- Thyroid nodules are common growths that develop within the thyroid gland and may be detected through physical examination or imaging performed for related neck or throat symptoms.
- Individuals may be evaluated by a thyroid specialist in Singapore if nodules are associated with compressive symptoms, voice changes, swallowing discomfort, or findings that require further clarification.
- Assessment typically involves clinical examination, imaging, and, where appropriate, tissue sampling to determine the nature of the nodule and guide discussion of management options.
- This page outlines how thyroid nodules are evaluated, when treatment or surgery may be considered, potential risks and considerations, and what recovery generally involves.
- Information is provided to support informed discussions between patients and their doctor, without making assumptions about suitability, outcomes, or treatment decisions.
What is a Thyroid Nodule
Location and Role of the Thyroid Gland
The thyroid is a butterfly-shaped gland located at the front of the neck, below the voice box (larynx). It produces hormones such as thyroxine (T4) and triiodothyronine (T3), which help regulate metabolism, body temperature, and heart rate.
Definition of a Thyroid Nodule
A thyroid nodule is a lump or growth that forms within the thyroid gland. Nodules may be solid or fluid-filled and can vary in size.
How Thyroid Nodules are Commonly Detected
Many thyroid nodules are discovered during routine physical examinations or incidentally on imaging studies performed for unrelated neck or throat concerns.
Symptoms and Hormone Function
Most thyroid nodules do not cause noticeable symptoms and do not affect thyroid hormone levels. Some individuals may remain unaware of their presence without medical evaluation.
Need for Further Assessment
While the majority of thyroid nodules are benign, further evaluation may be recommended to assess thyroid function or exclude less common conditions, including thyroid cancer. Assessment by a thyroid specialist in Singapore helps determine whether observation, further investigation, or treatment is appropriate based on individual clinical findings.
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
Pediatric Otolaryngology, Pediatric ENT Surgeon
Dr Leslie Koh is an ENT thyroid surgeon 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. What is the difference between an ENT thyroid surgeon and an endocrinologist?
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.
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. Is thyroid surgery painful?
Pain is usually mild and well-managed with oral medications. Most patients are discharged within a day or two post-surgery.
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. Which specialist treats thyroid nodules?
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.
- 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
- 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.