Thyroid Surgery

What is the Thyroid Gland?

The thyroid gland is part of the endocrine system, which is a collection of glands that produce chemicals known as hormones. Hormones are chemicals that are produced in one area of the body but exert their effect and a different site.  Hormones are carried to their site of the action through the bloodstream.  Hormones carry out a variety of different actions varying from control of the basal metabolic rate to digestive tract function.

Thyroid Gland Function

The thyroid gland is located at the base of the neck, in front of the trachea; and it has a variety of functions.  The primary function of the thyroid gland is to control the basal metabolic rate.  In essence, the thyroid gland functions as the metabolic thermostat.  The thyroid gland produces two hormones, T3 and t4 that influence a number of body functions.  Increased levels of thyroid hormones can result in chest palpitations, increased heart rate, heat intolerance, weight loss, anxiety, sleeplessness, and diarrhea.  Thyroid function is monitored and regulated by the pituitary gland which produces thyroid stimulating hormones or TSH.  As thyroid function diminishes, the pituitary gland increases the production of TSH to stimulate the thyroid gland activity. Conversely, when the thyroid is overactive, the pituitary decreases the production of TSH in an attempt to minimize thyroid stimulation.  Under active thyroid or hypothyroidism is a very common disease associated with the thyroid gland.  Most commonly, this is caused by a Hasimoto’s thyroiditis which is a disease that results in the patient’s own immune system attacking the thyroid gland.  The patient may go through a period of overactive thyroid, but the ultimate result will be hypothyroidism, requiring thyroid hormone replacement.  Overactive thyroid or hyperthyroidism is a derangement up thyroid function that results in access thyroid hormone production.  In the United States, the most common cause of hyperthyroidism in young to middle-aged the emails is Graves’ disease.  Other common causes of hyperthyroidism include toxic multi modular goiter or a solitary toxic nodule.  Unlike hyperthyroidism, many hyper thyroid patients will eventually require surgical consultation.  Graves’ disease is commonly treated by radioactive iodine (RAI), but there are a number of contraindications to RAI therapy in Graves’ disease.  Radioactive iodine is not as widely accepted in the treatment of toxic multinodular goiter or solitary toxic nodules.

Goiter

Goiter is a term that simply bricked first to enlargement of the thyroid gland.  This may involve the entire thyroid gland or a single side.  A goiter may be multinodular or diffuse (uniformly enlarged) and is not an indication for removal of the thyroid gland in invariably.  Indications for removal of the thyroid gland or thyroidectomy would include enlarging goiter or a goiter that causes compression of the chase and structures including the esophagus or trachea.  Patients that experience difficulty swallowing, changes in their voice, or difficulty breathing may need surgery in order to relieve they are symptoms.

Thyroid Nodules

Thyroid nodules are common findings that had been demonstrated in up to 50% of the general population.  About 8% of the general population will have nodules that are considered to be clinically relevant, meaning the nodule measures greater than a centimeter in diameter.  The vast majority of thyroid nodules prove to be benign, but there is no means a distinguishing the nine vs. malignant nodules on ultrasound or x-ray.  Thyroid nodules are often found incidentally on other imaging tests such as carotid dopplers or cervical spine MRI.  Nodules may also be found when the patient recognizes a lump in their net worth care Physician feels on nodule on examination.  Once the clinically relevant nodule is identified, the nodule must be investigated by means of tissue diagnosis through fine-needle aspiration.  Fine-needle aspiration is generally performed under ultrasound guidance and is very accurate.  If the nodule proves to be benign by fine-needle aspiration the nodule should be observed with repeat ultrasound in 4 to 6 months.  Fine-needle aspiration allows the surgeon to discuss treatment options with the patient.

Thyroid Cancer

Thyroid cancer is the most common endocrine malignancy in the United States.  Over the past 30 years the incidence of thyroid cancer has more than doubled.  Thyroid cancer is generally one of the last a crescent forms of cancer, in most can be cured when properly diagnosed and treated. 97 to 99% of all thyroid cancers are classified as well-differentiated which tend to have a very good long-term prognosis with greater than 80% survival over 20 years.  Papillary carcinoma is the most common form of well-differentiated thyroid cancer with other types including follicular carcinoma and Hurthle cell carcinoma.  Thyroid cancer is treated with removal of the entire thyroid gland and adjacent lymph nodes followed by thyroid hormone replacement and radioactive iodine.  Other forms of thyroid cancer include medullary carcinoma and anaplastic thyroid cancer which are classified as poorly differentiated tumors and tend to have a more aggressive course.

Thyroid cancers allow the physician to track tumor markers such as thyroglobulin for early evidence of recurrent disease.  Thyroglobulin levels are measured by blood work and may prompt a more detailed evaluation including radioactive iodine uptake scanning.  Thyroid ultrasound is a useful tool in identifying thyroid nodules that may represent thyroid cancers.  Ultrasound allows the surgeon Tim age the thyroid gland in a dynamic fashion allowing the ability eat to biopsy by fine-needle aspiration.  After surgery for thyroid cancer, the patient will undergo monitoring of their it thyroglobulin levels at three months and six months as well as neck alter sound evaluation at six months after surgery.  This allows the position to identified lymph node disease or recurrent thyroid cancer within the thyroid bed.

Thyroid Surgery

Thyroid surgery may involve removal of the entire thyroid gland or part depending on the disease process.  Removal of the entire thyroid gland is generally necessary for the treatment of thyroid cancer, while benign disease may be treated with 3 mile oval of a portion gland.  This may allow the patient to avoid thyroid replacement hormone therapy.  Thyroid surgery is performed through a small incision across the lower portion of the neck.  Recovery after thyroid surgery tends to be quick, but the patient having minimal Incisional pain.  Patients are often able to return to work and normal activity within one week after surgery.  They will often have a sore throat that last for 5 to 6 days.  Many patients will experience easy fatigue for the first month after surgery.

Postoperative Instructions following Thyroidectomy

  1. Synthroid will be started on the first morning at home. This is to be taken on an empty stomach with a glass of water.
  2. Calcium supplement can be taken in the form of Os-Cal or TUMS. If you are sent home with calcium supplement, 2 tablets should be taken 2 hours after Synthroid and again at bedtime.
  3. If you experience tingling in your fingertips or around your lips, you should take 2 Os-Cal. If the tingling continues after 30 minutes, take 2 more Os-Cal and wait 30 more minutes. If the symptoms persist, call my office at 595-8985 at any hour.
  4. Wait 30 minutes after taking Synthroid before eating. Try to avoid calcium-containing foods such as milk or cheese for 2 hours.
  5. Do 10 neck stretches by placing the arch anterior chet and then extending your neck fully. This should be repeated several times throughout the day.
  6. It is okay to shower on postoperative day one.
  7. Tape strips should be left in place until you return to the office. If the strips come off on their own, they can be left off.
  8. You may drive when you are off all pain medication and able to look over your shoulder without hesitation.
  9. Chloraseptic spray or Cepacol lozenges may be used for sore throat. Warm saltwater gargling may also be beneficial.
  10. Your diet may be advanced to a regular diet when you feel up to it.
  11. Call 595-8985 for any concerns or questions. This number may be called at any hour.

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