WHAT'S THAT LUMP ON MY NECK?
 
 
Thyroid lumps are mostly not cancerous, but need careful monitoring once they are detected.

The thyroid is a butterfly-shaped gland found on the lower part of the neck, where the Adam's Apple is located for men. It produces key hormones that regulate metabolic rate, heart function, digestion, muscle control, and brain and bone development.

Sometimes, lumps or nodules form, although experts don't know the exact cause. What is known is that people who have been exposed to radiation - either through the environment or from radiation treatment to the head, neck and chest - are more likely to develop thyroid lumps. They are also more common in those who have other thyroid conditions, or have a family history of them, and with age.

There is no need to be alarmed if you feel a lump around the thyroid region. The most common cause of it is an enlarged lymph node, which can be caused by the common cold or any other throat infection. But if the lump persists or grows larger over the next few weeks, you should see a doctor. This is especially true if the mass moves up upon swallowing - this is a distinctive sign that the lump may be a thyroid mass. There are several possible causes of a thyroid mass, the most common being the existence of separate small lumps creating the appearance of one large mass. It often feels like one, when it is actually a cluster of nodules with one dominant one.

Although thyroid nodules don't usually affect the functioning of the thyroid gland, they can sometimes cause hyperthyroidism, where the nodules cause too much hormone production. They can also cause breathing and swallowing difficulties, when large nodules press against the windpipe, voice box or oesophagus. The first is treated with medication, and the second with surgery.

Malignant or benign?

There are three kinds of nodules, namely, solid nodules, cystic nodules (filled with fluid) and partially cystic nodules. A patient can have one or a combination of these.

It can be a clinical challenge for doctors to separate lumps with malignant risk from those that are benign. There is a higher chance that the lump may be malignant if one or more of the following signs are present:
  • the mass has grown rapidly over the past few weeks;
  • the nodule is starting to put pressure on the rest of the neck, especially the vocal chords;
  • the lump appears fixed with respect to the rest of the neck structure;
  • the patient has a family history of thyroid cancer
To confirm malignancy, the typical regimen is an ultrasound and further testing to establish if there is microcalcification within the lump or if the lump has irregular margins. Both of these are associated with malignancy. If necessary, a fine needle test may be ordered. This is a biopsy using a very fine needle to extract a small tissue sample for further testing.

Generally, thyroid nodules are not cancerous, and are often overlooked because they are small. Many people have them but never discover or treat them. Early testing is critical, especially because it is estimated that about five out of 100 thyroid nodules are cancerous. If left untreated, the cancer can spread to the surrounding structures. But the good news is that early diagnosis and treatment almost always result in good outcomes.

A/PROF LUKE K S TAN
Ear Nose & Throat Surgeon

MBBS FRCS (England) MMEDS ci FAMS (ORL)
Head & Neck Surgery (Texas, USA)
Luke Tan ENT - Head & Neck Cancer and
Thyroid Surgery Centre
3 Mount Elizabeth #14-17 Mount Elizabeth Medical Centre. Tel: 6474 6116
www.thyroidsurgery.com.sg