Surgical Treatment for Thyroid Nodules: When Is It Necessary?

Thyroid nodules are a common clinical finding, affecting a significant portion of the population worldwide, and Singapore is no exception. With increased health screening, and widespread use of imaging technologies such as ultrasound, and CT scans, more people are being diagnosed with thyroid nodules, often incidentally.

What does it mean if your doctor detects a thyroid nodule — and does it immediately entail surgery? Contrary to common belief, not all nodules require immediate treatment, and determining when surgery is necessary can be complex, and deeply personal.

That being said, it is important to note that some thyroid nodules can grow large enough to cause physical discomfort, affect hormone levels, or more seriously, pose a risk of thyroid cancer. 

What are Thyroid Nodules?

The thyroid is a butterfly-shaped gland located at the front of your neck. It plays a vital role in regulating your body’s metabolism through the production of thyroid hormones. Sometimes, lumps or abnormal growths develop within the thyroid tissue. These are known as thyroid nodules.

Thyroid nodules are relatively common, especially in adults over the age of 40, and in women. Most are discovered during routine physical examinations or imaging tests performed for unrelated conditions. While the majority of nodules are harmless, some may require further investigation or treatment depending on their characteristics.

Meanwhile, a thyroid nodule is a growth or lump that forms within the thyroid gland. It can be:

• A single lump (solitary nodule).
• One of many within an enlarged gland (multinodular goitre).
• Detected during a self-examination, clinical exam or imaging test.

These nodules can vary significantly in size, number, and content. While many remain stable over time, others may grow or change, prompting further evaluation.

Benign vs Malignant Thyroid Nodules

Most thyroid nodules are benign, and many do not require any intervention beyond regular monitoring. However, a small percentage may turn out to be malignant, making early detection, and evaluation essential for timely treatment.

Below is a comparison to help you understand the key differences between benign, and malignant thyroid nodules:

What do Thyroid Nodules look like?

Thyroid nodules can be classified based on their physical structure, such as:

How do Thyroid Nodules develop?

The formation of a thyroid nodule is often the result of complex interactions between genetic, environmental, and hormonal factors. While many nodules remain harmless, identifying their root causes can help patients, and doctors make informed decisions about monitoring or treatment.

These potential causes include:

• Iodine Deficiency – iodine is a key mineral required by the thyroid gland to produce hormones. In areas with low iodine intake, such as parts of Southeast Asia before widespread salt iodisation, the thyroid may overwork to maintain adequate hormone levels. This overstimulation can lead to thyroid cell proliferation, resulting in glandular enlargement, and the eventual formation of nodules. 

• Thyroiditis – chronic inflammation of the thyroid, particularly in Hashimoto’s thyroiditis, is another common trigger. In autoimmune thyroiditis, the body’s immune system mistakenly attacks the thyroid gland, causing damage over time. As the thyroid tries to repair itself, areas of abnormal cell regeneration may develop, forming scar tissue or nodules. These nodules are usually benign but can coexist with thyroid dysfunction, such as hypothyroidism.

• Genetic Predisposition – a family history of thyroid disease, especially thyroid nodules, goitres or thyroid cancer, increases the risk of developing nodules. Certain genetic mutations are associated with abnormal growth patterns within the gland, which may predispose individuals to both benign and malignant nodules. In some cases, inherited syndromes such as multiple endocrine neoplasia (MEN) can also lead to the development of thyroid cancers, particularly medullary thyroid carcinoma.

• Environmental and Lifestyle Factors – exposure to radiation, especially during childhood, is a well-documented risk factor for thyroid nodule development, and thyroid cancer. This includes radiation therapy for other conditions or environmental exposure from nuclear fallout. Additionally, lifestyle factors such as smoking and, stress, though less direct, may contribute to thyroid dysfunction, and inflammation, indirectly leading to nodule formation over time.

Symptoms of Thyroid Nodules

Most of the time, thyroid nodules do not cause noticeable symptoms. However, some individuals may experience:

• A sensation of tightness in the throat.
• A visible lump or swelling in the neck.
• Difficulty swallowing or breathing.
• Hoarseness or voice changes.
• Persistent coughing that is not related to a cold.

How Thyroid Nodules affect your health and daily life

In the early stages, thyroid nodules are often asymptomatic, which means many people do not even realise they have one. While the absence of early symptoms may seem reassuring, it can also lead to delayed diagnosis, particularly when nodules begin to grow or affect thyroid function gradually over time.

As thyroid nodules enlarge or become hormonally active, they may start to cause noticeable physical, functional, and emotional impacts. These effects can disrupt everyday life and may indicate the need for medical intervention.

Here is how thyroid nodules can affect your health, and daily routine:

When is surgical treatment necessary?

While many thyroid nodules do not require surgery, there are certain situations where surgical removal becomes the safest and most effective treatment. The decision to operate depends on factors such as nodule size, function, cancer risk, symptoms, and patient preference.

Below is a summary of common indications for thyroid surgery:

Risks of delaying surgery

For some individuals, delaying surgery for thyroid nodules can lead to complications that may affect both health, and outcomes. These include:

• Increased surgical complexity, as larger nodules may involve surrounding structures or cause scarring.
• Nodule enlargement, leading to worsening pressure on the airway or oesophagus.
• Progression to thyroid cancer, particularly in nodules with suspicious features.
• Voice changes or swallowing difficulties, as nerves or muscles become compressed.
• Worsening hyperthyroidism, increasing the risk of heart rhythm disturbances or osteoporosis.

