Neck Lump: Overactive Thyroid vs Underactive Thyroid?

Lately, we have been seeing more patients at our ENT clinic in Singapore, coming in with thyroid problems. Thyroid problems are pretty common in Singapore, especially in women and can run in families. Sometimes, the thyroid problem is due to too much thyroid hormone being produced by the thyroid gland and other times, it may be due to not enough thyroid hormone being produced by the thyroid gland. If there are thyroid nodules, these may present with a neck lump too. In general, although most thyroid lumps are usually benign (non-cancerous), there is an approximately 10-15% risk of thyroid lumps turning into cancerous thyroid nodules. We worry more about thyroid lumps in Singapore if they occur in men and in the elderly.

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So what do we do about thyroid conditions in Singapore? They may present with a neck lump but sometimes, there are other symptoms of thyroid problems to watch out for. For example, I recently saw a young lady who had been feeling extremely nervous and agitated, having lost some weight recently. She had also been having difficulty sleeping and often felt hot and sweaty for now reason at all. She had noticed palpitations (feeling your heart beat fast in your chest) and said that her pulse had been running faster than usual. She also felt a funny sensation as if there was a lump in her neck, especially upon swallowing.

Upon examining her, her pulse was racing at 120 beats per minute at rest and her blood pressure was raised. She had a lump in her neck which I suspected to be an enlarged thyroid gland. We arranged some thyroid function blood tests for her and the results showed that her thyroid gland was producing too much thyroid hormone i.e. Hyperthyroidism was the name of her thyroid condition. Her ultrasound scan showed an enlarged thyroid gland with a solitary nodule which seemed to be the source of the high levels of thyroid hormone. She was prescribed some medication to slow down her heart and to treat the overactive thyroid gland. A month later, she was feeling much better. We just have to monitor the thyroid nodule carefully to make sure it doesn’t grow or change in a worrying manner.

At the other end of the thyroid spectrum in Singapore, we have the underactive thyroid condition. A 67 year old lady came to see me for weight gain, dry hair and skin and a feeling of a neck lump. She also said she felt easily tired pretty much all the time. Her thyroid function blood tests showed very low levels of thyroid hormone produced while her ultrasound scan showed a few nodules in her thyroid gland. She was started on thyroid hormone replacement medication to make up for the lack of natural thyroid hormone in her body.

So if you notice a neck lump or thyroid lump, then it would be wise to get it checked out by your friendly ENT doctor in Singapore. He or she will usually arrange the following thyroid tests:

1. Thyroid function blood tests: TSH (Thyroid Stimulating Hormone), T3 and T4 (thyroxine hormones), thyroid antibody levels
2. Ultrasound scan of thyroid/neck
3. Ultrasound-guided Fine Needle Aspiration (mini-biopsy) of larger or suspicious thyroid nodules

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