitoring
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.
Medications
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.
Radioactive Iodine Therapy
In overactive nodules, radioactive iodine may be used to shrink the nodules and reduce hormone production.
Ablation Therapy
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
- 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
Meet Dr Leslie Koh
ENT Thyroid Specialist
Dr Leslie Koh is an ENT thyroid specialist whose clinical practice includes the evaluation and management of thyroid conditions, including thyroid nodules. He works with patients who require assessment of neck lumps, thyroid-related symptoms, and conditions affecting the airway, voice, or swallowing.
As a thyroid specialist in Singapore, Dr Koh manages thyroid conditions from an otolaryngology perspective, with attention to anatomical, functional, and surgical considerations where indicated.
Clinical Background and Practice
- Medical training and specialist accreditation in otolaryngology
- Experience in hospital-based ENT and thyroid-related clinical practice
- Assessment and management of thyroid nodules, neck masses, and related ENT conditions
- Ongoing participation in professional development within Singapore’s medical community
Approach to Thyroid Care
Dr Koh’s approach to thyroid evaluation focuses on structured assessment and clear communication.
- Careful clinical examination of the neck and thyroid region
- Use of appropriate investigations to guide discussion and decision-making
- Clear explanation of findings, options, and possible next steps
- Consideration of observation, further testing, or surgical referral based on individual clinical findings
Patients seeking care for ENT thyroid conditions are assessed based on symptoms, examination results, and diagnostic findings, with management discussed in a measured and patient-centred manner.
FAQs about Thyroid in Singapore
1. Which doctor should I see for thyroid nodules?
A thyroid specialist in Singapore, particularly an ENT thyroid specialist practising at an ENT clinic in Singapore, is well-equipped to assess both the medical and surgical aspects of thyroid nodules. This includes evaluating structural changes in the neck, potential effects on swallowing or voice, and determining whether monitoring or further intervention is required.
2. Are all thyroid nodules cancerous?
No. Most thyroid nodules are benign. However, further tests such as an ultrasound and FNA biopsy help determine whether further action is needed.
3. Will I need to take medication after thyroid surgery?
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.
4. How long is the recovery after thyroid surgery?
Recovery time varies, but most individuals return to normal activities within 1–2 weeks. Full healing of the surgical site may take several weeks.
5. How much does thyroid surgery cost in Singapore (Private vs. Public)?
The cost of thyroid surgery in Singapore varies significantly based on whether you are a subsidised patient in a public hospital or a private patient.
Estimated Total Bill (Surgeon, Anaesthetist, & Hospital Fees)
- Public Hospital (Subsidised): Typical Bill Range SGD $2,200 – $5,800
- Public Hospital (Unsubsidised): Typical Bill Range SGD $8,500 – $15,000
- Private Hospital: Typical Bill Range SGD $25,000 – $40,000+
6. Can thyroid nodules go away on their own?
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.
7. When should I see a thyroid doctor in Singapore?
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.
8. Will I lose my voice after ENT thyroid surgery?
The fear of “losing your voice” is common because the recurrent laryngeal nerves (which control the vocal cords) sit directly behind the thyroid gland. However, total voice loss is extremely rare.
- Thyroid Conditions We Treat
- Common Thyroid Disorder Symptoms
- What is a Thyroid Nodule?
- What are the symptoms of Thyroid Nodules?
- What Causes Thyroid Nodules and Who Is at Risk?
- How are Thyroid Nodules diagnosed in Singapore?
- Possible FNA Results
- What Complications Can Thyroid Nodules Cause?
- What Are the Treatment Options for Thyroid Nodules?
- What Are Some Risks Of Thyroid Surgery?
- FAQs about Thyroid in Singapore