I often encounter friends and patients who tell me that they have “thyroid”, as if their thyroid gland is a disease or a problem. The fact is, everybody has a thyroid gland.
Your thyroid gland is a butterfly-shaped gland that sits in front of the windpipe. Its function is to produce thyroid hormones that regulate your metabolism (how your body uses energy).
Most people have a perfectly normal thyroid gland. You don’t have to do anything at all if your thyroid gland is healthy!
There's a right and left thyroid gland that's joined in the centre by the thyroid isthmus.
However, some people do have thyroid gland problems, which generally fall into 2 categories:
- Issues with the amount of thyroid hormone produced
- Thyroid nodules (growth or lumps on the thyroid gland)
1. Who should you see if you suspect that you've got a thyroid problem?
If you've got a problem with too much or too few thyroid hormones, you should see a family physician or endocrinologist (a specialist in managing hormonal problems).
Here are some symptoms you may experience if your body makes too much or too little thyroid hormones. Too much thyroid hormones (hyperthyroidism):
- Hand tremors
- Weight loss
- Palpitation (feeling your heart beating)
- Increased sensitivity to heat
Too few thyroid hormones (hypothyroidism):
- Weight gain
- Dry skin
- Slowed heart rate
- Poor memory and concentration
- Increased sensitivity to cold
The level of your thyroid hormones can be determined by a simple blood test (called the thyroid function test).
If you've got a problem with a thyroid lump/nodule, you should see a surgeon trained in head and neck surgery. This can be an ENT specialist, or a general surgeon with head and neck surgical training.
Sometimes both problems can co-exist - i.e. you have a thyroid nodule AND a problem with regulating your thyroid hormone levels. In such cases, both an endocrinologist and a head and neck surgeon should be involved.
2. How worried should you be if you have a lump in your neck?
Visible or palpable (can be felt with your hands) thyroid lumps are present in up to 8% of women and 2% of men.
Clinically undetectable thyroid lumps (ie not visible or palpable) are far more common, and can occur in up to 30% of adult women. These are usually picked up incidentally on an ultrasound scan, or radiological imaging done for other reasons.
A thyroid nodule at the left side of the neck.
Fortunately, over 90% of the time, thyroid lumps are benign (non-cancerous).
However, anyone with a visible/palpable thyroid lump or a thyroid lump found on ultrasound scan/imaging should consult an ENT Specialist or a Head & Neck Surgeon for further assessment.
Features of concern include if the lump is more than 1.5 cm, or if you have other suspicious features for cancer, such as weight loss.
3. What should you expect when you visit an ENT for thyroid lumps?
All consults typically begin with a complete medical history. Important parts of your clinical history include:
- Duration of the lump
- Symptoms from the lump (eg. pain, discomfort, concern on its appearance)
- Change in size of the lump
- Compressive symptoms (eg. difficulty in swallowing or hoarse voice)
- Risk factors for thyroid cancer (eg. family history of thyroid cancer and previous exposure to radiation)
- Symptoms of too much or too little thyroid hormone
After asking the necessary questions, I'll perform a complete head and neck examination, which may include the passage of a flexible nasoendoscope (a small lighted tube which is attached to a camera system) into your nose, down to the level of the voice box.
This is a simple and relatively painless procedure that's performed in the clinic under local anaesthesia. It's usually done if there's a change in your voice, or if you're otherwise considering thyroid surgery.
The purpose of a nasoendoscopy is to assess the function of the vocal cords (also known as the voice box), which may be affected by thyroid nodules.
4. What investigations are necessary if you've got a thyroid lump?
Most patients will require these 3 investigations:
- Thyroid function test
- This is a blood test to determine the level of your thyroid hormone
- The 2 hormones measured are T4 (Thyroxine) and TSH (Thyroid Stimulating Hormone)
- An ultrasound of the thyroid gland
- An ultrasound probe will be applied firmly but gently on your neck to assess your thyroid gland
- The purpose is to detect the number and size of the thyroid nodules, and to look for any suspicious features for cancer
- Fine needle and aspiration and cytology (FNAC) of the thyroid lump
- A small needle will be inserted into the thyroid lump to extract some cells for testing
- The extracted cells will be analyzed in a laboratory by a trained doctor to determine if the lump is cancerous or not
- FNAC is a well-tolerated procedure, and the pain is no more than that experienced during a blood test
5. Do you need surgery if you've got a thyroid lump?
Whether you need to undergo surgery or not depends primarily on the nature and size of the lump.
I often tell patients that the reasons to remove half or the whole thyroid gland can be simplified down to the 4 “C”s:
- Cancer, or suspected cancer
- Compression (large thyroid lump pressing on nearby structures, such as the windpipe or foodpipe)
- Control of hormones (in patients with persistently high level of thyroid hormone despite taking antithyroid medications, surgical removal of the thyroid gland is a treatment option to control overproduction of thyroid hormones)
- Cosmesis (sometimes the thyroid lump is not cancerous, but patients may want it removed as it may be unsightly)
It's best to consult your ENT specialist or head and neck surgeon, and discuss the pros and cons of having your thyroid gland removed if you have one of the four “C”s mentioned above.
I hope this post helps you to make sense of the next time someone in Singapore tells you that they've got "thyroid"!
Dr Gan Eng Cern is an ENT Specialist at Mount Elizabeth Novena Specialist Centre (A Specialist Centre for Sinus, Snoring & ENT), and is also a Senior Clinical Lecturer at the National University of Singapore. He obtained Subspecialty training in Nose and Sinuses, and has a passion for the treatment of snoring and Obstructive Sleep Apnoea (OSA). Dr Eng Cern enjoys jogging regularly to keep his spare tyres under control.