Thyroid Gland Disorders and Surgery

Thyroid gland disorders are a group of conditions related to the thyroid gland, found at the neck's base. This gland influences many vital body functions, such as metabolism, heart rate, and blood pressure.

Often, individuals with a thyroid disorder experience imbalances in their thyroid hormone production. Although initially mild, symptoms of most thyroid gland disorders may worsen to disrupt daily lives. In Singapore, thyroid gland disorders are treatable with medications or surgical intervention.

What are Thyroid Gland Disorders?

Thyroid gland disorders refer to a group of conditions that affect the thyroid’s function. The thyroid is a butterfly-shaped gland at the front of the lower neck. Its main functions include the production of thyroid hormones, which influence many of the body's key metabolic functions, such as metabolism, heart rate, and blood pressure.

When the thyroid produces too much or too little of these hormones, it is a disorder. In some cases, abnormal growths can also develop in the thyroid gland, which may or may not cause symptoms. While most of these growths are benign, there is a slight possibility that they could be cancerous and develop into thyroid cancer.

Types of Thyroid Gland Disorders

1. Function-Related Disorders:

• Hypothyroidism (Underactive Thyroid) is the opposite of hyperthyroidism. In this condition, the thyroid gland produces too few thyroid hormones, which can cause symptoms that interfere with a person’s everyday well-being. 
• Hyperthyroidism (Overactive Thyroid): This condition occurs when the thyroid produces too much thyroid hormone, leading to uncomfortable symptoms that impact daily life.

2. Physical Disorders:

Thyroid Nodules Types :

There are 3 types of Thyroid Nodules :

• Benign Nodules: Most thyroid nodules are non-cancerous and may not cause symptoms. They often do not affect thyroid function.
• Toxic Nodules (or Hyperfunctioning Nodules): These nodules produce excess thyroid hormones and can lead to hyperthyroidism.
• Cancerous Nodules: While most thyroid nodules are benign, a small percentage can be cancerous, and these are known as thyroid cancer. The risk increases with factors like family history and radiation exposure.

Goitre :

Enlargement of the thyroid, which can be diffuse or nodular, may lead to hypothyroidism or hyperthyroidism, depending on the cause. There 3 types of Goitre :

• Diffuse Goitre: The entire thyroid gland is enlarged, often due to iodine deficiency, autoimmune diseases (such as Hashimoto’s or Graves’ disease), or thyroiditis.
• Nodular Goitre: This is characterised by a goitre with nodules or lumps within it. Depending on whether the nodules are overactive, it can cause thyroid dysfunction.
• Endemic Goitre: Often caused by iodine deficiency in areas where iodine is scarce in the diet. It leads to compensatory enlargement of the thyroid to produce enough hormones.

What Are the Symptoms of a Thyroid Gland Disorder?

Symptoms of a thyroid gland disorder vary depending on the severity and condition of each patient.

In the case of patients with hyperthyroidism, they often experience:

• Unexplained weight loss despite no changes in diet or activity level
• Feelings of nervousness and anxiety
• Excessive sweating and sensitivity to heat
• Faster-than-normal heart rate
• Shaking or tremors
• Persistent fatigue
• Muscle weakness
• Trouble sleeping
• More frequent bowel movements
• Hair thinning
• Bulging eyes (exophthalmos)
• Irregular menstrual cycles
• Breast enlargement

In contrast, patients with hypothyroidism will experience the opposite symptoms:

• Fatigue
• Unexplained weight gain
• Increased sensitivity to cold
• Dry skin
• Brittle hair and nails
• Muscle pain or discomfort
• Difficulty with bowel movements
• Trouble concentrating or memory issues (brain fog)
• Swelling in certain areas
• Feelings of depression
• Irregular menstrual cycles

Patients with thyroid growth are less likely to experience apparent symptoms unless the lump is large enough. In some cases, the growth may also trigger changes in thyroid hormone production, which can lead to symptoms of hyperthyroidism or hypothyroidism.

Common signs of non-cancerous (nodule goitres) and cancerous thyroid growths include:

• Swelling or noticeable lump in the neck
• Change in voice, especially if the growth becomes too large
• Difficulty swallowing
• Difficulty breathing
• Neck pain or discomfort, such as tightness
• Fatigue
• Changes in thyroid function which result in symptoms of hyperthyroidism or hypothyroidism.

It is important to note that symptoms of thyroid gland disorders may not be evident from their onset. Symptoms can often be mistaken for other conditions. Therefore, some considerations you should make to seek an endocrine specialist include:

• If you feel persistent tiredness without probable cause
• If you notice significant mood changes without an explainable cause
• If you experience sudden weight changes for no reason
• If you always feel too cold or too hot compared to others in your surrounding
• If you have skipped or missed a period
• If you notice a lump or swollen neck

What Are the Causes of a Thyroid Gland Disorder?

Prolonged inflammation or mutation in the thyroid gland can trigger abnormal thyroid growth.

