Thyroid Disorders and Treatment

Anatomy and Function

The thyroid gland is one of the endocrine glands that secrete a hormone to help regulate your metabolism. Thyroid hormone is necessary for every cell in the body to function properly.

The thyroid gland is located low in the neck just above your breastbone (sternum) and inferior to your voice box (larynx). The gland is shaped like a butterfly with two lobes (or halves) connected by a bridge (isthmus). Occasionally, the thyroid gland can grow large enough to wrap around the windpipe or even extend into the chest cavity.

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Disorders of the Thyroid

Hyperthyroidism is a condition resulting from an overactive gland. A patient may experience weight loss, sweating, rapid heartbeat, sleeplessness, anxiety, swelling of the eyes, etc. This is typically the result of Grave’s Disease or a Toxic Nodule.

Hypothyroidism is a condition resulting from an underactive gland. A patient may experience fatigue, weight gain, depression, etc. This typically is the result of a condition known as Hashimoto’s Thyroiditis, but can also result from previous radiation therapy to the neck or prior thyroid surgery.

Benign Thyroid Nodules are known as goiters, adenomas or hyperplasia. Some benign nodules are also caused by inflammatory disorders such as Hashimoto’s Thyroiditis.

Malignant Thyroid Nodules usually present as a painless lump/mass in the thyroid that often feels firm or hard. Keep in mind that the blood tests for thyroid function are normal in thyroid cancer. The only risk factors for the development of thyroid cancer is a family history of at least two relatives with known thyroid cancer or a patient who has a history of radiation therapy to the neck region. However, most thyroid cancers develop sporadically. The most common types of thyroid cancer are Papillary or Follicular Cancers. The more unusual or rare forms are Medullary, Hurthle Cell, Anaplastic or Lymphoma. Your doctor can give you more specific details of all these cancers.

Work-up and Evaluation

The most important consideration regarding the work-up and evaluation of a thyroid condition or mass is that it can be variable and dependent upon your doctor’s experience and suspicions.  

Ultrasounds of the thyroid are the most common radiographic study of the thyroid. The study is performed by a radiologist and used to measure the size of nodules and often aid in obtaining a tissue sample via a Fine Needle Aspiration Biopsy (FNA). During this procedure, a skinny needle is passed through the skin and a core of tissue is aspirated from the thyroid nodule and tested by a pathologist to determine if cancer cells are present. The results of a Fine Needle Biopsy are variable and can be inconclusive. More recently, Genetic Testing can be performed on the FNA sample to further aid in the diagnosis.

CAT scans, MRI scans and PET scans are rarely used to evaluate thyroid conditions.

Thyroid Nuclear Uptake Scans are used when a consideration of hyperthyroidism is suspected. However, its purpose in treatment is less valuable more recently.  

Total Body Nuclear Uptake Scans are beneficial in the evaluation of thyroid cancer to determine if the cancer has spread to other areas of the body.

Treatment

Hyperthyroid conditions such as Grave’s Disease or Toxic Nodules can be treated medically with a variety of anti-thyroid medications (i.e. Methimazole, Tapazole, PTU, etc.). Another option in the treatment of hyperthyroidism is Radioactive Iodine Therapy. A final consideration in the treatment is a Thyroidectomy, which is the surgical removal of the thyroid tissue. Your doctor can discuss the pros and cons of each option.

The treatment of most thyroid nodules and thyroid cancer is a Thyroidectomy. Your doctor will determine the extent of removal (Total Thyroidectomy vs. Partial Thyroidectomy) based on the facts of the case.

Radioactive Iodine Ablation is used to treat Papillary and Follicular cancers of the thyroid after surgery has been performed. This will help ensure that any metastatic disease is treated.

External Radiation and Chemotherapy would rarely be a treatment consideration for thyroid cancers.

Thyroid Surgery

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Your doctor may recommend a Thyroidectomy, which is the surgical removal of all (Total Thyroidectomy) or part (Thyroid Lobectomy) of the diseased thyroid. This could be performed either in the hospital or an outpatient surgical center. In general, the patient is put completely to sleep (general anesthesia). The total time can range from 1-3 hours depending on the extent of surgery required.

An incision is made low in the neck. Occasionally a drain is placed in the neck to help reduce swelling or risk of bleeding. Your doctor will inform you to stop certain medications that thin the blood, reducing the risk of bleeding. Infection is extremely rare.  

There are other structures in the neck that your surgeon needs to be careful working near. The vocal cord nerves are just deep to the thyroid gland. If they are inadvertently injured you may experience hoarseness, breathing trouble and even swallowing problems. Usually this is temporary, but can occasionally be permanent (<1% chance). Other nerves/muscles control the “singing voice” and may be affected by surgery and the healing process.

The four Parathyroid glands are situated adjacent to the thyroid and if they are inadvertently injured, you may experience numbness or tingling in your fingers or lips. Less than 1% of the time this could be permanent, but most of the time the injury to the parathyroid glands is temporary resulting in the need to take calcium supplements briefly.

Removal of all or part of the thyroid gland may require taking supplemental thyroid replacement medication (i.e. Synthroid) permanently.

Under normal circumstances, you should be able to drive a car in 2 days, exercise in 1 week, and return to work in 1 week.