What is Your Thyroid Gland?
Your thyroid gland is one of several endocrine glands, which makes hormone to regulate physiological functions in your body. The thyroid gland manufactures thyroid hormone, which regulates the rate at which your body carries on its necessary functions. Other endocrine glands are the pancreas, the pituitary, the adrenal glands, the parathyroid glands, the testes, and the ovaries.
The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and just above your clavicles (collarbones). It is shaped like a “bow tie,” having two halves (lobes): a right lobe and a left lobe joined by an “isthmus.” You can’t always feel a normal thyroid gland.
When Is a Thyroid Gland Abnormal?
Diseases of the thyroid gland are very common, affecting millions of Americans. The most common diseases are an over- or under-active gland. These conditions are called hyperthyroidism (e.g., Grave’s disease) and hypothyroidism. Sometimes the thyroid gland can become enlarged from over-activity (as in Grave’s disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a “goiter.” Sometimes an inflammation of the thyroid gland (Hashimoto’s thyroiditis) will cause enlargement of the gland.
Patients may develop lumps or nodules in their thyroid gland. They may appear gradually or rapidly. Patients who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy. Your doctor should evaluate all thyroid nodules.
How Does Your Doctor Diagnose Thyroid Problems?
Thyroid gland function is best evaluated with blood tests. Nodules of the thyroid gland are best evaluated with Ultrasound examination. Your doctor may also order a needle biopsy of any nodule and this is sometimes performed with Ultrasound guidance.
Fine Needle Aspiration
If a lump in your thyroid is diagnosed, your doctor may recommend a fine needle aspiration biopsy. This is a safe, relatively painless procedure. A small needle is passed into the lump, and samples of tissues are taken. Several passes with the needle are required in order to obtain enough tissue for a diagnosis. There is little pain afterwards and complications are uncommon. This test gives the doctor more information on the nature of the lump in your thyroid gland and can help to differentiate a benign from a malignant thyroid mass. While some thyroid cancers are easily diagnosed with a needle biopsy, others are not. Your doctor will help interpret the pathology results and formulate a treatment plan that is best for your situation.
Treatment of Thyroid Disease
Abnormalities of thyroid function (hyper or hypothyroidism) are usually treated medically. If there is insufficient production of thyroid hormone, a supplemental thyroid hormone pill can be taken daily. Hyperthyroidism is treated by either medication or surgery.
If there is a thyroid nodule or a diffuse enlargement (goiter), your doctor will propose a treatment plan based on the examination and your test results. Most thyroid nodules are benign. Sometimes they may be treated with thyroid hormone, and this is called “suppression” therapy. The object of this treatment is to attempt shrinkage of the mass over time, usually 3-6 months. If the lump continues to grow during treatment when you are taking the medication, most doctors will recommend removal of it.
If the fine needle aspiration is reported as suspicious for cancer, thyroid surgery is indicated.
What Is Thyroid Surgery?
Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital and general anesthesia is required. Usually the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (an immediate microscopic reading) may be used to determine if the rest of the thyroid gland should be removed.
After surgery, you may have a drain (a tiny piece of plastic tubing), which prevents fluid from building up in the wound. This is removed within a few days when the fluid accumulation is minimal. Most patients are discharged 1-2 days after surgery. Complications after thyroid surgery are uncommon but include bleeding, a hoarse voice, difficulty swallowing, and low blood calcium. Patients who have all of their thyroid gland removed have a higher risk of low blood calcium post-operatively.
Patients who have thyroid surgery may be required to take thyroid medication to replace thyroid hormones after surgery. Some patients may need to take calcium replacement if their blood calcium is low. This will depend on how much thyroid gland remains, and what was found during surgery.