Did you know that Ear, Nose, and Throat (ENT) head and neck surgeons can perform thyroid surgery? Thyroid conditions are often related to hormonal imbalances, which typically require the expertise of a thyroid specialist for diagnosis and treatment.
Fun fact – ENT head and neck specialists are well equipped to perform both non-surgical and surgical interventions for thyroid conditions, thanks to their extensive training in the head and neck area.
For those who have been diagnosed with or suspect that you might have a thyroid issue, read on to understand if you have a thyroid problem and what the potential solutions are for you in Singapore.
How Do You Know If You Have Thyroid Problems?
The thyroid gland is a butterfly-shaped organ responsible for producing hormones influencing key metabolic functions in the body.
Thyroid problems refer to any condition affecting the thyroid, a gland that produces hormones essential for key metabolic functions. The butterfly-shaped gland sits at the front of the neck, near where the collarbones meet. Its primary function is to secrete hormones, which include:
- Thyroxine (T4) & Triiodothyronine (T3): These are the two primary hormones considered ‘thyroid hormones.’ Both work together and influence:
- The rate at which your body breaks down nutrients to produce energy (metabolism)
- Blood pressure
- Body temperature
- Heart rate
- The body’s reaction to other hormones
When it comes to thyroid diseases, people of all ages can be affected. A thyroid problem occurs when the thyroid gland fails to produce the right amount of hormones or if there is a growth in the gland. A telltale sign of growth in the gland is a visible lump on neck.
Common thyroid conditions include:
- Underactive thyroid (hypothyroidism): This is when the thyroid produces too little thyroid hormone for the body’s needs.
- Overactive thyroid (hyperthyroidism): In contrast, the thyroid gland releases too much thyroid hormone.
- Thyroid nodule: This refers to a growth in the thyroid gland that can sometimes be felt as a lump in the neck area. In rare cases, a nodule can develop into thyroid cancer.
Depending on the type of thyroid condition, patients may experience varying symptoms. For those with an underactive thyroid, common symptoms include:
- Unusually slow heart rate than the norm
- Persistent fatigue
- Unexplained weight gain
- Sensitivity to cold
- Dry skin and coarse hair
- Depressed mood
- Heavy menstrual periods
Conversely, those with hyperthyroidism may experience:
- Increased heart rate (tachycardia)
- Difficulty sleeping
- Unexplained weight loss
- Sensitivity to heat
- Sweaty skin
- Feeling anxious, irritable, or nervous
- Irregular menstrual cycles or a lack of periods
In some patients, the presence of a thyroid condition may result in an enlarged thyroid (goitre), which is often indicated by visible swelling at the base of the neck.
An important symptom that patients should not ignore is the presence of swelling or lump in the neck that persists.
Patients with a thyroid lump often do not experience symptoms. However, when the condition develops, patients may notice symptoms such as:
- A visible lump on neck, especially near the middle of the neck
- A sensation of pressure or tightness in the throat
- Difficulty swallowing or breathing, especially when lying down
- Hoarseness or voice changes
- In some cases, thyroid nodules can produce excessive thyroid hormones, leading to the same symptoms of hyperthyroidism.
At times, symptoms may not be obvious from the get-go. If you experience any of the following, it may be a sign to get your thyroid checked by a Head & Neck, Thyroid specialist in Singapore:
- You have noticed significant weight changes despite the same dietary habits and physical activity level.
- You have also noticed certain changes in your physical appearance, such as:
- Weaker or more brittle hair
- Dry, red, itchy, thinning, or irritated skin
- Swelling in the joints
- A puffy face
- Swelling at the base of the neck
- These symptoms can often overlap with many other conditions. However, when a combination of these occurs at the same time, they could indicate a thyroid issue.
- You have noticed a drop in your mood or increased anxiety for no apparent reason.
- You have noticed a persistent drop in your overall energy levels.
- Hyperthyroidism can cause sleeping difficulties, leading to lasting fatigue.
- Hypothyroidism can deplete all energy from your body due to a lack of hormones.
- Both conditions can also cause muscle weakness, which adds to the fatigue.
- You feel either too hot or too cold most of the time and never seem to find the right temperature.
- For women, missing a menstrual cycle could indicate underlying thyroid issues.
Thyroid tests in Singapore include:
- Thyroid Blood Test/Thyroid Function Tests: The level of thyroid hormones in the blood may indicate abnormal thyroid function. This test evaluates the gland’s hormone production to assess if there is any abnormality present.
