What is the thyroid gland?
The thyroid is a butterfly-shaped hormone gland at the front of the lower neck, in front of the windpipe. Its hormones regulate the body's metabolic rate, heart rate, temperature and energy balance. Its diseases fall into three main groups: enlargement of the gland (goiter), lumps within it (nodules) and disturbed hormone production (under- or over-activity).
What is goiter?
Goiter means an abnormally enlarged thyroid gland. The gland may enlarge diffusely or together with one or more nodules (nodular goiter). Mild enlargement usually causes no symptoms; with advanced enlargement, neck swelling, difficulty swallowing, shortness of breath and voice changes may appear.
When does a thyroid nodule matter?
Thyroid nodules are very common and the great majority are benign; however, since a small proportion may harbour cancer, every nodule deserves proper evaluation. Three basic tools are used: thyroid hormone tests, neck-thyroid ultrasound and, for nodules that require it, fine-needle aspiration biopsy. The ultrasound features and the size of the nodule determine the decision for biopsy. The biopsy result is reported as benign, suspicious or malignant, and follow-up or treatment is planned accordingly.
When is surgery needed?
Surgery comes into consideration mainly in these situations: cancer found or suspected on biopsy; nodules pressing on the windpipe or gullet and causing swallowing or breathing complaints; large goiters extending towards the chest; toxic (hormone over-producing) goiters and nodules that cannot be controlled with medication; and suspicious nodules that grow clearly during follow-up. Half of the gland (lobectomy) or all of it (total thyroidectomy) may be removed; the extent is determined by the type of disease.
The operation and afterwards
Thyroid surgery is performed under general anesthesia through a small incision in the neck. Its most important priorities are protecting the nerves that move the vocal cords and the parathyroid glands that maintain calcium balance. Patients usually go home after one night. When the whole gland is removed, lifelong thyroid hormone replacement is used; after removal of half, most patients need no extra hormone. Follow-up continues with hormone levels and planning of any additional treatment. For neck swellings you may have noticed, see also Lymph Nodes in the Neck.
This article is for general information purposes only; please consult your physician for diagnosis and treatment.