Thyroid Nodules: Health Facts to be Aware

Thyroid nodules can be identified as either solid or fluid filled lumps. These are small glands which are located at the base of the neck. Generally, most of the thyroid nodules are benign and cause no serious symptoms, however, on rare occasions it can turn out to be cancerous.

Thyroid nodules may not always be visible. It is usually discovered during a routine medical examination or uncovered during a scan done for another reason. However, some thyroid nodules are  large enough to make it visible and this will impact breathing or swallowing. 

The ENT Clinic has experienced ear, nose and throat doctors and the latest technology to review your thyroid nodules  and evaluate its status for malignancy. The practice treats both adult and pediatric thyroid conditions in multiple Singapore locations.

What are the symptoms of having a thyroid nodule?

Larger thyroid nodules can be:

  • Felt
  • Visible as a swelling below the neck
  • Cause difficulty in swallowing causing shortness of breath

The presence of thyroid nodules may also cause more production of the thyroid hormone, thyroxine. The extra thyroxine can lead to hyperthyroidism causing:

  •  Unexplained loss of weight
  •  Irregular heartbeat
  • Anxiety and nervousness
  • Tremors
  •  More sweating

Only a very small number of thyroid nodules are cancer causing. However, it is important to evaluate which nodules have malignancy. This cannot be evaluated through symptoms alone. Cancerous thyroid nodules are rarely aggressive causing rapid growth. They are mostly slow growing when discovered by a doctor.

When should you see a doctor for thyroid nodules?

Although most of the thyroid nodules are benign, it is important that there is timely evaluation to see if the thyroid nodules are cancerous or not. Thus, if you have an unusual swelling on the neck, it is important to consult an ENT doctor.

The following are some signs of hyperthyroidism:

  • Weight loss through normal appetite
  •  Trouble sleeping
  • A pounding heart
  •  Irritability

Additionally, the below signs and symptoms should also be considered:

  • Constipation
  • Dry skin
  • Feeling cold
  •  Memory problems
  • Fatigue

What is a thyroid biopsy?

A thyroid nodule biopsy is the only way to diagnose if a nodule is cancerous. It involves removing a sample of cells from the nodule and examining them in a laboratory. This helps your doctor determine if the nodule is benign or malignant. If you experience a lump in your thyroid gland, it is referred to as a nodule. Nodules in the thyroid are quite common, and often not a cause for concern. Your doctor will likely suggest a biopsy to investigate the nodule more closely.

When do you need to do a thyroid nodule biopsy?

Imaging tests can help your doctor identify a thyroid nodule, but it can’t tell if the nodule is cancerous. Whether or not you need a biopsy depends on the size of the nodule and your risk of thyroid cancer.

Best candidates for a thyroid nodule to go in for a nodule biopsy include:

  • If you have a nodule larger than 1 centimeter (cm) and a moderate to high risk
  • A nodule larger than 1.5 cm and a low risk
  • A nodule larger than 2 cm and a very low risk

Your risk is determined by analyzing the imaging test results and looking for certain features.

What are the different types of thyroid biopsies?

Different types of thyroid biopsies exist, all of which are accurate, though some may pose greater risks than others.

Fine Needle Aspiration

Fine-needle aspiration is a commonly used thyroid biopsy procedure due to its low rate of side effects. It has been found to be accurate in diagnosis approximately 95% of the time. In the procedure, a thin needle is inserted into the nodule, which extracts some of the contents for testing and analysis.

Core needle biopsy

If fine-needle aspiration doesn’t provide enough information, your physician may suggest a core needle biopsy. This procedure is similar, but uses a larger needle. The accuracy rate is the same as that of fine-needle aspiration, but with the bigger needle comes a higher risk of causing injury to the trachea and carotid artery, which is why the former is chosen more often.

Surgical Biopsy

Surgical biopsy is a rarely used procedure that involves making an incision into a nodule and taking out a sample of tissue for examination.

The value of gene expression classifiers to identify cancerous thyroid cells

Molecular markers can be used to identify cancerous or benign nodules in thyroid biopsy specimens. The Gene Expression Classifier is a test that assesses a group of molecular markers to help determine whether a thyroid nodule is cancerous or benign.

When a nodule is found, a physician looks at certain features of it to decide how to treat it. Sadly, many patients receive inconclusive results from cytopathology and end up having to have a thyroidectomy. However, with the Gene Expression Classifier (GEC) up to 80% of those patients can avoid this surgery. This comprehensive solution not only includes initial thyroid-specialized cytopathology, but also molecular testing to help with preoperative decisions in those that do need surgery.

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