What Your ENT Specialist Wants You to Know about Thyroid Nodule Treatment

Thyroid nodules are a common clinical finding, and with the increasing use of imaging for unrelated health concerns, more people are discovering them incidentally. While the majority are benign and harmless, a small percentage may represent early thyroid cancers. Knowing when to investigate further, and how to do so, is key to making informed decisions about management.

This article provides a complete overview of when a thyroid nodule should be biopsied, how the biopsy is performed, the role of gene expression classifiers, and modern, minimally invasive treatments such as radiofrequency ablation (RFA). These services are available through experienced ENT specialists in Singapore who offer comprehensive evaluation and treatment for thyroid and neck-related conditions.

What Are Thyroid Nodules?

Thyroid nodules are abnormal growths or lumps that develop within the thyroid gland, located at the front of the neck. They may be solid or filled with fluid, and most are discovered during routine health screenings, physical examinations, or imaging studies like ultrasound.

While the vast majority of thyroid nodules are benign, a small number may be malignant. The challenge lies in distinguishing between nodules that require active treatment and those that can be safely monitored. A skilled ENT doctor or endocrinologist plays a crucial role in this risk stratification process, often beginning with a thorough clinical evaluation and targeted imaging.

When Should a Thyroid Nodule Be Biopsied?

Not every thyroid nodule needs to be biopsied. Decisions around whether or not to proceed with a thyroid biopsy are based on a combination of factors, including the nodule’s size, ultrasound appearance, and the patient’s clinical background.

Typically, a fine needle aspiration (FNA) biopsy is recommended if:

• The nodule is larger than 1 cm and has suspicious ultrasound features such as irregular margins, microcalcifications, or marked hypoechogenicity.
• The patient has risk factors such as a personal or family history of thyroid cancer, previous radiation exposure, or rapid nodule growth.
• The nodule is causing compressive symptoms like difficulty swallowing or changes in voice.

If the nodule is small and lacks high-risk features, it may simply be monitored with periodic ultrasounds. A reputable ENT doctor in Singapore will be able to advise on whether surveillance or biopsy is the right next step.

How Is a Thyroid Biopsy Performed?

A fine needle aspiration biopsy is a quick, outpatient procedure that uses a thin needle to collect cells from the nodule for microscopic evaluation. The procedure is typically done under ultrasound guidance to ensure accuracy and minimise discomfort.

Steps include:

1. Identifying the nodule using real-time ultrasound imaging.
2. Applying local anesthesia to the skin over the thyroid area.
3. Inserting a thin needle into the nodule to collect cellular material.
4. Sending the sample to a pathology lab for analysis.

The entire procedure takes about 20–30 minutes. There is no downtime, and most patients return to their normal routine immediately after. Minor bruising or tenderness at the site may occur but usually resolves within a day or two.

What If the Biopsy Results Are Indeterminate?

In roughly 15–30% of cases, the results of a thyroid biopsy fall into an indeterminate category, meaning that it’s unclear whether the nodule is benign or malignant. This can leave patients in a difficult position, unsure whether to proceed with surgery or adopt a wait-and-watch approach.

This is where gene expression classifiers (GECs) offer significant value. These molecular tests analyse gene activity in the nodule’s cells to predict the risk of cancer. They are especially helpful in cases where the cytology (cell analysis) is inconclusive.

Benefits of gene expression testing include:

• Avoiding unnecessary thyroid surgery for benign nodules
• Providing clearer guidance in ambiguous cases
• Supporting evidence-based decisions on whether to operate or observe

GECs are becoming an essential part of thyroid nodule evaluation, especially when managed by experienced teams that include otolaryngologists and endocrinologists working collaboratively.

Do All Benign Thyroid Nodules Require Treatment?

Not at all. Many benign thyroid nodules are asymptomatic and stable, requiring no intervention beyond regular monitoring. However, if a nodule is large enough to cause symptoms such as a visible neck lump, difficulty swallowing, or discomfort, treatment may be considered, even if it is non-cancerous.

In the past, surgery was often the only option. Today, patients have access to non-surgical treatments that are both safe and effective, with fewer risks and shorter recovery times. One such option is radiofrequency ablation.

What Is Radiofrequency Ablation (RFA)?

Radiofrequency ablation is a minimally invasive outpatient procedure that uses heat to reduce the size of thyroid nodules. It involves inserting a small probe into the nodule under ultrasound guidance and delivering targeted energy to destroy abnormal tissue, which is then gradually reabsorbed by the body over time.

RFA is performed under local anaesthesia and typically takes less than an hour. Patients can go home the same day with minimal discomfort and resume daily activities almost immediately. There is no surgical incision, no general anaesthesia, and no long recovery period.

This technique is ideal for patients who:

• Have benign thyroid nodules confirmed by biopsy
• Want to avoid surgery or general anaesthesia
• Are concerned about visible neck scars
• Experience symptoms or cosmetic concerns

Microwave ablation is another similar option, though radiofrequency ablation remains the more widely adopted method for thyroid nodule treatment.

Is RFA Safe and Effective?

Yes, clinical studies have consistently shown that RFA is both safe and effective in shrinking benign thyroid nodules. Patients typically experience:

• 50–90% reduction in nodule volume within six months
• Relief from symptoms like neck pressure and discomfort
• Preservation of healthy thyroid tissue and hormone function
• High satisfaction due to minimal downtime and no scarring

These benefits make RFA an excellent alternative to thyroid surgery, especially for patients with aesthetic or lifestyle concerns.

Where Can I Get RFA for Thyroid Nodules?

If you’re considering radiofrequency ablation for thyroid nodules, it’s important to choose a provider with expertise in both thyroid imaging and interventional techniques. Our clinic offers comprehensive ENT care in Singapore, including RFA performed by skilled specialists with extensive experience in thyroid and neck procedures.

We provide:

• Detailed ultrasound assessment of thyroid nodules
• Biopsy and gene expression testing if needed
• Personalised treatment planning
• State-of-the-art RFA technology and post-procedure monitoring

Final Thoughts

Thyroid nodules are common, often benign, and typically manageable with the right clinical approach. Knowing when to biopsy a thyroid nodule, understanding the value of gene expression classifiers, and having access to non-surgical options like RFA can make a significant difference in how your condition is managed.

If you’re looking for an otolaryngologist in Singapore who offers advanced diagnostic and treatment options for thyroid nodules, we invite you to visit our clinic. From evaluation to minimally invasive treatment, we provide expert care that’s modern, effective, and tailored to your needs.