ENDOCRINE SYSTEM - THYROID
The thyroid is one of the endocrine organs. It produces a substance known as thyroid hormone. This hormone regulates many aspects of our metabolism, from how fast our heart beats to how we burn calories. The thyroid is butterfly shaped and lives in the neck below the voice box (Adam’s apple). The wings of the butterfly are referred to as “lobes” while the bridge that connects them is called the “isthmus”. Most people will not be able to feel a normal thyroid.
POTENTIAL THYROID PROBLEMS
Problems associated with the thyroid can usually be broken down into function (how the gland is working) or its anatomy (size or nodules). It is possible to have problems in both areas at the same time.
- Function- Hyperthyroidism: This is when the thyroid is producing too much
thyroid hormone. This can be managed by
the use of anti-thyroid drugs, radioactive
Iodine, or surgery. Sometimes a combination
of these options are used.
- Hypothyroidism: This is when there is not enough thyroid
hormone. Treatment usually involves taking
medication to replace the right amount of hormone.
- Anatomy- Enlargement: Often referred to as a goiter- the thyroid may
have gotten bigger without working too much
or too little. When the thyroid gets bigger it
may push on other structures in the neck
causing difficulty breathing or swallowing.
Sometimes growth may cause cosmetic
problems improved by removal.
- Nodules: Sometimes one area of the thyroid will enlarge
more than surrounding portions of the thyroid
causing solid or fluid filled (cystic) nodules.
The majority of these nodules are benign;
however, a small number (approx. 5%) may
be a cancer.
EVALUATION
The thyroid can be evaluated by physical exam, sonogram, nuclear scanning, CT scanning, and FNA (fine needle aspiration). You are probably familiar with these x-ray terms but possibly not FNA. Fine needle aspiration involves using a small needle to obtain some cells from the thyroid for review by the pathologist. Your doctor may simply do this in the office or it may require ultrasound guidance to locate smaller nodules which are hard to feel.
Results of this aspirate may be: benign, indeterminate (not enough cells to make a decision), suspicious, or clearly malignant. This information is used to help decide for surgery or observation of some nodules.
THYROID SURGERY
Some indications for surgery include: hyperthyroidism, solitary nodules, and multinodular goiters. Surgery usually involves removing one lobe or the entire thyroid. Surgery can be offered for concern of cancer or management of symptoms (swallowing difficulty, breathing difficulty, discomfort, unsightly appearance). When removing a portion or the entire thyroid one may require lifelong medication to achieve the right amount of thyroid hormone.
Complications of thyroid surgery are uncommon but may include bleeding, infection, low blood calcium, hoarse voice, as well as more major complications. Low blood calcium may be a result of parathyroid gland dysfunction as these glands are frequently located very close to the thyroid. A hoarse voice may be a result of laryngeal nerve dysfunction. These changes are usually temporary but can be permanent.
Surgery for the thyroid frequently involves general anesthesia and an over-night stay. A small drain tube may be left over-night to keep fluid from accumulating in the wound. After surgery please call your doctor for numbness around the mouth or in your fingers and toes. These can be symptoms of low blood calcium. You should call for any change in swelling of the wound, drainage, or redness.
Call for any questions.
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