Anatomy and Physiology
The thyroid is a butterfly-shaped gland lying directly over the trachea (windpipe). It measures about 2 inches long and 3 - 4 inches wide, and weighs 20 - 25 grams. The recurrent laryngeal nerve courses directly behind the thyroid to supply the larynx (voice-box). The parathyroids are four small glands adjacent to the thyroid and receive their blood-supply from the same sources as the thyroid. The thyroid produces thyroid hormone which regulates metabolism for the entire body.
Thyroid Nodules and Goiters
Thyroid nodules are a common disorder and raise concerns about potential malignancy in the thyroid. Since less than 10% of thyroid nodules are malignant, judicious use of diagnostic and surgical resources by a multidisciplinary team of endocrinologists, endocrine surgeons, and cytopathologists is required to appropriately manage these patients. Generally, the best method to evaluate a nodule is through a fine-needle aspiration. This procedure is frequently performed during a clinic visit and generally is not painful. When cancer is known to be in a nodule or is suspected, surgery is recommended.
Goiters are generally caused by non-malignant enlargement of the thyroid gland. They can become quite large and cause neck discomfort. If they become large enough, they can interfere with swallowing and can obstruct the trachea. Some of these goiters can extend into the chest and are known as substernal goiters.
Thyroid cancer can be divided into the well-differentiated types (papillary and follicular), medullary thyroid cancer, and anaplastic thyroid cancer. The most common are the well-differentiated forms, which generally have an excellent prognosis. Typically, they are treated with a combination of surgery, radioactive iodine, and thyroid suppression. The less common types of thyroid cancer can be very aggressive. Specialized surgical expertise in the thyroid is essential for management of all these patients. Following the diagnosis of thyroid cancer, close teamwork between the endocrinologist, endocrine surgeon, and nuclear medicine physician is required to care for these patients. Some thyroid cancers can be inherited. The RET proto-oncogene is a gene which causes medullary thyroid cancer when it contains certain mutations. The Endocrine Surgery Center can arrange for a patient to be screened for the presence of this mutated gene.
Hyperthyroidism (overactive thyroid) may cause weight loss, increased nervousness, tremors, and palpitations, and usually affects previously healthy individuals. Some types of thyroid disease are accompanied by eye disorders which cause protrusion of the eyes and sometimes threaten vision. Treatment options for hyperthyroidism are medication, radioactive iodine administration, surgery, or a combination of these treatments. With appropriate treatment, the patient returns to his/her previous state of health, but a life-long, daily medication may be required. State-of-the art treatment requires an endocrinologist, a nuclear medicine physician, an endocrine surgeon, and sometimes an ophthalmologist with expertise in thyroid-related eye disease. Grave's disease is a common condition which causes hyperthyroidism.
Thyroid surgery is performed for a variety of indications, including hyperthyroidism, thyroid growth, compression of the windpipe/swallowing tube, or the diagnosis and suspician of thyroid cancer. The surgery usually consists of either a total thyroidectomy (removing the entire thyroid) or a thyroid lobectomy in which one half of the thyroid is removed (either the right or left lobe). Patients are usually admitted to the hospital on the day of their surgery. Generally, they are able to eat regular food later that night, and are discharged home the following morning. Typically, they are able to resume their daily routine after several days.
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