Thyroid Gland Surgery 1: Reasons for Thyroid Surgery

The thyroid gland is located in the middle of the neck (above the trachea) and is shaped like a butterfly. It is an endocrine gland – the part of the endocrine system - and produces and releases hormones into the bloodstream. The main hormones produced by thyroid gland are thyroxin and triiodothyronin (T4 and T3) and they play a major role in regulating the body's metabolism. If these hormones are not produced in sufficient amounts, the body’s metabolism can be lowered by 40%!

If you are experiencing problems that may be caused by thyroid dysfunction (like fatigue, sleepiness, constant feeling cold etc.) your physician may order the thyroid hormone analysis. A condition in which the thyroid gland does not make enough thyroid hormones is called hypothyroidism. On the other side, condition in which the thyroid gland produces too much of thyroid hormones is called hyperthyroidism, and is characterized by overactive metabolism (insomnia, nervousness, overactive sweating, handshake, problems with heart rhythm etc.). In cases in which hyperthyroidism cannot be treated with medications, surgical removal of the part of the thyroid gland is the option.

Goiter is a term that refers to any enlargement of the thyroid gland and can be associated with a gland that is functioning properly or not. Worldwide, over 90% cases of goiter are caused by iodine deficiency. For particularly large masses, compression of the local structures (larynx, trachea, esophagus) may result in difficulty in breathing or swallowing, and in these cases surgical removal of the mass will help.

Today, the most common reason for the thyroid gland surgery is the nodule in the thyroid – but not every nodule discovered in the thyroid should be the reason to perform a surgery! About 5 to 10 percent of adults may have lumps in their thyroid that can be palpated by fingers on a simple physical exam, but with the aid of high-resolution imaging techniques nodules can be discovered in 30-40 percent of adults!

Ultrasound image of thyroid nodule (arrow) 

Thyroid gland is best evaluated using high-resolution ultrasonography. If one or more nodules are detected within the thyroid gland, doctor who specialize in neck ultrasonography will recognize detailed features of these nodules, like shape, vascularity, calcifications, diameter, and density. Some features are strongly suggestive that a nodule is benign in nature, and some raise concern that the nodule may be a cancer. In some cases it is impossible to distinguish between benign and malignant nodules with complete certainty. In these cases fine needle aspiration biopsy and review of tissue under a microscope may be recommended for further evaluation.

If a fine needle aspiration biopsy proves the diagnosis of cancer or further raises suspicion that the nodule may be a cancer, it is necessary to surgically remove a thyroid. An operation that involves the surgical removal of all or part of the thyroid gland is called a thyroidectomy. If treated on time, majority of thyroid cancer patients have an excellent prognosis. With the aid of surgery, and postoperative iodine treatment, cured are more that 95% of patients!!

Dr. Sasa Janjanin is double European Board-certified in ENT and Facial Plastic Surgery. He extensively trained in complete surgical and medical treatment of patients with disorders and diseases of the head and neck. However, his major expertise is in facial plastic, aesthetic and reconstructive surgery; problems related to thyroid and parathyroid glands; skin cancer; kid’s ENT problems; nose, sinus and snoring complaints; and sport and diving-related ENT problems.

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