Thyroid Disorders and Surgery

In Denver and Lone Tree, Colorado

Your thyroid gland is one of the endocrine glands that makes hormones to regulate physiological functions in your bodylike metabolism (heart ratesweatingenergy consumed)Other endocrine glands include the pituitaryadrenaland parathyroid glands and specialized cells within the pancreas.

The thyroid gland is located in the middle of the lower neckbelow the larynx (voice box) and wraps around the front half of the trachea (windpipe)It is shaped like a bow tiejust above the collarboneshaving two halves (lobes) joined by a small tissue bar (isthmus.)You can’t always feel a normal thyroid gland.

What is a thyroid disorder?

Diseases of the thyroid gland are very commonaffecting millions of AmericansThe most common thyroid problems are:

  • An overactive glandcalled hyperthyroidism (e.g., Graves’ diseasetoxic adenoma or toxic nodular goiter).
  • An underactive glandcalled hypothyroidism (e.g., Hashimoto’s thyroiditis).
  • Thyroid enlargement due to overactivity (as in Graves’ disease) or from under-activity (as in hypothyroidism)An enlarged thyroid gland is often called a “goiter.

Patients with a family history of thyroid cancer or who had radiation therapy to the head or neck as children for acneadenoidsor other reasons are more prone to develop thyroid malignancy.

If you develop significant swelling in your neck or difficulty breathing or swallowingyou should call one of our ENT physicians or be seen in the emergency room.

Thyroid disorder treatment

Depending on the nature of your conditiontreatment may include the following:

Hypothyroidism treatment:

  • Thyroid hormone replacement pills.
  • Hyperthyroidism treatment.
  • Medication to block the effects of excessive production of thyroid hormone.
  • Radioactive iodine to destroy the thyroid gland.
  • Surgical removal of the thyroid gland.

Goiters (lumps) Treatment: 

If you experience this conditionone of our ENT physicians will propose a treatment plan based on the examination and your test resultsHe may recommend:

An imaging study to determine the sizelocationand characteristics of any nodules within the glandTypes of imaging studies include CT or CAT scansultrasoundor MRIs.

A fine-needle aspiration biopsy—a saferelatively painless procedureWith this procedurea hypodermic needle is passed into the lumpand tissue fluid samples containing cells are takenSeveral passes with the needle may be requiredSometimes ultrasound is used to guide the needle into the noduleThere is little pain afterward and very few complications from the procedureThis test gives the doctor more information on the nature of the lump in your thyroid gland and may help to differentiate a benign from a malignant or cancerous thyroid mass.

Thyroid surgery may be required when:

  • The fine needle aspiration is reported as suspicious or suggestive of cancer.
  • Imaging shows that nodules have worrisome characteristics or that nodules are getting bigger.
  • The trachea (windpipe) or esophagus are compressed because both lobes are very large.

Historicallysome thyroid nodulesincluding some that are malignanthave shown a reduction in size with the administration of thyroid hormoneHoweverthis treatmentknown as medical “supression” therapyhas proven to be an unreliable treatment method.

What is thyroid surgery?

Thyroid surgery is an operation to remove part or all of the thyroid glandIt is performed in the hospitaland general anesthesia is usually requiredTypicallythe operation removes the lobe of the thyroid gland containing the lump and possibly the isthmusA frozen section (immediate microscopic reading) may be used to determine if the rest of the thyroid gland should be removed during the same surgery.

Sometimesbased on the result of the frozen sectionthe surgeon may decide not to remove any additional thyroid tissueor proceed to remove the entire thyroid glandand/or other tissue in the neckThis decision is usually made in the operating room by the surgeonbased on findings at the time of surgeryYour surgeon will discuss these options with you preoperatively.

As an alternativeyour surgeon may choose to remove only one lobe and await the final pathology report before deciding if the remaining lobe needs to be removedThere also may be times when the definite microscopic answer cannot be determined until several days after surgeryIf a malignancy is identified in this wayyour surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedureIf you have specific questions about thyroid surgeryask your otolaryngologist to answer them in detail.

What happens after thyroid surgery?

During the first 24 hours after surgeryyou may have a drain (tiny piece of plastic tubing)which prevents fluid and blood from building up in the woundThis is removed after the fluid accumulation has stabilizedusually within 24 hours after surgeryMost patients are discharged later the same day or the next day.

Complications are rare but may include:

  • Bleeding.
  • Bleeding under the skin that rarely can cause shortness of breath requiring immediate medical evaluation.
  • A hoarse voice.
  • Difficulty swallowing.
  • Numbness of the skin on the neck.
  • Vocal cord paralysis.
  • Low blood calcium.

At home, following the procedureif it is determined that you need to take any medicationyour surgeon will discuss this with you prior to your discharge.

Medications may include:

  • Thyroid hormone replacement.
  • Calcium and/or vitamin D replacement.
  • Some symptoms may not become evident for two or three days after surgeryIf you experience any of the followingcall your surgeon or seek medical attention:
  • Numbness and tingling around the lips and hands.
  • Increasing pain.
  • Fever.
  • Swelling.
  • Wound discharge.
  • Shortness of breath.

If a malignancy is identifiedthyroid replacement medication may be withheld for several weeksThis allows a radioactive scan to better detect any remaining microscopic thyroid tissueor spread of malignant cells to lymph nodes or other sites in the body.

Thyroid disorder diagnosis

The diagnosis of a thyroid function abnormality or a thyroid mass is made by taking a medical history and a physical examinationIn additionblood testsimaging studiesand/or fine-needle aspiration may be requiredAs part of the examone of our ENT physicians will examine your neck and ask you to lift up your chin to make your thyroid gland more prominentYou may be asked to swallow during the examinationwhich helps to feel the thyroid and any mass in it.

Tests your doctor may orderinclude:

  • Evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope.
  • An ultrasound examination of your neck and thyroid.
  • Blood tests of thyroid function.
  • A radioactive thyroid scan.
  • A fine-needle aspiration biopsy.
  • A chest X-ray.
  • A CT or MRI scan.