Thyroid Surgery

Introduction:

The thyroid gland is a bowtie-shaped endocrine gland located in the lower part of the front of the neck. It is positioned just below the voice box (larynx) and in front of the wind pipe (trachea) and food pipe (esophagus). The thyroid gland has two sides known as the left and right "lobes" that are connected to each other by a narrow segment of thyroid tissue called the "isthmus."

Formation of nodules within the thyroid gland is quite common in the general population. While up to 50% of the adult population may have nodules, only a fraction of these nodules become visibly detectable or palpable by your physician during a routine physical examination. Statistically, approximately 300,000 new thyroid nodules are found every year in the United States. Fortunately only less than 5% of all thyroid nodules are malignant (cancerous) and the remaining 95% of thyroid nodules are "benign" (noncancerous). However, when a thyroid nodule is found either by the patient on self examination, by the physician during a physical examination and/or incidentally during an imaging study (such as MRI, CAT scan or ultrasound) performed for another reason, it is important to perform the necessary tests to make sure that the nodule is not cancerous. There are many different types of cancer that may arise in the thyroid gland. The most common ones originate in the thyroid cells themselves such as "Papillary carcinoma" and "Follicular carcinoma". Others arise from cells associated with the thyroid gland such as "Medullary carcinoma". The most aggressive form of thyroid cancer is "Anaplastic carcinoma". In addition, other cancers such as lymphoma and squamous cell cancer may occur in thyroid gland. To correctly diagnose thyroid cancer and its type, the thyroid physician or surgeon will perform variety of medical tests including a high resolution thyroid ultrasound (imaging the thyroid gland using sound waves without exposure to X-ray radiation), a fine needle aspiration biopsy (a minor procedure, usually done at the doctor's office, to remove a few cells from the nodule using a small needle under local anesthesia to be evaluated under the microscope) and possibly a radionuclide thyroid scan to assess the metabolic function of the thyroid gland or its nodules. Sometimes, depending on the findings during the office examination, the physician may recommend MRI scan (Magnetic Resonance Imaging) or CAT scan (Computerized Axial Tomography) in order to accurately evaluate the thyroid gland and the adjacent structures such as the lymph nodes, the windpipe and the voice box. Sometimes, given the size or location of the thyroid nodule, the needle biopsy needs to be performed under ultrasound guidance to improve its accuracy in sampling the target tissues.

Types of Thyroid Surgery:

Most thyroid conditions such as overactive thyroid ("hyperthyroidism"), underactive thyroid ("hypothyroidism") and inflammatory thyroid diseases ("thyroiditis") do not need surgery. However, under certain circumstances a portion or the entire thyroid gland may need to be removed by surgery. Thyroid surgery is usually recommended if there is suspicion or diagnosis of cancer, the thyroid gland is so enlarged ("goiter") that causes compression of the food pipe (esophagus) causing difficulty swallowing or if it causes compression and displacement of the wind pipe (trachea) resulting in difficulty breathing, or if a benign (noncancerous) thyroid cyst or solid nodule is very large and cannot be drained with a needle or shrunk with medication. In addition, some times in inflammatory diseases of thyroid that does not respond to antithyroid medications or the patient is reluctant to undergo radioiodine therapy (nuclear radiation to the thyroid gland) such as in Grave's Disease, thyroid surgery is indicated and recommended as an alternative treatment.

The extent and the type of thyroid surgery vary a great deal and are dictated by the type of the thyroid condition and the extent of the disease. For known benign (noncancerous) tumors that are confined to one lobe, only that lobe of the thyroid is removed in an operation called "thyroid lobectomy" or "hemithyroidectomy". If thyroid cancer is diagnosed definitively, usually a "total thyroidectomy" is the minimum operation during which the entire thyroid gland is removed. In such cases, often times, the lymph nodes around the thyroid, in the center compartment of the neck is also removed surgically in an operation called "central compartment lymph node dissection". In case of thyroid cancer that has spread (metastasized) to the lymph nodes of the neck lateral to the thyroid around the jugular veins, a "modified neck lymph node dissection" is indicated in order to remove all the disease bearing lymph nodes. By doing so, chances of recurrence and persistence of thyroid cancer is significantly reduced. In other times, when there are multiple nodules on both sides of the thyroid, but they are not malignant (cancerous) a "subtotal thyroidectomy" is performed which removes most of the thyroid tissue from both sides leaving a small but normal thyroid tissue behind.

Thyroid Surgery Continued »

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