What is the thyroid? How important is it for my health?
The thyroid gland is a butterfly-shaped endocrine organ located in the lower front portion of the neck. The thyroid primarily produces thyroxine hormone which is secreted into the bloodstream and carried to the rest of the body. Thyroxine contributes to the body’s metabolism such as keeping the body warm and keeping the brain, heart, muscles, and other vital organs working as they should.
Why would I need thyroid surgery?
Thyroid surgery offers the advantage of removing the diseased gland for the following conditions:
.Cancer is diagnosed or strongly suspected
.Hyperparathyroidism of the parathyroid glands resulting in excess calcium levels
.Possible cancer on FNAB (follicular neoplasm or atypical findings)
.Thyroid gland and condition is not responding to medical treatment (typically Graves’ disease)
.Presence of symptoms arising from a goitre (large overgrowth of gland)
.Nodule(s) that continue to enlarge on surveillance
The indication for thyroid surgery should be clearly explained by your surgeon.
The thyroid gland is a butterfly-shaped endocrine organ located in the lower front portion of the neck. The thyroid primarily produces thyroxine hormone which is secreted into the bloodstream and carried to the rest of the body. Thyroxine contributes to the body’s metabolism such as keeping the body warm and keeping the brain, heart, muscles, and other vital organs working as they should.
Patients with over-production of thyroid hormone or hyperthyroidism may experience symptoms such as increased heart rate, sweatiness, significant weight loss, mood changes, irregular menses, just to name a few. Conversely, patients with under-production of thyroid hormone or hypothyroidism may experience symptoms such as significant lethargy, weight gain, mind ‘fog’ and mood changes.
If you are diagnosed with the first category of disease, your doctor would have ordered a panel of blood tests called thyroid function test (TFT) and you may be prescribed medications to lower or raise the thyroid hormone level. Subsequently, you may need repeated TFTs as well as other blood tests to monitor the condition or treatment regime. You may also require an ultrasound scan to image the gland as part of the overall evaluation.
If you are diagnosed within the second group, you may also be required to undergo evaluation with blood tests and ultrasound imaging. In addition, your specialist may advise a fine needle aspiration biopsy (FNAB) of the thyroid growth or nodule(s). This is important to rule out the possibility of a cancerous growth within the thyroid. This is a simple and safe outpatient procedure performed in the doctor’s office. Typically, the biopsy is performed under ultrasound guidance to ensure accurate placement of the needle within the thyroid nodule. You will be asked to lie down on your back with your head tipped backwards, so that your neck is extended. During the procedure you may feel some neck pressure from the ultrasound probe and from the needle. You will be asked to remain as still as possible and to avoid coughing, talking, and swallowing during the biopsy (see annex). In my practice, patients who require a thyroid ultrasound and FNAC will be provided these evaluations within the same consultation.
This is a simple and safe outpatient procedure performed in the doctor’s office. Typically, the biopsy is performed under an expertise diagnostic ultrasound guidance to ensure accurate placement of a fine needle within the thyroid gland nodule. You will be asked to lie down on your back with your head tipped backwards, so that your neck is extended. During the procedure you may feel some neck pressure from the ultrasound probe and from the needle. You will be asked to remain as still as possible and to avoid coughing, talking, and swallowing during the biopsy. In my practice, patients who require a thyroid ultrasound and FNAC will be provided these evaluations within the same consultation so as to expedite a diagnosis.
Papillary thyroid cancer is the most common type, making up about 70% to 80% of all thyroid cancers. Papillary thyroid cancer can occur at any age. It tends to grow slowly and often spreads to lymph nodes in the neck. However, unlike many other cancers, papillary cancer has a generally excellent prognosis, even if there is spread to the lymph nodes in the neck.
Follicular thyroid cancer is the next most common and makes up about 10% to 15% of all thyroid cancers. Follicular cancer can spread to lymph nodes in the neck, but this is much less common than with papillary cancer. However, follicular thyroid cancer is more likely than papillary cancer to spread to distant organs, particularly the lungs and bones.
Both papillary and follicular thyroid cancers are also known as well-differentiated thyroid cancers (WDTC) and account for the majority of thyroid cancers diagnosed.
Medullary thyroid cancer is less common, only accounting for approximately 2% of all thyroid cancers. While most patients with medullary thyroid cancer are sporadic (occur in isolation), approximately 25% of these cancers occur in families and is associated with other endocrine tumours (Multiple Endocrine Neoplastic Syndrome). In family members of an affected person, a test for a genetic mutation in the RET proto-oncogene can lead to an early diagnosis of medullary thyroid cancer and, as a result, to curative surgery.
Anaplastic thyroid cancer is rare and found in less than 2% of patients with thyroid cancer. It is also the most aggressive cancer type, is often diagnosed at a later stage and hence, the least likely to respond to treatment. The overall prognosis is not favourable.
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