Endocrine Surgery

Thyroid Nodules

Thyroid Gland

The thyroid is a butterfly-shaped gland in the neck that consists of two lobes and a narrow isthmus between them. It lays over the trachea, or windpipe. The gland makes thyroid hormone, an important regulator of metabolism. Overproduction of thyroid hormone is called hyper thyroidism. Symptoms of hyper thyroidism include nervousness, irritability, heat intolerance, rapid heartbeat, muscle weakness, fatigue, frequent bowel movements, light menstrual periods, weight loss, and hair loss. Under production is called hypothyroidism. Symptoms of hypothyroidism include decreased energy level, feeling cold, muscle pain, slowed thinking, constipation, long menstrual periods, weight gain, brittle nails and hair, and depression.

Thyroid Nodules and Goiter

A nodule is a lump of tissue in the thyroid gland. The gland may develop one or many nodules. Most of the time, nodules do not affect the production of thyroid hormone and do not cause symptoms. It may or may not be possible to feel thyroid nodules. Most nodules are benign, but on occasion, they can be malignant. A goiter is the enlargement of the whole thyroid gland. You may be able to see or feel a swelling in the neck. Goiters can develop from enlargement of the gland tissue or from the presence of multiple nodules.

Thyroid Evaluation

Thyroid function tests can help diagnose hyper thyroidism or hypothyroidism. Ultrasound can identify nodules and cysts, provide measurements of these lesions, and identify areas that are suspicious for cancer. A thyroid scan is a nuclear medicine test that can identify whether nodules are “hot” or “cold”. Hot nodules can be associated with hyperthyroidism. Cold nodules are more likely to harbor malignancy. Fine needle aspiration (FNA) biopsy can help determine if a thyroid nodule is malignant. It is often done with ultrasound guidance.

Treatment of Nodules

Small, stable, and asymptomatic nodules may need no specific treatment other than periodic follow-up by your primary care physician. In some situations, thyroid hormone medication may be prescribed to suppress further growth of a nodule.

Surgical removal of part or the entire thyroid is necessary if an enlarged gland is symptomatic or if the nodules are growing. Surgery is also necessary if cancer is suspected or confirmed. Further treatment after surgery with radioactive iodine may also be necessary. An endocrinologist will coordinate iodine treatment.

Treatment for an overactive thyroid can include medications, radioactive iodine treatment, or surgery. The decision regarding which treatment is best for you depends on your particular situation.

Surgery

Thyroid surgery requires general anesthesia. The incision is two to three inches long and is placed across the front of the neck. Surgery usually involves removing either the entire thyroid gland (total thyroidectomy) or just one lobe (lobectomy).

Total thyroidectomy is generally recommended if the entire gland is abnormally enlarged, if a fairly large cancer has been diagnosed, or if there are suspicious nodules in both lobes.

A lobectomy is recommended if there is a concerning nodule in only one lobe. This nodule may be large and symptomatic, overactive, or suspicious for being a cancer.

Often it is not possible to know with certainty if a nodule is cancerous prior to surgery, so the suspicious nodule is removed in order to determine this. If the nodule does turn out to be malignant, then it may be necessary to remove the other lobe as well. So that subsequent radioactive iodine treatment can be effective. The pathologist may not be able to make the diagnosis of cancer until one or two days after surgery. Therefore, it is occasionally necessary to return to surgery at that point for removal of the other lobe. Sometimes removal of lymph nodes may also be necessary if cancer is present.

Recovery

Thyroid SurgeryAfter the procedure, you will be watched in the recovery room until awake. If you had a lobectomy, you may be able to go home the same day.

If you had a total thyroidectomy, you will stay at least one night and possibly longer. After a total thyroidectomy, it is necessary to monitor your calcium level. The parathyroid glands are four tiny glands found near the thyroid gland. They regulate calcium metabolism. They are often tightly adhered to the thyroid, and are separated from it during surgery. Removal of the entire thyroid gland can affect their function. You will be placed on calcium supplements after surgery, and this will be continued until your parathyroid glands have resumed normal function.

You may eat and drink after surgery as tolerated. We encourage you to get up and walk. A sore throat and mild hoarseness are common. You may shower the day after surgery. You should follow-up in the office about one week after surgery.

Complications

Fortunately, complications are rare. As with any surgical procedure, there are risks, and you should be aware of them. Risks can include

  • Bleeding in the neck after surgery. This can be serious if the blood puts pressure on the trachea (wind pipe).
  • Infection.
  • Injury of nerves going to the vocal cords. This can lead to temporary or permanent hoarseness.
  • Injury of the parathyroid glands with resulting low blood calcium level. This may result in the need for temporary or permanent calcium supplements. Extremely low calcium levels can be dangerous.
  • Complications related to anesthesia.
  • Other complications.

Be sure to call us if you experience increasing swelling at the incision site (some swelling is expected), severe pain, bleeding, signs of infection, or temperature over 100.4 F degrees. You should also call if you experience tingling around the lips or cramping of the hands or feet (signs of low calcium).