THE THYROID GLAND & THYROID SURGERY

The thyroid gland lies in front of the neck just below the Adam’s apple. It is butterfly shaped. The right and left wings (lobes) are joined by a small bridge of thyroid tissue (body) called the isthmus, and surround the windpipe. The thyroid gland manufactures thyroid hormones, which are chemicals that are essential for survival.

Goitre and its implications

Any enlargement of the thyroid gland is called goitre. When the whole gland is enlarged it is called a diffuse goitre. If there is a single nodule, it is termed a solitary nodule. The majority of goitres are not cancerous, but a small proportion of goitres may harbour cancer cells. Therefore all thyroid swellings should be investigated by an ENT specialist.

Investigation and treatment of a thyroid lump

During the consultation, a detailed history the problem is noted and an examination is carried out. This is followed by an ultrasound scan, during which a needle may be inserted into the lump to collect a sample of cells, this is called fine needle aspiration cytology test (FNAC). These cells are analysed under the microscope to determine the nature of the growth.

Other tests, such as a CT scan, MRI scan or nuclear isotope scan which may be required in some cases. Often no treatment may be necessary and you will be advised to adopt a ‘watch and wait policy’.

Alternatively, surgery may be advised. This is commonly undertaken when there is a suspicion of cancer, pressure symptoms (problem swallowing or tightness in the neck and chest etc.), altered activity, and cosmetic concerns. The surgery is called Thyroidectomy and is explained briefly below.

Thyroidectomy

There are different terms used to describe thyroid surgery. The following is a summary:

• Hemi-thyroidectomy or lobectomy implies a part (usually a lobe) of the gland is removed
• Isthmusectomy: where only the midline bridge of the gland is removed
• Total thyroidectomy implies removal of all the thyroid gland
• Sub-total or near-total thyroidectomy: most of the gland is removed. This procedure is not generally performed these days

Risks involved in Thyroid Surgery

The risks involved are significant but are rare and will be discussed before surgery:

• Bleeding
• Changes in voice: Nerves called the recurrent laryngeal nerve (RLN) and the superior laryngeal nerve (SLN) that maintain normal function of the voice box (larynx) are in close proximity to the thyroid gland. These may be affected during surgery, and may cause voices changes, cough, and sometimes problems swallowing
• Parathyroid – calcium problems: This is applicable for total thyroidectomy. The parathyroid glands that control the level of calcium in the blood lie close to the thyroid gland. If these glands are affected, the calcium levels may fall. As a result, you may experience tingling sensations in your hands, fingers, toes, in your lips or around your nose. All of this is monitored closely after surgery
• Neck and shoulder stiffness: Some discomfort and stiffness around the neck and shoulders is common. Regular massage helps this situation and settles quickly

Effects of removing the thyroid gland

If the entire thyroid gland is removed you will need to take replacement thyroid hormone, thyroxine (T4) in tablet form indefinitely. The amount of thyroxine needed will be monitored based on blood tests.

If only part of the thyroid gland is removed, then no hormone replacement is required and the remaining gland will produce enough hormones to meet the demands of the body. Blood tests will be done to confirm this after the operation.