A common and accurate method to determine the presence of cancerous growths in the thyroid is Fine-Needle Aspiration Biopsy.
For further evaluation of detected thyroid lumps, your Head & Neck, Thyroid specialist will conduct:
- Ultrasound: A crucial imaging technique used to evaluate a lump’s size, number, and features. It can also help doctors distinguish between the type of lump present, and detect signs of malignancy.
- Fine-Needle Aspiration Biopsy (FNAB): A minimally invasive procedure where a thin needle extracts cells from a lump. This is one of the methods to determine if a lump is benign or malignant.
- Thyroid Scan: Involves the use of radioactive iodine or technetium to evaluate lump function and is particularly useful for lumps causing hyperthyroidism.
When a thyroid gland is too active and does not respond well to medications, a partial or total gland removal may be necessary via a thyroid removal surgery known as thyroidectomy. If you are diagnosed with a thyroid lump, you will need to undergo thyroid lump treatment which could involve a series of therapies or a thyroidectomy.
What Nerves Can Be Damaged During Thyroidectomy?
Anatomy of the recurrent laryngeal nerve and the superior laryngeal nerve concerning the thyroid gland | Source: Biomedicines
It is also common practice for Head & Neck, Thyroid surgeons to remove a thyroid nodule as part of benign thyroid nodule treatment or treatment for a potentially cancerous thyroid lump. This is because, whether benign or malignant, certain nodules can impact a patient’s quality of life by obstructing breathing or swallowing.
Given the delicate nature of the neck and throat, surgery in this area can carry a risk of nerve damage. In the case of thyroid surgery, there is a small risk of nerve damage occurring.
Injury to the Superior Laryngeal Nerve (SLN)
One of the most common nerve injuries in thyroid surgery is injury to the external branch of the superior laryngeal nerve (SLN). The injury rate for this nerve ranges from 0% to 58% in various studies due to differences in detection methods and study design.
During thyroid surgery, your surgeon operates in an area very close to where the external branch of the SLN is located. If this nerve is affected, it can cause paralysis of a small muscle that controls voice pitch (the cricothyroid muscle).
Damage to this nerve can lead to several voice-related issues, most commonly difficulty producing high-pitched sounds. This is a significant concern for singers or professionals who rely on their voices. However, most patients do not notice any major changes. Occasionally, mild hoarseness or decreased vocal stamina may occur. If SLN injury occurs, it can be managed with speech therapy.
Injury to the Recurrent Laryngeal Nerve (RLN)
Another possible nerve injury during thyroid surgery is damage to the Recurrent Laryngeal Nerve (RLN). Although various techniques have been introduced to prevent nerve injury, the chances of recurrent laryngeal nerve palsy occurring vary from 0% to 2.1% when the nerve is properly identified during surgery. If not properly identified, the risk increases to 4%–6.6%.
Unlike the SLN, the RLN primarily controls the opening and closing of the vocal cords, which is essential for breathing and speaking. Damage to one vocal cord can cause vocal cord paralysis, hoarseness, or breathiness, which may develop gradually over days or weeks.
If both vocal cords are affected, you may immediately notice a high-pitched noise when breathing or experience difficulty breathing. If only one vocal cord is affected, your surgeon may recommend an initial observation period before considering corrective surgery, as the damage may be temporary. However, if both vocal cords are affected, surgery may be required immediately.
In spite of the above, you can be assured that Head & Neck, Thyroid surgeons in Singapore are well-trained and equipped to minimise such complications arising during a thyroidectomy. One preventive measure widely adopted includes the use of nerve monitoring during surgery.
What is Nerve Monitoring for Thyroidectomy?
Nerve monitoring is a prevention surgery for nerve damage during a thyroidectomy. | Journal of the Sciences and Specialties of the Head and Neck
Nerve monitoring, also known as intraoperative nerve monitoring (IONM), is a technique in which surgeons use electrical stimulation to track the function of vocal nerves during thyroid surgery. This approach allows surgeons to monitor these nerves in real-time, helping to prevent injuries that could lead to hoarseness or vocal cord damage during the procedure.
In a thyroidectomy, nerve monitoring is primarily used to track the function of the RLN to prevent permanent vocal damage. The general process includes:
- Electrode Placement: Electrodes are positioned on the vocal cords to record electromyographic (EMG) signals.
