Thyroid nodules usually do not cause
symptoms, but some symptoms include:
The exact cause of thyroid nodules is
not known, but the following factors
may be involved:
If you have a lump in the middle of
your neck (below your Adam’s apple)
or just off the centre, which moves with
swallowing, it is probably a thyroid
nodule. Your doctor will be able to
confirm this finding.
The lump you feel may be either a
solitary nodule or a dominant nodule
in a background of multiple nodules, or
even a diffusely enlarged thyroid gland.
Fine needle aspiration cytology
(FNAC) – A minor procedure performed
in the clinic, a fine needle is inserted into
the nodule and cells are withdrawn for
evaluation. You will be able to return
home or to work immediately. The
test aims to determine if your thyroid
nodule is cancerous, but the result is
Ultrasound – Sound waves are used to
form a picture of the thyroid gland. It
allows your doctor to determine if your
thyroid nodule is solid, cystic (fluidfilled)
or mixed, the number of nodules
and also to take measurements to track
the growth of the nodules.
Most importantly, it allows the
doctor to identify features that may
be suggestive of cancer, including
microcalcifications, internal vascularity
and hazy boundaries, possibly from
invasion of surrounding tissue. It may
also be used to help locate nodules and
to guide the needle in FNAC for more
Thyroid scan – A small amount of
radioactive iodine is administered
orally. It is taken up by functioning
thyroid cells, which will show up on a
Functioning nodules are less likely to
be cancerous. Cold nodules or nonfunctioning
nodules require further
evaluation with FNAC.
Thyroid function test – A blood test to
determine the level of thyroid hormone
and thyroid stimulating hormone.
It may be useful if you have hyper
or hypothyroid symptoms or if you
This depends on the nature of the nodule, whether it is benign or malignant and also if it causes symptoms.
Cancer – Surgery is the treatment of choice. Depending on the size of the tumour, either half or the entire thyroid gland may need to be removed. Additional treatment like radio-iodine treatment or radiotherapy may be necessary.
Benign nodules – may be observed if not causing any symptoms. Follow-up of the nodules is usually by ultrasound.
The interval will be decided by your doctor.
Surgery is an option if symptoms are present, including difficulty swallowing or breathing, or even just to remove the unsightly lump.
Indeterminate – if the nature of the nodule is indeterminate on FNAC, your doctor will discuss with you the options of close observation versus surgery. The risk of your nodule being cancerous depends on the exact findings on ultrasound and FNAC.
Thyroid surgery is performed under general anaesthesia. It may be:
Your surgeon will explain to you which operation you require and the reason for it.
Other than the risks that apply to all
surgery including general anaesthesia
risk, risk of bleeding and infection, the
risks specific to thyroidectomy are:
In suitable patients, thyroid surgery
can be performed without using a
neck incision. The surgery may be
endoscopic or robot-assisted. Skin
incisions are located in the axilla or
armpit and are less visible than a neck
scar and easily hidden by clothing.
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