Enlarged Lymph Nodes

What are Thyroid lumps (nodules) ?

The thyroid gland is a butterfly or wing-shaped organ that sits in front of the windpipe (trachea) in the neck (Figure 1). Thyroid nodules are unusual growths, either solid or fluid-filled lumps form within your thyroid. Most of these nodules do not cause symptoms and are usually benign. However, a small percentage of them may be cancerous.

Thyroid lumps (nodules)

The thyroid gland produces thyroid hormones that regulate your body’s metabolism (the way your body uses energy). Thyroid nodules (Figure 2) can occur in any part of the thyroid gland. Up to 8% of women and 2% of men have clinically palpable thyroid nodules (detectable by physical examination – Figure 3). Most people are unaware of thyroid nodules until it becomes large enough to press against your windpipe. With the availability of modern imaging such as ultrasound, MRI and CT scans, thyroid nodules are increasingly detected incidentally. Up to 30% of women may have thyroid nodules detectable by an ultrasound scan.

Thyroid nodules can be split into cold, warm, or hot, depending on the production of thyroid hormones. Cold nodules do not produce thyroid hormones, while warm nodules act as normal thyroid cells. Hot nodules on the other hand, overproduce thyroid hormones.

Causes

There are several conditions that can cause nodules to develop within your thyroid gland and these can include:

• Overgrowth of normal thyroid tissue: Also known as thyroid adenoma, it is unclear why the thyroid tissue becomes enlarged. This condition is usually not serious unless it causes uncomfortable symptoms due to its size.
• Thyroid cyst: Degenerating thyroid adenomas can result in fluid-filled cavities (cysts) developing in the thyroid. While these cysts are usually benign, they may occasionally contain cancerous solid components.
• Inflammation of the thyroid: Hashimoto’s disease is a thyroid disorder that causes long-term inflammation of the thyroid gland, resulting in enlarged nodules.
• Goiter: The enlargement of thyroid gland, also known as goiter, is often caused by iodine deficiency or thyroid disorder. Some goiters have multiple distinct nodules within the goiter itself.
• Thyroid cancer: A large or hard nodule that causes pain or discomfort can be an indication of something more serious. Thus it is recommended that you consult with your doctor or ENT specialist on your condition.

Risk factors

You are more at risk of developing thyroid nodules if you had X-rays performed on your thyroid in your childhood, or have a pre-existing thyroid condition like Hashimoto. People who have a family history of thyroid disorders or nodules may have a higher risk of developing thyroid nodules. Furthermore, thyroid nodules are more common in women as compared to men.

Symptoms

Most thyroid nodules do not have noticeable symptoms, however if the nodule gets large enough, you may experience:

• Pain at the base of your neck
• Difficulty swallowing
• Breathing difficulty
• Hoarse voice

Hyperthyroidism happens in patients with thyroid nodules producing excess thyroid hormones. Thus they may develop hyperthyroidism symptoms such as:

• Irregular and rapid heartbeat
• Unexplained weight loss
• Difficulty sleeping
• Increased nervousness/anxiety

On the other hand, Hashimoto’s thyroiditis patients with thyroid nodules have an underactive thyroid gland – does not produce enough thyroid hormones (hypothyroidism). Thus, they may experience hypothyroidism symptoms such as:

• Persistent fatigue
• Unexplained weight gain
• Constipation
• Increased sensitivity to cold
• >Dry skin and hair

Diagnosis

Some nodules may be big enough to be felt, others may only be discovered during a medical examination. Upon discovering a nodule, your doctor or ENT specialist may order for some tests.

Assessments for thyroid nodules include a full ENT, head & neck history and physical examination, blood tests (to check thyroid hormone level), imaging scan (usually an ultrasound scan) and fine needle aspiration and cytology (FNAC – Figure 4) of the thyroid nodule.

Treatment

Treatment options for thyroid nodules in Singapore are dependent on the size and type of thyroid nodule that you have. If your thyroid nodule is not cancerous, neither is it causing any problems, your doctor or specialist may decide that you do not need treatment. Instead, they will closely monitor your condition and the thyroid nodule by getting you to do regular checks and ultrasounds.

Non-cancerous nodules may require surgery if they become too large and are causing the patient discomforts like difficulty swallowing or breathing. ENT specialists in Singapore may also recommend surgery for people with large multinodular goiters. Nodules diagnosed as suspicious by a biopsy may also require surgical removal.

