Thyroid Nodules

Thyroid nodules are solid or fluid-filled lumps that form within the thyroid gland, located at the base of the neck. These growths are common and occur when thyroid tissue cells multiply, forming a lump. Most thyroid nodules are benign and do not cause symptoms; however, some may produce excess thyroid hormones or, rarely, contain cancerous cells. Thyroid nodules can vary in size, and while many are too small to feel, larger ones may create a visible swelling in the neck or lead to difficulties with swallowing or breathing.

Dr Donovan Tay

Senior Consultant Endocrinologist

Dr Ben Ng

Senior Consultant Endocrinologist

Symptoms of Thyroid Nodules

Thyroid nodules may present with various symptoms depending on their size, location, and whether they affect hormone production. The following signs may indicate the presence of thyroid nodules:

Visible Neck Swelling

A noticeable lump in the neck that can be seen or felt. The swelling may be more apparent when swallowing or when the neck is extended.

Difficulty Swallowing

Pressure from larger nodules on the oesophagus. The sensation may feel like food is stuck in the throat or create discomfort during meals.

Hoarseness or Voice Changes

Pressure from nodules on the voice box or laryngeal nerves. The voice may sound raspy, weak, or show unexpected changes in pitch or quality.

Pain in the Neck

Discomfort or tenderness in the area of the thyroid gland. The pain may radiate to the jaw or ears in some cases.

Breathing Difficulties

Compression of the trachea by larger nodules. This may cause shortness of breath, particularly when lying down or during physical activity.

Hyperthyroidism Symptoms

Rapid heartbeat, unexplained weight loss, increased appetite, and nervousness due to overactive nodules. These symptoms occur when nodules produce excess thyroid hormones.

Hypothyroidism Symptoms

Fatigue, weight gain, cold sensitivity, dry skin, and hair loss from underactive nodules. These symptoms are less common but may develop if nodules interfere with normal thyroid function.

Causes and Risk Factors

The development of thyroid nodules stems from various factors, with certain individuals facing higher risks than others.

Thyroiditis

Inflammation of the thyroid gland resulting in tissue damage and nodule development. Autoimmune conditions like Hashimoto’s thyroiditis increase the likelihood of nodule formation.
Genetic Factors

Inherited genetic mutations that affect thyroid cell growth and division. A family history of thyroid nodules or thyroid cancer increases the risk by two to four times.
Age and Gender

Women are four times more likely to develop thyroid nodules than men, with risk increasing after age 60.
Pregnancy

Hormonal changes during pregnancy affect thyroid function and growth. The increased production of human chorionic gonadotropin during pregnancy may stimulate thyroid tissue growth.
Existing Thyroid Conditions

Other thyroid disorders, such as Graves’ disease, create an environment conducive to nodule formation. The presence of one nodule increases the likelihood of developing additional nodules.
Iodine Deficiency

Insufficient dietary iodine intake leading to thyroid enlargement and nodule formation. This is a rare condition in Singapore and the surrounding region.
Radiation Exposure

Previous radiation treatments to the head, neck, or chest area. Medical radiation treatments for conditions like acne or enlarged tonsils, especially during childhood, may increase risk.

Diagnostic Methods

Physical Examination

This involves the manual palpation of the thyroid gland to detect any abnormal growths. This initial assessment helps determine the size, consistency, and mobility of the nodule, as well as any associated lymph node enlargement.

Thyroid Function Tests

Blood tests measuring levels of thyroid hormones (T3, T4) and thyroid-stimulating hormone (TSH). These tests determine whether the nodule affects hormone production and overall thyroid function.

Ultrasound

This non-invasive imaging uses sound waves to visualise the thyroid gland and characterise nodules. Ultrasound reveals the size, number, composition (solid, cystic, or mixed), and features that may suggest malignancy, such as irregular margins or microcalcifications.

Fine Needle Aspiration (FNA) Biopsy

This procedure collects cells from the nodule for microscopic examination. A thin needle is inserted into the nodule, often guided by ultrasound, to extract cells that are then analysed for signs of cancer.

Thyroid Uptake Scan

This nuclear medicine test uses radioactive iodine or technetium to evaluate nodule function. This scan identifies whether nodules are functioning (hot) or non-functioning (cold), with cold nodules requiring further evaluation for malignancy.

Treatment Options

The management of thyroid nodules follows an individualised approach based on nodule characteristics, test results, and patient factors. Treatment aims to address symptoms, manage hormone abnormalities, and rule out malignancy.

Monitoring

This involves regular monitoring of stable, benign nodules with periodic ultrasound examinations. This approach is suitable for nodules with benign FNA results, no compressive symptoms, and normal thyroid function.
Levothyroxine Therapy

Administration of synthetic thyroid hormone to potentially shrink nodules in select cases. This treatment may be considered for smaller nodules in areas with iodine deficiency but has limited effectiveness and is less commonly recommended now.
Radioactive Iodine Therapy

Oral administration of radioiodine to treat hyperfunctioning (hot) nodules. The radioactive iodine is selectively absorbed by overactive thyroid cells, reducing their hormone production and often shrinking the nodule.

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Prevention and Management

Regular health check-ups allow for early detection of thyroid nodules, particularly for individuals with risk factors. Maintaining adequate iodine intake through a balanced diet helps support normal thyroid function. For existing nodules, adhering to follow-up appointments enables monitoring of any changes in size or characteristics. Addressing underlying thyroid conditions can help manage associated symptoms and reduce complications. Individuals with thyroid nodules can generally maintain normal activities, though some may need to modify neck movements or clothing choices for comfort.

Frequently Asked Questions

Can thyroid nodules resolve without treatment?

Some fluid-filled (cystic) nodules may shrink or resolve spontaneously, particularly after drainage or aspiration. Solid nodules rarely disappear but often remain stable in size for years.

How often should thyroid nodules be monitored?

Benign nodules typically require follow-up ultrasounds every 6-12 months initially, then every 1-2 years if stable. The schedule varies based on nodule characteristics.

Are there dietary changes that help manage thyroid nodules?

No specific diet has been proven to shrink nodules. However, adequate iodine intake supports overall thyroid health, while excessive iodine may worsen some conditions.

Dr Ben Ng

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr Ben Ng provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, obesity, and a range of other metabolic and endocrine conditions.

Adj Asst Professor Dr Ben Ng Jen Min graduated from the Queens University of Belfast Northern Ireland, United Kingdom (UK).
He completed his postgraduate training with the certificate of completion of training (CCT) from the Royal College of Physicians (UK) with dual accreditation in diabetes and endocrinology and in general internal medicine.
In 2010, he was awarded an MD with honours by the University of Hull, UK, in recognition for his research in diabetes mellitus

Dr Donovan Tay

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr. Donovan Tay provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, osteoporosis, and a range of other metabolic and endocrine conditions.

Dr. Donovan Tay graduated from the National University of Singapore (NUS) and obtained his membership in the Royal College of Physicians (UK), Master of Medicine (NUS), and Master of Clinical Investigation (NUS).
After completing training in endocrinology, he was conferred as a Fellow of the Academy of Medicine, Singapore (FAMS).
He further specialised in endocrinology with a fellowship at the prestigious Columbia University Medical Centre in New York City.

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