Thyroid

Thyroid Nodules

Thyroid DiagramThe thyroid gland is a butterfly-shaped gland located in the low anterior neck. It produces thyroid hormone, which helps to regulate the body’s metabolism. The functional capacity of the thyroid is measured by blood tests. Excessive production of thyroid hormone (hyperthyroidism) can cause palpitations, tremors, weight loss, and heat intolerance. Conversely, an under-active thyroid gland (hypothyroidism) can result in fatigue, weight gain, and cold intolerance.

A thyroid nodule is a growth in the thyroid gland. Thyroid nodules are extremely common, and may be solitary or multiple (multinodular goiter). It is estimated that approximately 5-10% of the population has a palpable thyroid nodule, and between 30-85% have tiny thyroid nodules that are too small to palpate.

In most people with thyroid nodules, the gland produces a normal level of thyroid hormone (euthyroid state). Statistically, approximately 5-10% of nodules are cancerous. Some patients have findings that increase the risk of Thyroid and Parathyroid gland malignancy. A history of exposure to ionizing radiation to the neck is a risk factor, as is a family history of thyroid cancer. Hoarseness, lymph node enlargement, and fixation of the nodule can also increase the risk of malignancy. Fortunately, the vast majority of thyroid cancers are treatable and carry an excellent prognosis.

Thyroid Diagram

Most thyroid nodules do not require surgery. The primary indications for thyroidectomy are suspicion of cancer, large size, substernal location (nodules that grow inferiorly into the chest), or symptoms (throat pressure, difficulty swallowing, respiratory distress, or cosmetic disfigurement from a visible goiter). Over-functioning nodules are sometimes best treated by surgery, as well.

The most important tests to evaluate a thyroid nodule are a TSH level (a blood test that evaluates the function of the gland) and a fine needle aspiration (FNA) biopsy to evaluate the nodule for malignancy. Although FNA is highly accurate, it is not 100% accurate in making a diagnosis. FNA is usually performed in our office, but for smaller nodules and others that are difficult to palpate, the biopsy is done by the radiologists under ultrasound guidance. There are some types of thyroid nodules (follicular tumors) where FNA cannot distinguish benign from malignant nodules- these nodules are usually best managed by thyroidectomy.

Endoscopic Thyroidectomy

Many patients with diseased thyroids have safe, effective treatment options. At the Northwest Thyroid and Parathyroid Center, Dr. Shatul Parikh offers certain patients the option of an endoscopic thyroidectomy. This procedure offers thyroid surgery in a way that can dramatically reduce the size of their neck incisions and speed recovery.

In endoscopic thyroidectomy Dr. Parikh works through an incision about one-third of the normal incision. Dr. Parikh is the only surgeon in the metro-Atlanta area that provides this option to his patients.

With the use of video cameras and slender instruments during surgery, Dr. Parikh is able to gain access to the thyroid gland by pushing muscles aside rather than cut through them. Not only does this allow for a significantly smaller incision, but decreased post-operative pain and risk of bleeding. Video monitoring equipment attached to the endoscope magnifies the anatomy about 20 times allowing for safe and effective removal of the diseased thyroid gland. The average time for surgery for endoscopic thyroidectomy is 45 minutes, and most patients who undergo this procedure go home within a few hours of the surgery and return to work within 3-5 days after surgery.

Thyroid Surgery Scars

Conventional Thyroidectomy

A thyroidectomy is an operation that removes part or all of the thyroid gland. The most common indications for this operation are suspicion of malignancy, large nodules, substernal nodules (nodules that grow inferiorly into the chest), and nodules that cause symptoms (throat pressure, difficulty swallowing or breathing, or nodules so large they cause cosmetic disfigurement). Occasionally hyperthyroidism is treated surgically. The three most common types of thyroidectomy are total, subtotal (removes most of the gland), and hemi (removes one lobe of the thyroid). The extent of the operation depends upon the nature and extent of the pathology.

The patient is usually admitted on the morning of surgery, and the operation is done under general anesthesia. It generally takes about 1- 2 hours to perform, and is done through a horizontal incision (usually placed within a skin crease) in the low, anterior neck. Recovery is usually rapid- most patients are ambulatory the day of surgery, and most experience little or no pain after the first 24 hours. Most return to work with no restrictions within 1 week of surgery.

Visit Dr. Parikh’s Thyroid surgery website to learn more >>