Doctors in Singapore usually recommend radioactive iodine or thyroid surgery as treatment options for patients with nodules that cause hyperthyroidism. Radioactive iodine is absorbed into the thyroid gland, causing the nodules to shrink. Some doctors in Singapore may also prescribe thyroid-blocking medications as an alternative for thyroid surgery.

Reach out to us if you see or feel a thyroid nodule in the middle of your lower neck, just above your breastbone. Let us help you improve your health and quality of life, make an appointment at our specialist ENT clinic today.

What are Salivary gland lumps ?

The major salivary glands are the parotid, submandibular and sublingual glands (Figure 1). They produce saliva that is important in food digestion, keeping your mouth moist, fighting bacteria and keeping your teeth and gums healthy. Lumps or growths can occur in the salivary glands (Figure 2a and 2b). The likelihood of a lump being benign (non-cancerous) is about 80% in the parotid gland, 50% in the submandibular gland and 20% in the sublingual gland.

Thyroid SpecialistThe investigation of a salivary gland lump includes a fine needle aspiration and cytology (FNAC) or biopsy of the lump as well as an imaging scan (usually a CT scan of the neck with intravenous contrast). Treatment of salivary gland lumps depends on the nature of the lump (benign vs malignant). Most of the time, surgical removal of the salivary gland (either partial or total) will be recommended. As there are important structures close to the salivary gland, you should have an in-depth discussion with your doctor on the risks involved in surgical removal of the salivary glands.

What are Salivary gland and duct stones ?

The chemicals in the saliva can sometimes crystalise to form stones. These stones can block the salivary gland and ducts. Why some people have stones in their salivary gland or ducts is still unknown. Majority of stones occur in the submandibular gland. When stone blocks up the salivary duct system, saliva backs up into the gland. This causes pain and swelling in the gland which is worse during meals. In some cases, the gland can be infected, resulting in fever, pain as well as redness and tenderness over the gland. The assessment for a salivary gland stone involves a thorough clinical history, physical examination and likely an imaging scan (usually a CT scan of the neck region). Treatment of salivary duct or gland stones depends on the size and location of the stone. Small stones ( <5mm) can be observed and may pass out on its own by stimulating production of saliva (e.g. taking sour sweet or food). Larger submandibular stones can be removed either through a small cut in the mouth (Figure 1a-d), by a minimally invasive procedure called sialendoscopy (Figure 2a-c) or by removing the salivary gland.

What are Mouth lesions?

The oral cavity can have many lesions, ranging from ulcers to large growths. It is best to consult a doctor if you have a mouth lesion that you are worried about.

What is a Nose cancer ?

The area behind the nose is called nasopharynx (Figure 1). Cancer in this region is called nasopharyngeal carcinoma (often just called nose cancer). NPC is not so common in the West. It is more common in Southern China, Hong Kong, Vietnam, Singapore and Malaysia. In Singapore, NPC is the 8th most common cancer in men.

Risk factors for NPC include family history of NPC, dietary habit (consumption of preserved and salt-cured fish or meat) and Epstein Barr Virus (EBV) infection. Due to the location of the tumour, majority of the time, patients with early NPC may not have any symptoms. The most common symptom of NPC is a lump in the neck (when the cancer has spread to the lymph node in the neck). Other symptoms include blocked ear (due to fluid collecting in the middle ear – Figure 2), blood-stained nasal discharge or saliva and blocked nose.

Assessment of a patient suspected of NPC includes a clinical history, physical examination and nasoendoscopy. If a growth or mass is found in the nasopharynx (Figure 3), a biopsy (removal of a small sample of tissue for analysis) is performed. If NPC is confirmed, staging investigations (scans of the neck and other parts of the body) will be required to determine the extent of the disease. NPC is treated by radiotherapy with or without chemotherapy, depending on the stage of the disease. An oncologist (a doctor specializing in giving radiation therapy or chemotherapy) will plan the treatment for patients with NPC. Surgery is usually reserved for recurrent cases of NPC.

What are the other head & neck lumps & bumps

The head and neck region can have many different types of lumps and bumps ranging from small benign cyst, fat overgrowth (lipoma), skin lesions that can be benign (non-cancerous) or malignant (cancerous), to large growths like thyroglossal duct cyst, vascular tumours (e.g. carotid body tumour) or nerve tumours (Schwannomas). It is best to consult an ENT Specialist to have these lumps assessed.