- Baseline Measurements: Before the surgery begins, a record of the signals is captured and used as a baseline to detect any changes during the procedure.
- Continuous Monitoring: Throughout the operation, continuous or periodic electrophysiological signals are obtained and analyzed. Significant deviations from the baseline may indicate potential nerve compromise.
- Immediate Feedback: If adverse changes are detected, the surgical team is promptly informed, allowing for immediate interventions to mitigate potential nerve damage.
How to Find the Right Thyroid Surgeon in Singapore?
Dr Ker Liang is the Medical Director of Aglow ENT Centre and an experienced ENT Head and Neck Surgeon in Singapore capable of performing thyroid surgeries.
In Singapore, you can visit an ENT head and neck surgeon for a thyroidectomy. While an endocrine specialist is often the first point of contact for diagnosing thyroid hormonal disorders, ENT head and neck surgeons are increasingly recognised for their expertise in this area. Given their experience and familiarity with the neck and throat, patients with a noticeable lump on their neck can visit an ENT head and neck surgeon for a diagnosis.
As an experienced ENT head and neck surgeon and Laryngologist, Dr Ker Liang adeptly navigates the intricate network of facial, neck, and throat nerves during surgical procedures, leading to a variety of benefits, including fewer post-surgical complications and less scarring. As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from Yong Loo Lin School of Medicine, NUS. She is actively involved in the training of postgraduate junior doctors and residents in the ENT Head and Neck Surgery department.
When choosing the right Head & Neck, Thyroid surgeon in Singapore for your condition, it is important to consider:
- Relevant training in performing thyroidectomy
- Surgical experience and volume in handling ENT head and neck surgeries, including thyroid surgery.
You can visit Aglow ENT Centre, an ENT clinic in Singapore that is conveniently located at Orchard for thyroid surgery in Singapore.
What to Expect During Thyroid Surgery?
During thyroid surgery, a portion or the entire gland is removed, and patients are placed under general anaesthesia. Your surgeon will then make an incision in the lower neck to reach the thyroid gland and remove the necessary parts. In cases of suspected thyroid cancer, the entire thyroid gland and surrounding tissues may be removed.
Surgery on its own can be scary for most people, much less with the surrounding myths about certain procedures. There are several myths about thyroidectomy that need to be clarified:
Myth #1: Thyroidectomy is a major surgery with serious complications
Although thyroidectomy requires precise handling, it is generally considered a safe surgery with minimal complications. As with most surgeries, there are risks that comes with the procedure. However, in the case of a thyroid surgery, surgeons have adapted to include mitigation strategies to prevent side effects, such as the use of a nerve monitor.
Partial/Hemi-thyroidectomies are performed as a day-surgery case.
Myth #2: Voice change after a thyroidectomy is guaranteed
Voice change is not a definite side effect of thyroidectomy, only a small percentage of patients experience voice changes post-surgery. To minimise this risk, choosing an experienced head & neck, thyroid surgeon with the relevant expertise is crucial.
Myth #2: I will gain weight after thyroid removal
Some people worry that removing their thyroid gland may slow their metabolism due to decreased thyroid hormone production. This usually happens if the entire thyroid gland is removed during surgery, and happens much less frequently in partial/hemi-thyroidectomies. However, if such changes occur, your head & neck, thyroid surgeon can prescribe hormone therapy to help manage your condition.
What to Do After Thyroid Surgery?
After a thyroidectomy, most patients will be able to eat, drink, and carry on with usual activities in the following days. For patients who only require a partial removal of their thyroid, they may even be able to return home the same day of their surgery.
Here are some post-operative care pointers to help optimise your recovery:
- Incision Area: Be sure to keep your incision area clean and replace your bandages as instructed by your surgeon.
- Swelling: It is normal to experience swelling or numbness in the operated area. A thyroidectomy does not usually result in significant post-operative pain. However, you may request pain relievers when necessary.
- Wound Drainage: You may need a wound drain placed in your neck area for the first few days after surgery. Make sure to maintain it as instructed by your surgeon.
- Shower: You are allowed to shower the next day after surgery but it is advisable to not soak the incision area entirely.
- Diet: There is usually no diet restriction after a thyroidectomy, but you are advised to eat soft food in the first few days. Foods like porridge and oatmeal may be easier to swallow in the newly operated area. It is normal if you feel a lump sensation in the throat at the beginning.