What are the surgical options for Thyroid Nodules?

Once a thyroid nodule has been carefully assessed, through physical examination, ultrasound imaging, blood tests, and often a fine needle aspiration biopsy (FNAB), our doctor may recommend surgery if there is a significant risk of cancer, troublesome symptoms or other clinical concerns.

Before selecting the appropriate surgical approach, several key factors are considered, including:

• The patient’s age, overall health, and preference.
• The size, location, and number of nodules.
• Whether the nodule is benign or malignant.
• Whether the nodule is causing hormonal imbalance or compressive symptoms.
• Whether there is disease in one or both lobes of the thyroid.

Lobectomy (Hemithyroidectomy)

A lobectomy involves the removal of one lobe of the thyroid gland. The remaining lobe is usually left intact, allowing some natural hormone production to continue.

Which type of nodule is it suitable for?

• Solitary benign nodules confined to one lobe.
• Small, low-risk papillary or follicular thyroid cancers.
• Indeterminate nodules where only part of the thyroid is affected.

Total Thyroidectomy

A total thyroidectomy involves the removal of the entire thyroid gland. This option is more definitive and often used in higher-risk cases.

Which type of nodule is it suitable for?

• Confirmed thyroid cancer, especially if bilateral or aggressive.
• Large goitres or multinodular goitres.
• Recurrent or multifocal nodules.
• Patients requiring radioactive iodine therapy post-surgery.

Minimally Invasive Thyroid Surgery

This approach uses smaller incisions. and specialised instruments to reduce surgical trauma. and promote faster healing.

Which type of nodule is it suitable for?

• Benign nodules in patients seeking less visible scarring.
• Small, well-localised nodules.
• Select low-risk cancers.

Endoscopic or Robotic-Assisted Thyroid Surgery

These minimally invasive techniques use an endoscope or robotic system to assist in thyroid removal through incisions that are hidden, such as under the arm and chest.

Which type of nodule is it suitable for?

• Cosmetic concerns, such as patients who prefer no visible neck scar.
• Small, benign nodules or select early-stage cancers.
• Patients meeting strict eligibility criteria.

Risks and benefits of thyroid surgery

Thyroid surgery is generally safe, and effective, especially when performed by experienced surgeons. It provides relief for patients with troublesome thyroid nodules, cancer concerns or hormonal imbalance. However, like all surgical procedures, it carries certain risks.

Risks of Thyroid Surgery

Benefits of Thyroid Surgery

Summary

Thyroid nodules are common, and often harmless, but they deserve careful attention, especially when they grow, cause symptoms or raise concerns about cancer. Many people live with thyroid nodules without even knowing, until symptoms such as a neck lump, swallowing difficulty or voice changes prompt further investigation.

Whether it is a small benign nodule or a suspicious lesion, treatment can be personalised to your needs, and health goals. Thyroid surgery is not always necessary, but when it is, it can provide clarity, relief, and peace of mind. Schedule a consultation with us today, for a detailed diagnosis and personalised treatment plan.

Frequently Asked Questions

Can thyroid nodules go away on their own?
Some benign thyroid nodules, especially simple cystic nodules, may shrink or even disappear over time without treatment. However, most remain stable or grow slowly. It is essential to attend regular check-ups to monitor for any changes in size, function or appearance.

How fast do thyroid nodules grow?
The growth rate can vary widely. Slow, gradual growth is more typical of benign nodules, while rapid enlargement may raise suspicion for malignancy or bleeding within the nodule. Any noticeable increase in size should be evaluated promptly by a specialist.

Do all thyroid nodules require surgery?
No. Surgery is only necessary in selected cases, typically when nodules are:

• Functionally overactive, in other words, producing excess hormones.
• Indeterminate on biopsy.
• Large, and causing symptoms.
• Suspicious or confirmed to be cancerous.

Is surgery the only treatment for thyroid nodules?
Not always. Depending on the nodule’s nature, and behaviour, alternative options include:

• Ethanol ablation – a minimally invasive option for certain fluid-filled (cystic) nodules.
• Radioactive iodine therapy – effective for treating hyperfunctioning nodules.
• Observation – especially for small, benign or asymptomatic nodules.

What is recovery like after thyroid surgery?
Most patients recover quickly. You may stay in hospital for 1 night, with full recovery within 1 to 2 weeks. Apart from that, you will also be asked to adhere the following post-care tips:

• Follow-up consultations to adjust medication and assess healing.
• Monitoring of thyroid hormone and calcium levels.
• Voice rest if vocal strain occurs.
• Wound care to ensure proper healing.

Is a thyroid nodule always a sign of cancer?
No. In fact, over 85% of thyroid nodules are benign. While any new lump should be assessed, a thorough evaluation, including ultrasound, and biopsy, can determine the risk. Many benign nodules never require treatment. 

Can I live a normal life after thyroid surgery?
Yes. Most people resume normal daily activities after surgery. If the entire thyroid is removed, you will need lifelong thyroid hormone tablets, but with proper monitoring, these allow you to lead a completely normal life. Furthermore, regular follow-up ensures long-term health, and hormonal balance. 

Does having a thyroid nodule affect pregnancy or fertility?
Not necessarily. However, thyroid function plays a role in fertility, and pregnancy health. If you are planning to conceive or are already pregnant, it is important to monitor thyroid hormone levels and ensure nodules are not causing dysfunction.