Understanding Thyroid Nodules When to Biopsy, Treatment Options, and the Role of Gene Expression Classifiers

Thyroid nodules are common and can often be detected during routine examinations or imaging studies. In Singapore, where healthcare awareness is on the rise, understanding the implications of thyroid nodules, when to seek help from an ENT specialist, and the latest treatment options available can empower patients to make informed decisions about their health.

What Are Thyroid Nodules?

Thyroid nodules are growths that form within the thyroid gland, which is located at the base of the neck. These nodules can be solid or filled with fluid and vary in size. While the majority of thyroid nodules are benign, a small percentage may be cancerous. This is where the expertise of an ENT doctor comes into play, particularly for those who may be experiencing symptoms such as hoarseness, difficulty swallowing, or noticeable neck lumps.

When to Biopsy Thyroid Nodules

Deciding when to biopsy a thyroid nodule typically depends on several factors, including the size of the nodule, its characteristics observed through imaging (such as ultrasound), and the patient’s clinical history. In general, the following guidelines are useful:

1. Nodule Size: Nodules larger than 1 cm are often considered for biopsy, especially if they exhibit suspicious features on ultrasound.
2. Ultrasound Characteristics: Nodules that appear solid, have irregular margins, or show microcalcifications are more likely to require further investigation.
3. Patient Symptoms: If a patient is experiencing symptoms like hoarseness, difficulty swallowing, or persistent neck discomfort, these can also prompt a biopsy recommendation.

A specialist at The ENT Clinic can perform a fine-needle aspiration biopsy (FNAB), which involves using a thin needle to extract tissue from the nodule for laboratory analysis.

How a Thyroid Biopsy Is Done

A fine-needle aspiration biopsy (FNAB) is a crucial procedure for diagnosing thyroid nodules and is typically performed in an outpatient setting. Here’s a detailed breakdown of how this procedure is conducted:

1. Preparation: Before the biopsy, the healthcare provider will explain the procedure to the patient, addressing any concerns or questions. The patient is then positioned comfortably, often lying back with their neck slightly extended to expose the thyroid gland. The skin over the neck is cleaned with an antiseptic solution to reduce the risk of infection.
2. Local Anaesthesia: Although the procedure is generally well-tolerated, a local anaesthetic may be administered to numb the area around the nodule. This helps minimise discomfort during the needle insertion.
3. Ultrasound Guidance: To ensure precision, an ultrasound is usually performed before the biopsy. The ultrasound helps the ENT doctor visualise the thyroid gland and locate the nodule accurately. The ultrasound technician or doctor may apply a gel to the neck to facilitate clear imaging.
4. Needle Insertion: Once the nodule is identified, the doctor uses a thin, hollow needle to extract cells from the nodule. The needle is inserted into the nodule, often with the aid of ultrasound guidance, to ensure accurate placement. The procedure may involve inserting the needle multiple times to collect sufficient tissue samples. Patients may feel a brief sensation of pressure or a slight prick, but significant pain is uncommon.
5. Sample Collection: The extracted cells are placed on glass slides or into vials for laboratory analysis. The ENT doctor may also perform a smear on the slides immediately to prepare the samples for cytological examination.
6. Post-Procedure Care: After the biopsy, patients are monitored for a short period to ensure there are no immediate complications, such as bleeding or difficulty swallowing. Patients are typically advised to avoid strenuous activities for a few days, but they can resume normal activities shortly after the procedure.
7. Analysis: The collected samples are sent to a laboratory, where a pathologist examines them under a microscope. The results of the biopsy are usually available within a week. The ENT specialist will discuss the findings with the patient, providing guidance on next steps based on whether the nodule is benign or malignant.

In Singapore, patients can expect a quick turnaround for biopsy results, typically within a week. If malignancy is detected, prompt treatment options can be discussed.

The Value of Gene Expression Classifiers

In recent years, the development of gene expression classifiers has added a valuable tool for assessing the risk of thyroid cancer in indeterminate nodules. These tests analyze the genetic material from the nodule samples to provide a risk assessment that can guide clinical decision-making.

1. Increased Accuracy: Gene expression classifiers can improve the accuracy of predicting whether a thyroid nodule is benign or malignant, helping patients avoid unnecessary surgeries.
2. Personalised Care: By providing more precise risk stratification, these tests enable tailored management plans for patients, ensuring they receive appropriate monitoring or intervention based on their specific risk profile.
3. Guided Treatment Decisions: Discussing the possibility of gene expression testing with their ENT specialist can be an essential step in the decision-making process following a biopsy.

Treatment Options for Thyroid Nodules

For benign thyroid nodules, observation is often recommended, especially if the nodules are small and asymptomatic. However, in cases where nodules cause symptoms or aesthetic concerns, treatment options include:

Radiofrequency Ablation (RFA)

Radiofrequency ablation (RFA) is an innovative, minimally invasive procedure that has gained popularity as a treatment option for benign thyroid nodules. It employs heat generated by radio waves to reduce the size of the nodules, providing relief from symptoms and improving cosmetic appearance. Here’s a closer look at the key aspects of RFA:

• Procedure Overview: RFA is performed under local anaesthesia in an outpatient setting. After preparing the patient and using ultrasound to locate the nodule, a thin electrode is inserted, and radiofrequency energy is applied to generate heat that destroys the excess tissue.
• Effectiveness: Studies show that RFA can significantly reduce the volume of benign thyroid nodules by 50% or more within six months. Patients often report relief from symptoms such as neck pressure or discomfort, along with improved swallowing and breathing if previously affected.
• Benefits: One of the major advantages of RFA is its minimally invasive nature. Unlike traditional surgery, RFA requires no large incisions, which translates to less pain, a lower risk of complications, and a quicker recovery time. Many patients can return to their normal activities almost immediately after the procedure.
• Safety Profile: RFA is generally considered safe, with a low incidence of complications. Some patients may experience mild soreness or swelling at the treatment site, but serious adverse effects are rare. Long-term follow-up studies indicate that the procedure is effective in preventing the recurrence of nodules.
• Patient Experience: The procedure typically lasts about 30 to 60 minutes, depending on the size and number of nodules being treated. Patients often describe the experience as comfortable, with many reporting minimal discomfort. The outpatient nature of RFA allows for greater convenience, making it an attractive option for those with busy lifestyles.

Microwave Ablation

Similar to RFA, microwave ablation employs microwave energy to destroy tissue within the nodule. It is another effective alternative for patients seeking non-surgical options. The choice between RFA and microwave ablation often depends on the specific characteristics of the nodule and patient preferences.

Conclusion

Thyroid nodules are a common concern among patients, and understanding when to consult an otolaryngologist is crucial. With advancements in biopsy techniques, the use of gene expression classifiers, and innovative treatments like radiofrequency and microwave ablation, patients have access to comprehensive care options. If you suspect you have a thyroid nodule or are experiencing symptoms like hoarseness or difficulty swallowing, consulting an experienced ENT doctor is essential for timely diagnosis and appropriate management.

For those in Singapore seeking expert care for thyroid nodules, The ENT Clinic offers radiofrequency ablation and a thorough evaluation of symptoms, ensuring that you receive the highest quality of care tailored to your needs. Don’t hesitate to reach out for a consultation and take the first step towards better thyroid health.