What is thyroid?
Thyroid gland is a butterfly-shaped organ immediately beneath the cartilage called Adam’s apple in anterior part of the neck. It weighs approximately 20 grams. The gland secretes the hormones that are vitally important for our body.
What are the functions of thyroid gland?
Thyroid gland secretes the hormones T3 and T4. Those hormones enter into blood circulation, regulate our metabolism and control the metabolic rate. It affects many functions of various body systems, such as heart rate, cholesterol level, bodyweight, mood and menstrual cycle in various organs and tissues of the body. Various diseases of thyroid gland are detected in approximately 30-40% of the population. Thyroid gland diseases are more common in women.
What are common diseases of thyroid gland?
- Goiter
- Thyroiditis
- Thyroid cancers
- What is goiter?
- Goiter occurs when thyroid gland enlarges due to various reasons. Generally, this growth is in the form of nodules in thyroid gland. There may be single or multiple nodules. They may be in the form of fluid-filled cysts. In diffuse goiter, the entire thyroid gland enlarges. Although they are common, they are mostly benign. Nodules can be millimetric while they can reach to large sizes and involve the entire neck. Thyroid nodules should necessarily be examined.
- What are the symptoms?
- The disorder is mostly asymptomatic. However, an enlarging lump can be palpated in anterior part of the neck. As the size increases, they may result in shortness of breath, difficulty swallowing and hoarseness. Hyperactive nodules that secrete too much thyroid hormone to the blood are manifested by increased heart rate, bad temper, weight loss, tremor and sweating in hands, sleep deprivation and diarrhea. Symptoms of hypothyroidism are slow heart rate, weight gain, constipation, depression, tiredness, weak hair and hair loss, dry skin, memory impairment and irregular menstrual cycles.
- What is Hyperthyroidism?
- Hyperthyroidism occurs when thyroid gland secretes hormones that are more than the need of the body (toxic goiter). Toxic goiter may be associated or not associated with a nodule. The toxic goiter without nodule is also called Basedow Graves’ Disease.
Hyperthyroidism
Symptoms of hyperthyroidism (toxic goiter):
- Palpitation,
- Tremor in hands and body,
- Sudden weight loss,
- Hair loss,
- Itching,
- Feeling of congestion in throat,
- Eating too much and drinking too much water due to strong appetite,
- Abnormal sweating,
- Poor exercise capacity,
- Bad temper are the common complaints.
Some patients complain of nausea, diarrhea, vomiting and frequent defecation. The above listed complaints may not develop simultaneously. Some of those complaints are more dominant; other complaints may only be specified when questioned by the physician. Enlargement and bulging of the eyes can also be noted in some of the patients who have goiter without any nodule. In the examination of these patients, heart rates are too high, respiratory rate increases, tremor is observed in hands and the palms are sweaty.
Treatment of Hypothyroidism
After the diagnosis is verified in the light of blood tests, the deficient amount of thyroid hormone can be administered and healing can be achieved very quickly. These patients need to take medicines lifelong. There is no standard dose for the thyroid hormone used in treatment. Therefore, real and accurate maintenance dose should be determined through analyses and follow-up.
How is thyroid nodule recognized?
Thyroid gland is checked in front of the mirror. For this purpose, an enlargement or swelling immediately under Adam’s Apple in anterior part of the neck should be checked. Thyroid gland is located in this region. These controls should be done by leaning the head back. If any enlargement or swelling is recognized in this region, a physician should be seen.
What should be done for diagnosis of thyroid nodule?
If a nodule is detected in your thyroid gland, you should be followed up and treated by an endocrinologist or an endocrine surgeon. Your physician will obtain detailed information from you to investigate your risk factors, perform the examinations and order necessary tests. First, blood thyroid hormones and thyroid ultrasound are ordered. Fine needle biopsy is performed to collect cell samples from the nodules of thyroid gland in most of the patients. This procedure is called thyroid fine needle aspiration biopsy. The procedure is mostly performed under ultrasonographic guidance in cooperation with a pathologist. Another method that is frequently used for thyroid nodules is thyroid scintigraphy. In this diagnostic method, information can be obtained regarding nodules that are functioning too much (hot nodules) and nodules with insufficient function (cold nodule).
Treatment of thyroid nodules
Treatment of thyroid nodules depends on characteristics of the nodule. If a benign nodule is detected in thyroid fine needle aspiration biopsy, the small nodules that do not tend to enlarge can be followed up. Sometimes, thyroid hormone therapy can be preferred to prevent enlargement of nodules or to reduce them. If the nodules tend to grow in thyroid ultrasound, needle biopsies should be repeated. Patients who have suspicious cells in needle biopsy are operated on. Moreover, surgery is preferred for the patient who suffers shortness of breath and difficulty swallowing due to the pressure on trachea and esophagus.
Is thyroid surgery risky? Does not cause a scar in the surgical site?
Similar to many disciplines of surgery, minimally invasive techniques (that cause less harm) are primarily preferred. Thanks to the technologic advancements, thyroid surgeries are performed using certain devices without any need for stitching or tying the vessels.
The surgery can be performed through a very small incision in selected patients. This technology uses high-frequency ultrasound energy and destructs the hydrogen bands of proteins inside the tissue.
Blood vessels are sealed with lesser thermal damage in a relatively low temperature (80 ℃). Since it is likely to damage the nerves that innervate the vocal cords and the parathyroid glands that regulate calcium homeostasis of the body in thyroid gland surgery, relatively low thermal effect may preserve them in a less hemorrhagic environment.
Studies showed that the surgery shortens with this method comparing to the conventional technique. Moreover, patients’ need for painkillers can be minimized as thyroid surgery can be completed with less bleeding. Avoiding large skin incisions ensures a more aesthetic appearance and helps quick recovery.
The patients usually stay at the hospital for one night after the surgery and they are discharged to home in the next day. There is no need to restrict the volume of voice after the surgery. The patients can resume their daily activities in a short time. As the incision is closed with an aesthetic method, there is no need to remove the sutures.
Who are at risk?
- Individuals who have family members with thyroid diseases such as goiter, thyroid nodule, thyroid cancer and thyroiditis,
- Individuals with history of surgery due to thyroid nodule,
- Smokers,
- Post-menopausal women,
- Individuals with history of radiotherapy for head and neck should have follow-up examinations regularly.
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