Neck & Face
EARS & HEARING
What Do I Do About a Thyroid Problem?
The thyroid gland is a bowtie shaped gland in the lower part of your neck that sits on top of your trachea (windpipe) attaching a larger lobe on each side. The thyroid gland uses iodine from your diet to make thyroid hormones that control many functions in the body. It is supposed to be under the control of chemicals from the brain but in certain situations functions independently of that control. The parathyroid glands are separate endocrine glands that are found on the back sides of the thyroid gland and secrete parathyroid hormone that specifically controls calcium balance in the body. Ordinarily, there are two glands on each side, a total of four.
Diseases of the thyroid gland are very common, affecting millions of Americans. Thyroid problems come in several “flavors”. These include functional problems involving overproduction or underproduction of thyroid hormone resulting in hyperthyroidism or hypothyroidism, respectively. There are also structural problems of growth regulation of the gland itself which can cause abnormal growth (nodules or cysts) within the gland or enlargement of the gland (goiter). Some of these growths can harbor thyroid cancer. All of the problems in the thyroid have a variety of causes that range from problems stemming in the gland itself to problems completely external to our own bodies (such as exposure to ionizing radiation which can cause both functional and structural problems).
As you might guess, the evaluation and treatment of thyroid problems is highly dependent on what the problem was that drew attention to the thyroid. Did you experience symptoms of thyroid overactivity (rapid heart rate, anxiety, shortness of breath, tremor, heat intolerance) or thyroid underactivity (sluggishness, fatigue, coarsening of the skin, constipation, cold intolerance) that revealed a problem with your thyroid hormone levels? Did you or your doctor feel a knot in or an enlargement of the thyroid gland in your neck? Did someone notice a problem on a test done for other reasons but you aren’t having any related issues? Are you having problems thought to be related to growth of the gland such as hoarseness, excessive throat pressure, unexplained wheezing and tightness with breathing or difficulty swallowing?
Further evaluation might include additional blood work, additional radiographic or nuclear medicine tests, or a biopsy of the thyroid. Thyroid biopsy is almost always best performed with a skinny needle under ultrasonic guidance to try to get the most concerning area. The results of a needle biopsy may be benign (non-cancerous), suspicious or atypical, indeterminate, or malignant (cancerous). Depending on the nature of your condition, treatment may include the following: medication, ablation (non-surgical destruction) of the thyroid, surgical removal of part of the thyroid or the whole thyroid or simply ongoing monitoring of your thyroid.
Thyroid surgery is recommended for most thyroid cancers and when there is a high suspicion of cancer, when an enlarged thyroid (goiter) is causing problems for you, ongoing surveillance of your thyroid is showing continued growth of a nodule or other worrisome signs. It should be noted, that not every thyroid cancer requires treatment; this is an important question that should be discussed with your doctor.
Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Typically, the operation removes the lobe of the thyroid gland containing the lump vs. the entire gland. The decision to remove all or part of your gland should be discussed prior to the surgery but in many cases will be in the operating room by the surgeon, based on findings at the time of surgery. The pros and cons of taking only a single lobe of the gland at the cost of possibly needing a second surgery will be thoroughly disclosed with you as part of your informed consent.