- Sleeping: Avoid lying flat and try to prop several pillows to keep your head elevated. This helps to prevent swelling of the surgical site.
- Sore Throat or Cough: This is a normal occurrence which may last up to a week after the surgery. At times, you may also experience phlegm in your throat which is caused by the breathing tube placed during surgery. This should resolve on its own and you can take lozenges to help manage the irritation.
- Physical Activity: While you are allowed to resume your daily activities after the surgery, you should refrain from strenuous activities in the first two weeks of recovery or as advised by your surgeon.
What is the Cost of Thyroid Surgery in Singapore?
In Singapore, thyroid surgery may range from $7,000 – $21,000, however, insurance coverage could be an option with most patients. At Aglow ENT Centre, we have an experienced and friendly team committed to addressing any financial concerns, enabling patients to focus on their recovery with peace of mind.
What are the Alternatives to Thyroid Surgery?
Not all thyroid lumps require surgery. Depending on the diagnosis of your condition, your head & neck, thyroid surgeon in Singapore may suggest other treatment measures.
Alternatives to thyroid surgery include:
- Observation: Small, benign nodules that don’t cause symptoms may simply be monitored over time with periodic ultrasounds. This may involve routine checks spaced out over a period of 6-18 months.
- Radioactive Iodine: Iodine is typically required to produce thyroid hormone. When the thyroid gland is too active, iodine exposed to radiation is ingested to be absorbed by the thyroid cells. Once absorbed, the cells will die which minimises the thyroid activity or nodule growth.
- Nodule Ablation (using Ethanol or Radiofrequency): Involves injecting alcohol or a radiofrequency probe into the thyroid nodule to reduce the size of a nodule, typically used for cystic and solid nodules, respectively.
Consult Dr Ker Liang, an Experienced Head & Neck, Thyroid Surgeon in Singapore for Thyroid Surgery
The thought of undergoing surgery, especially in a delicate area such as the head or neck, can be terrifying. In reality, with today’s surgical techniques and assistive devices, complications are minimal.
If you have a thyroid condition that requires a thyroidectomy or alternative therapies, you can be assured that with the right doctor, you will be on the path to better health.
If you notice a lump on your neck or symptoms related to thyroid issues, schedule an appointment with Dr Ker Liang at Aglow ENT Centre. With a focus on tailored care, Dr Ker Liang is committed to addressing your health concerns and helping you achieve full recovery.
References
- Cleveland Clinic. Thyroid Hormone. Updated June 14, 2023. Accessed March 3, 2025. https://my.clevelandclinic.org/health/articles/22391-thyroid-hormone.
- Cleveland Clinic. Thyroid Disease. Updated October 11, 2023. Accessed March 3, 2025. https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease.
- Randolph GW, Dralle H, Abdullah H, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement. World J Surg. 2011;35(3):577-591. doi:10.1007/s00268-010-0981-4. https://pmc.ncbi.nlm.nih.gov/articles/PMC3191623/.
- Medscape. Thyroidectomy Images. Updated May 4, 2023. Accessed March 3, 2025. https://emedicine.medscape.com/article/852184-images?form=fpf.
- Lo CY, Kwok KF, Yuen PW. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg. 2001;136(5):519-523. doi:10.1001/archsurg.136.5.519. https://pubmed.ncbi.nlm.nih.gov/11769989/.
- Silverline Hospital. Voice Changes After Thyroid Surgery: Common Myths and Facts. Accessed March 3, 2025. https://silverlinehospital.in/blog/voice-changes-after-thyroid-surgery-common-myths-and-facts#:~:text=Myth:%20Voice%20Change%20Is%20Guaranteed,with%20their%20voices%20post%2Dsurgery.
- University of Maryland Medical System. After Thyroid Surgery. Accessed March 3, 2025. https://www.umms.org/ummc/health-services/surgery/endocrine-surgery/conditions/thyroid-gland/after?__cf_chl_tk=dVa0sQFOQihb5hFcyYsYYYgMXF9Ld6Kcqvmx1rmMq5U-1740991906-1.0.1.1-_y3vs240kjPmSbJgpARG9LdQHVftejIisI5BAuKuDaw.
- Ministry of Health Singapore. Thyroid Gland Bill Information. Accessed March 3, 2025. https://www.moh.gov.sg/managing-expenses/bills-and-fee-benchmarks/cost-financing/tosp-sj803t-thyroid-gland-bill-information.
