Global Health Asia-Pacific Issue 1 | 2023 GHT64B | Page 10

You Ask , They Answer

Q

: What are thyroid nodules and which risks are associated with them ?

A

: A thyroid nodule is an abnormal growth of cells in the thyroid gland , a butterfly shaped gland in the lower front of the neck . Most thyroid nodules are not cancerous ( benign ). They can be solid , cystic ( fluid collection ), or mixed solid-cystic .
Thyroid nodules are more common in women than in men ( ratio of 4 to 1 ). There may be a single nodule or more than one nodule called a multinodular goitre . The frequency of thyroid nodules increases with age , with 50 percent of people having at least one thyroid nodule by the age of 60 .
Thyroid nodules may be associated with hyperthyroidism ( high thyroid hormone levels ) or hypothyroidism ( low thyroid hormone levels ), but the majority of people with thyroid nodules have normal thyroid hormone levels .

Q

: How can people spot them and when should they see a doctor for a potential thyroid nodule ?

A

: Symptoms of hyperthyroidism include palpitations , loss of weight , and increased appetite . People can also feel tired , hot and sweaty , have difficulty falling asleep , and / or wake up often . Some experience hand tremors , while women have light and / or irregular periods . Other symptoms include muscle weakness or pain , shortness of breath on exertion , and a hot temper , anxiety , agitation , and mood swings . Symptoms of hypothyroidism include tiredness , weight gain , constipation , and feeling bloated or cold . People can also have dry , coarse skin and brittle hair and increased hair loss . Poor memory and slowness of thought are other symptoms , as are heavy periods and / or shorter menstrual cycles . Muscle aches , weakness , and cramps , as well as depression , are also possible .
Thyroid nodules often do not cause any symptoms , and many do not realise they have them . Sometimes they are found on palpation of the thyroid gland by a doctor or on an ultrasound scan of the thyroid when patients show symptoms of high or low thyroid hormones . Thyroid nodules are often detected incidentally either by examination of the thyroid gland or during imaging of the neck or chest with an ultrasound or CT scan for entirely different conditions . If the thyroid nodule is large enough , a lump in the lower part of the neck may be noticeable . Some nodules grow large enough to cause a hoarse voice or problems with swallowing or breathing . As around five percent of thyroid nodules are malignant , they need to be evaluated by ultrasound to determine the risk of malignancy .

Q

: Can thyroid nodules resolve on their own or do they always require treatment ?

A

: Sometimes small thyroid nodules , especially those that are cystic , may slowly decrease in size or disappear . Thyroid nodules that are due to iodine deficiency may slowly disappear when salt is iodinated .
People with low-risk thyroid nodules and normal thyroid hormone levels do not need any treatment but need followup with an ultrasound of their thyroid glands and thyroid hormone measurement . If the thyroid nodules are large enough to cause trouble swallowing or breathing , are cancerous or have a high suspicion of cancer , then treatment may include partial or total thyroidectomy either by open surgery or keyhole surgery ( no scar in the neck ), following current clinical practice guidelines .
In summary , although most thyroid nodules are noncancerous and do not cause any symptoms , please see a doctor if you notice a lump in your neck . Thyroid nodules should be evaluated for risk of cancer .
Dr Leslie Charles Lai Chin Loy
Dr Leslie Charles Lai Chin Loy is an endocrinology specialist at Gleneagles Hospital Kuala Lumpur .
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