Download Thyroid Surgery - parathyroidindia

Thyroid
The thyroid gland is shaped like a butterfly and usually controls the rate at which the
body produces energy from nutrients. If the body does not get enough iodine, the
thyroid gland cannot produce a proper amount of hormones for this conversion process.
The result can be a goiter, an enlargement of the thyroid gland. The thyroid gland also
secretes hormones that regulate energy, and emotional balance may rely upon its
normal functioning. When the rate of production is excessive, the results can be weight
loss, nervousness, or even emotional disturbances. If the rate of production is
excessively low, a slowing of bodily functions may result.
Thyroid gland disorders may include:
Hypothyroidism
Thyroid nodules (Solitary thyroid nodule STN and Dominant thyroid
nodule)
Multinodular goiter (MNG)
Hyperthyroidism, including:
Graves disease
Toxic multinodular goiter
Toxic solitary nodule
Thyroid cancer, may be of following type:
Papillary thyroid cancer (PTC)
Follicular thyroid cancer (FTC)
Hurthle cell thyroid cancer
Medullary thyroid cancer (MTC)
Poorly differentiated thyroid cancer (PDTC)
Anaplastic thyroid cancer (ATC)
HYPOTHYROIDISM:
Symptoms of hypothyroidism: Some people with hypothyroidism have no symptoms.
But most people feel tired. That can make the condition hard to diagnose, because a lot
of conditions can make you tired.
Other symptoms of hypothyroidism include:




Lack of energy
Getting cold easily
Developing coarse or thin hair
Getting constipated (having too few bowel movements)
If it is not treated, hypothyroidism can also weaken and slow your heart. This can make
you feel out of breath or tired when you exercise and cause swelling (fluid buildup) in
your ankles. Untreated hypothyroidism can also increase your blood pressure and raise
your cholesterol—both of which increase the risk of heart trouble.
In women, hypothyroidism can disrupt monthly periods. It can also make it hard to get
pregnant. In women who do get pregnant, hypothyroidism can cause problems. For
instance, it can increase the chances of having a miscarriage and of having a baby with
low intelligence.
Treatment: Treatment for hypothyroidism involves taking thyroid hormone pills every
day. After you take the pills for about 6 weeks, your doctor or nurse will test your blood
to make sure the levels are where they should be. He or she may adjust your dose
depending on the results. Most people with hypothyroidism need to be on thyroid pills
for the rest of their life.
Thyroid hormone pills come in different brand name and generic forms. All the pills work
equally well. But you should not switch from one generic or brand name to another.
Switching between pills can cause your levels to go up and down.
Never change your dose of thyroid hormone on your own. Taking too much thyroid
hormone can cause heart rhythm problems and even damage your bones.
HYPERTHYROIDISM:
Hyperthyroidism is a condition that can make you feel shaky, anxious, and tired. The
most common cause of hyperthyroidism is called Graves’ disease.
Symptoms of hyperthyroidism: Some people with hyperthyroidism have no
symptoms. When they do occur, symptoms can include:








Anxiety, irritability, or trouble sleeping
Weakness (especially in the arms and thighs, which can make it hard to lift heavy
things or climb stairs)
Trembling
Sweating a lot and having trouble dealing with hot weather
Fast or uneven heartbeats
Feeling tired
Weight loss even when you are eating normally
Frequent bowel movements
Hyperthyroidism can also cause a swelling in the neck called a “goiter.” If it is caused by
Graves’ disease, the condition can also make the eyes bulge.
Untreated hyperthyroidism can cause a heart rhythm disorder called “atrial fibrillation,”
chest pain, and rarely, heart failure.
In women, hyperthyroidism can disrupt monthly periods. It can also make it hard to get
pregnant. In men, hyperthyroidism can cause the breasts to grow or lead to sexual
problems. These problems go away when hyperthyroidism is treated.
Treatment: Hyperthyroidism can be treated with:

Medicines – Two types of medicines can be used to treat hyperthyroidism:

Anti-thyroid medicines reduce the amount of hormone your thyroid gland
makes.

Beta-blocker medicines help reduce the symptoms of hyperthyroidism. Betablockers can make you more comfortable until the thyroid imbalance is under
control.
Medical therapy usually provide symptomatic relief in almost all patients but on
long term recurrence is common after stoppage of therapy so definitive
management in form of Surgery or Radioactive iodine is chosen in majority of
patients.

