What's That Lump On My Neck

Thyroid lumps are mostly not cancerous, but need careful monitoring once they are detected.

The thyroid is a butterfly-shaped gland found on the lower part of the neck, where the Adam's Apple is located for men. It produces key hormones that regulate metabolic rate, heart function, digestion, muscle control, and brain and bone development.

Sometimes, lumps or nodules form, although experts don't know the exact cause. What is known is that people who have been exposed to radiation—either through the environment or from radiation treatment to the head, neck, and chest—are more likely to develop thyroid lumps. They are also more common in those who have other thyroid conditions, a family history of the condition, and with age.

Causes and Risk Factors for Thyroid Lumps

There is no need to be alarmed if you feel a lump around the thyroid region. The most common cause of it is an enlarged lymph node, which can be caused by the common cold or any other throat infection. But if the lump persists or grows larger over the next few weeks, you should see an ENT doctor. This is especially true if the mass moves up upon swallowing - this is a distinctive sign that the lump may be a thyroid mass. There are several possible causes of a thyroid mass, the most common being the existence of separate small lumps creating the appearance of one large mass. It often feels like one, when it is actually a cluster of nodules with one dominant one.

Although thyroid nodules don't usually affect the functioning of the thyroid gland, they can sometimes cause hyperthyroidism, where the nodules cause too much hormone production. They can also cause breathing and swallowing difficulties, when large nodules press against the windpipe, voice box or oesophagus. The first is treated with medication, and the second with surgery.

Several factors may increase the risk of thyroid lumps, including:

A family history of thyroid nodules or thyroid disorders
Previous thyroid X-rays or radiation treatment, especially during childhood
Thyroid conditions such as goitre or Hashimoto's thyroiditis
A low-iodine diet (iodine deficiency)
Women are four times more likely to develop thyroid nodules than men
The risk of thyroid nodules increases with age, particularly in the 30s to 60s

Thyroid Lump Evaluation

Thyroid nodules can vary in their size. While some nodules are palpable and easily felt, other nodules are so small that they can only be detected while undergoing an imaging evaluation of the head and neck for another medical condition.

Nevertheless, individuals should consult an ENT doctor if they observe a lump in their neck or experience symptoms related to a nodule. During the evaluation, the doctor may inquire about any personal or family history of thyroid conditions and conduct a physical examination by palpating the neck region to identify potential thyroid nodules.

To further confirm the presence of a thyroid nodule and understand its nature, the doctor may also order different diagnostic tests, which may include:

Blood Tests - This test assesses thyroid function by measuring the levels of thyroid hormones produced by the thyroid gland.
Soft Tissue CT Scan - This test uses a specialised X-ray machine and contrast dye to generate detailed images of the soft tissues and organs in the neck region, including the muscles, throat, and thyroid glands. A CT scan is typically performed when there are large nodules or suspicion of cancer.
Ultrasound - In this test, high-frequency sound waves are used to identify thyroid nodules as small as 2-3 millimetres. It can also determine the nature of the nodule (solid or fluid-filled).
Fine-Needle Aspiration Biopsy (FNAB) - This procedure involves inserting a thin needle into the thyroid lump to collect a sample of cells for laboratory analysis to determine if it's cancerous or benign. In some cases, additional tests or a repeat biopsy may be necessary.

Malignant or Benign?

There are three kinds of nodules, namely, solid nodules, cystic nodules (filled with fluid) and partially cystic nodules. A patient can have one or a combination of these.

It can be a clinical challenge for doctors to separate lumps with malignant risk from those that are benign. There is a higher chance that the lump may be malignant if one or more of the following signs are present:

the mass has grown rapidly over the past few weeks;
the nodule is starting to put pressure on the rest of the neck, especially the vocal cords;
the lump appears fixed with respect to the rest of the neck structure;
the patient has a family history of thyroid cancer

To confirm malignancy, the typical regimen is an ultrasound and further testing to determine if there is microcalcification within the lump or if the lump has irregular margins. Both of these are associated with malignancy. If necessary, a fine needle test may be ordered. This is a biopsy using a very fine needle to extract a small tissue sample for further testing.

Generally, thyroid nodules are not cancerous, and are often overlooked because they are small. Many people have them but never discover or treat them. Early testing is critical, especially because it is estimated that about five out of 100 thyroid nodules are cancerous. If left untreated, the cancer can spread to the surrounding structures. But the good news is that early diagnosis and treatment almost always result in good outcomes.

If you notice visible lumps in your neck region that aggravate discomfort, consult your physician for a detailed diagnosis as soon as possible.

With years of experience, our ENT doctor, A/Prof Luke Tan, offers comprehensive screening and treatments in Singapore to manage various thyroid and neck conditions accurately. Contact +65 6474 6116 to schedule a consultation with A/Prof Tan to address your neck lump concerns.

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