General & Laparoendoscopic Surgery - Endocrine - Thyroid
WHAT IS THE THYROID GLAND?
The thyroid is butterfly-shaped gland located in the lower neck. Normally, it is a small, soft gland that wraps around the front and sides of the trachea (windpipe). The gland uses iodine to produce thyroid hormone, which has a key role in regulating such functions as:
- Rate of metabolism
- Body temperature
- Heart rate
- Menstrual periods
- Mental alertness
- Skin and Hair integrity
Fine needle aspiration results may be benign, malignant (cancer), indeterminate (canít tell whether the cells are benign or malignant), or nondiagnostic (biopsy was unsuccessful).
- Benign - the nodule size and imaging characteristics are followed every 6-12 months. If there is growth or change, another biopsy or surgery is usually recommended.
- Malignant - a total thyroidectomy is recommended.
- Nondiagnostic - a repeat biopsy, observation, or surgery may be recommended and depends on multiple factors which will be discussed with you by your surgeon.
- Indeterminate - these are usually follicular or hurthle cell lesions/neoplasms. A determination of being benign or malignant can not be made until the pathologist can evaluate whether there is invasion of the capsule of the nodule or invasion of blood vessels by the cells within the nodule. The only way to make this determination is by having surgery. If there are no other abnormalities in the thyroid, and there are no other risk factors for thyroid cancer, a lobectomy (removal of half the thyroid) is performed. Otherwise, a total thyroidectomy may be performed.
Other reasons surgery may be recommended:
- A lump or tumor that may be cancerous
- Enlargement (commonly termed a goiter) causing compressive symptoms, such as difficulty swallowing food or liquids, a feeling of pressure in the neck, or difficulty breathing.
- Overactivity (hyperthyroidism or thyrotoxicosis, like Gravesí disease or Plummerís disease)
Surgery to remove the entire thyroid is called a total thyroidectomy. If only a portion is removed, the operation is termed a partial, sub-total, hemi-thyroidectomy or thyroid lobectomy.
Thyroid cancer is rare, but the overall prognosis is quite good. There are several different types of thyroid cancer:
- Papillary - (70%) 10-year survival 85-90% dependent on many factors.
- Follicular - (10%) 10-year survival 70-80%.
- Hurthle Cell - (5%) 10-year survival 60%.
- Anaplastic - (3%) 5-year survival 5%. Mean survival 2-4 months.
- Medullary - (7%)
- Lymphoma - (5%) 5-year survival 80% if confined to gland, otherwise 40%.
Treatment of some types of thyroid cancer involves the use of radioactive iodine after thyroid surgery. This allows your doctors to see if there is any evidence of spread of the cancer outside the thyroid gland to other parts of the body. Increased doses of radioactive iodine can also be used to destroy remaining areas of thyroid cancer. It is a very well tolerated treatment and does not have the same side effects as chemotherapy.
After surgery, patients who have undergone a total thyroidectomy will need to take a pill to replace their thyroid hormone. Patients who have undergone removal of one side of their thyroid gland may or may not need supplemental thyroid hormone, and this can only be determined after surgery. This medicine is well tolerated and has very few side effects. Thyroid hormone levels are usually checked six weeks after medication is adjusted, and it may take several adjustments to achieve appropriate levels of thyroid hormone replacement.