Surgery – Surgery i.e total removal of thyroid gland is the best choice in selected
case of hyperthyroidism like those having associated thyroid nodule and thyroid
cancer, large goiter, during pregnancy and lactation, with symptoms of airway
compression, if goiter going into chest, severe eye disease, and also preferably
in children. Surgery offers one time permanent cure without any recurrence with
minimal surgical risk if performed by an experienced endocrine surgeon.

Radioactive iodine – Radioactive iodine comes in a pill or liquid you swallow. It
destroys much of the thyroid gland. Pregnant women should not use this
treatment, because it can damage the baby’s thyroid gland. But the treatment is
safe for women who are not pregnant and for men. The amount of radiation used
is small. It does not increase the chance of getting cancer, and it does not cause
problems getting pregnant in the future or increase the risk of birth defects in
future pregnancies.
Most people who are treated with radioactive iodine or who have surgery end up making
too little thyroid hormone after treatment. They must take thyroid hormone pills after
treatment—for the rest of their life.
Thyroid Cancer:
One or more of the following tests may be used to find out if you have cancer and if it
has spread. These tests also may be used to find out if treatment is working.
Fine-needle aspiration cytology (FNAC): Cytology (removal of a small number of
cells and looking at them under a microscope) is the most effective way to diagnose
the thyroid cancer. In FNAC, a thin needle is inserted into the nodule a painless
procedure, and cells are taken out to cytology. Most thyroid nodules are proved by
FNAC to be benign (not cancer).
Imaging tests, which may include:


Ultrasound
CT (computed tomography) scans


MRI (magnetic resonance imaging) scans
PET/CT (positron emission tomography) scans
Radioactive thyroid scan: If a nodule is papillary or follicular cancer, a radioactive
thyroid scan may be used after thyroid surgery to determine if cancer remains or has
spread to other parts of the body. Medullary thyroid cancer cells don't absorb iodine,
so this test is not useful in this type of thyroid cancer.
Genetic testing: If you have medullary thyroid cancer, you will be given a blood test
to determine if you carry a gene that sometimes causes this cancer. If the test is
positive, your children and parents should be tested to see if they have the gene or
thyroid cancer. More than 90% of people who have the gene will eventually develop
thyroid cancer.
If your child has the gene, the doctor probably will suggest removal of the thyroid.
Although children rarely develop cancer before 5 years old, one type of MTC known
as MEN-2B can develop in the early months of life. Based on genetic testing child
may be offered a Prophylactic Thyroidectomy a form of codon-oriented
prophylactic surgery eliminating the risk of medullary thyroid cancer for remaining
lifespan.
Surgery:
Most people with thyroid cancer are treated with surgery. The surgery most likely will be
one of the following:


Total thyroidectomy: The entire thyroid is removed
Hemi thyroidectomy: Only the side of the thyroid where the tumor is located is
removed. This type of surgery may be used for papillary cancers smaller than 1
centimeter that have not spread to lymph node.

Lymph nodes in the area of the tumor or in the neck and/or chest also may be
removed i.e. Central Compartment Lymph Node Dissection (CCLND) and
Modified Radical Lymph Node Dissection (MRND).
If your entire thyroid gland is removed, you will take thyroid hormone replacement pills
daily for the rest of your life.
Radioactive iodine: You drink a liquid or swallow a pill that contains radioactive
iodine, which collects in thyroid tissue and destroys cancer cells. This method also is
used to eliminate any thyroid cells in other parts of the body remaining after
thyroidectomy for thyroid cancer in selected patients.
If radioactive iodine is used after surgery, you may be asked to discontinue your
thyroid hormone medicine to make the iodine more effective. This can sometimes be
uncomfortable. A newer method gives recombinant thyroid stimulating hormone
(rTSH) by injection and does not require stopping thyroid medicine. Women should
not become pregnant for six months to a year after radioactive iodine treatment.
Thyroid Hormone Therapy: This treatment uses thyroid hormone pills to stop the
growth of cancer cells. In papillary or follicular thyroid cancer, hormone treatment
may be used to lower the level of thyroid stimulating hormone (TSH), which may help
stop the cancer from coming back. In other thyroid cancers, it may be used to keep
thyroid hormone levels normal.
Chemotherapy: Chemotherapy often is used in combination with external beam
radiation therapy to treat anaplastic thyroid cancer. It is usually not effective in other
types of thyroid cancer.
External beam radiation: This type of therapy is most effective for thyroid cancers
that do not absorb iodine, including anaplastic thyroid cancer. It may be used to fight
thyroid cancer cells remaining after surgery or if cancer spreads to the bones.