The causes of a thyroid gland disorder may vary due to the condition's nature. However, overlapping causes that frequently result in a thyroid disorder include:

• Autoimmune Disorder: An autoimmune disorder may incorrectly trigger your body’s immune response, which results in inflammation and disruption of the thyroid’s function.
• Lack or Excess of Iodine: Iodine also affects the level of thyroid hormones produced. Any imbalance can cause a thyroid disorder.
• Thyroid inflammation: Persistent thyroid gland inflammation could lead to structural changes that affect the thyroid’s function or cause unusual growth.
• Mutation: Specific to thyroid cancers, a mutation must have occurred to cause the cells to turn cancerous. The exact reason for this phenomenon is still unclear. 

What Are the Risk Factors for a Thyroid Gland Disorder?

Many factors can contribute to the increased risk of developing thyroid disorders in Singapore. Certain thyroid conditions may have their distinct risk factors, but the common denominators include:

Radiation exposure: Individuals with radiation exposure in the head and neck area are more prone to develop thyroid conditions.

Gender: In general, thyroid disorders are more prevalent in women than men.

Age: Age also contributes to the increased risk of thyroid disorders.

Family history: Those with a family history of thyroid disorders are more likely to develop a thyroid condition. Hence, routine screening is recommended for this group of individuals.

Iodine level: Iodine plays a key role in the thyroid's function, especially in the production of hormones. An excess or lack of this element may result in increased risk.

Radiation exposure: Individuals with radiation exposure in the head and neck area are more prone to develop thyroid conditions.

How is a Thyroid Gland Disorder Diagnosed?

In Singapore, you should visit an endocrine surgeon or endocrinologist (hormone specialist) for issues related to the thyroid. A vital step that will be conducted regardless of your thyroid symptoms will be assessing your medical history and physical condition.

At this stage, your endocrine doctor will look for signs of a swollen thyroid gland by feeling a lump in the neck.

When a patient is suspected of a thyroid hormone disorder, a blood test is frequently ordered to evaluate the thyroid’s function and health. If a lump is detected or suspected, your endocrinologist will request an imaging test to visualise the thyroid better and identify possible growths.

At ACE Specialist Surgery and Endoscopy (ACE), our specialist may use ultrasound to evaluate the thyroid lump's size, location, and characteristics. When deemed necessary, our specialist may perform a Fine Needle Aspiration. This diagnostic procedure involves using a fine, thin needle to collect a sample from the nodule for further lab analysis. This test is important to determine whether a growth might be cancerous or not.

Notably, a thyroid disorder may often go unnoticed and be discovered incidentally. This means finding a thyroid issue, such as growth, during a physical exam or imaging tests for other conditions. Regardless, if your doctor flags such an issue, you may be advised to seek further consultation.

How is a Thyroid Gland Disorder Treated?

The treatment approach for a thyroid gland disorder is largely based on the diagnosis by an endocrinologist. For mild to moderate cases, treatment typically begins with medications. This includes medication that helps to either increase or decrease the production of hormones. In the case of a thyroid nodule, medication for hyperthyroidism can also be prescribed to shrink the nodule.

In instances where the thyroid is cancerous, too enlarged or overactive, surgery may be recommended. At ACE, our surgeon is experienced in performing these thyroid surgeries:

• Total endoscopic trans-axillary thyroidectomy: This is a minimally invasive surgery that involves accessing the thyroid via the armpit, resulting in concealed scars.
• Minimally invasive video-assisted thyroidectomy (MIVAT): Also a minimally invasive technique, this thyroid removal procedure involves small incisions guided by video assistance of the surgical area.
• Conventional open hemithyroidectomy: This is a more extensive surgery in which half of the thyroid gland is removed in an open procedure. This is usually done in patients diagnosed with thyroid cancers or large nodular goitres.
• Near total thyroidectomy: Nearly all of the thyroid gland is removed in this procedure, which is typical for benign thyroid disorders.
• Total thyroidectomy +/- neck lymph node dissection: This involves the complete removal of the thyroid gland, standard for patients with thyroid cancer. Simultaneously, removal of the lymph nodes may occur to prevent or treat the spread of cancer.

Can I prevent a Thyroid Gland Disorder?

Most thyroid gland disorders cannot be prevented, especially if the cause is linked to your genetics. Nevertheless, for individuals with a known predisposition towards thyroid issues, scheduling a routine thyroid screening can be advantageous for early detection and management.

At ACE, our clinic is a one-stop thyroid screening clinic. It involves testing for thyroid function via blood tests and an imaging test. As with any health condition, early diagnosis is often beneficial to minimise complications and maintain a positive quality of life.

Endocrine Consultant for Thyroid Disorders in Singapore

Book an appointment with an endocrine doctor in Singapore if you notice symptoms related to a thyroid disorder or apparent swelling of the lower neck. At ACE Specialist Surgery & Endoscopy, the team is led by Dr Reyaz Singaporewalla, an experienced endocrine consultant and surgeon. With a focus on providing patients with tailored care, the team is committed to providing a prompt and accurate diagnosis that results in an optimal treatment plan and recovery outcomes.

References

1. Cleveland Clinic. Thyroid disease. Cleveland Clinic. Updated September 6, 2023. Accessed March 4, 2025. https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease.
2. Penn Medicine. What is thyroid disease? Penn Medicine. Published August 4, 2017. Accessed March 5, 2025. https://www.pennmedicine.org/updates/blogs/health-and-wellness/2017/august/thyroid.