thyroid troubles
The thyroid gland - also known simply as the thyroid - is an endocrine gland found in the neck near where the Adam’s apple would be located in men. Aside from controlling how quickly the body uses energy and makes protein, the thyroid is also responsible for controlling how sensitive the body is to other hormones.

Should one feel a lump in the neck around the thyroid region, there is no need for alarm. The commonest cause for a lump in the neck is an enlarged lymph node, a condition which may be caused by the common cold or any other infection of the throat. If the lump persists or enlarges over the next few weeks, however, you should see a doctor. This is especially true if the mass moves up upon swallowing: a distinctive sign that the lump may be a thyroid mass.

There are several possible causes of a thyroid mass, but the most common is the result of specific lumps forming within the thyroid. Lumps can be solitary solid nodules, multinodular goitres (which often feel as if it were just one lump due to the prominence of the most dominant nodule) or thyroid cysts. Thankfully, most thyroid nodules are benign, but it can be a clinical challenge for doctors to separate the lumps with malignant risk from those that are benign.
Doctors can often use several pieces of clinical information to determine if a lump is malignant or benign. If the mass has grown rapidly over the past few weeks, if the nodule is starting to exert pressure on the rest of the neck (especially on the vocal cords), if the lump appears fixed with respect to the neck structure or if the patient has a family history of thyroid cancer, there is a higher chance that the lump may be malignant.
In order to confirm if the lump is malignant, the doctor will typically order an ultrasound to further study if there is microcalcification within the lump or if the lump has irregular margins: both of which are further associated with malignancy. In addition, if the doctor thinks it necessary, he/she may also order something known as a fine needle test: a biopsy that uses an extremely thin needle to draw out a small sample of the lump for further study under a microscope. This will provide the doctor with additional information and allow him/her to determine if the lump is benign or malignant.
If the thyroid lump has been determined to be benign, it need not be operated upon and removed unless it is causing problems with swallowing, breathing or vocal changes. However, it is still a good idea for the patient to continue watching for any further changes within the thyroid mass, and to follow-up with the doctor if it starts growing again or exhibiting other changes.
If the thyroid nodules are determined to be malignant, surgical removal is the cornerstone treatment. Adjuvant treatment will included radio-iodine and hormonal therapy. The good news is that the majority of thyroid cancers have excellent outcomes with survivor data at more then 90 percent over more then 20 years. Thus, one should not delay the treatment if malignancy is suspected.
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