Thyroid GDisease

The thyroid is a vital gland in the body responsible for producing hormones that regulate various bodily functions. Thyroid diseases occur when the gland produces either excessive or insufficient amounts of these hormones. Common types of thyroid diseases include hyperthyroidism, hypothyroidism, thyroiditis, and Hashimoto's thyroiditis.

Located at the front of the neck, wrapped around the windpipe (trachea), the thyroid gland resembles a butterfly in shape, with a smaller middle portion and two wider wings extending around the sides of the throat. As a gland, the thyroid releases hormones that play crucial roles in numerous bodily processes.

When the thyroid malfunctions, it can affect the entire body. Excessive production of thyroid hormone leads to hyperthyroidism, while insufficient production results in hypothyroidism. Both conditions require medical attention and treatment by a healthcare provider due to their serious implications for overall health.

What is the Thyroid?

Thyroid disease refers to a range of medical conditions that disrupt the normal functioning of the thyroid gland, leading to imbalances in hormone production. Normally, the thyroid gland produces hormones that help regulate various bodily functions.

When the thyroid gland produces an excessive amount of thyroid hormone, a condition known as hyperthyroidism occurs. In hyperthyroidism, the body's metabolism accelerates, leading to symptoms such as rapid heartbeat, unintentional weight loss, and nervousness.

Conversely, when the thyroid gland produces insufficient thyroid hormone, it results in hypothyroidism. In hypothyroidism, the body's metabolism slows down, causing symptoms such as fatigue, weight gain, and intolerance to cold temperatures.

Both hyperthyroidism and hypothyroidism require medical evaluation and treatment to manage symptoms and restore thyroid hormone levels to normal.

What is Thyroid Disease?

Thyroid disease can be caused by various factors, leading to either hypothyroidism or hyperthyroidism. Here are some common causes:

Causes of Hypothyroidism:

Thyroiditis: Inflammation of the thyroid gland can reduce hormone production.
Hashimoto's thyroiditis: An autoimmune disease where the body's immune system attacks the thyroid gland, leading to decreased hormone production.
Postpartum thyroiditis: Temporary inflammation of the thyroid gland occurring after childbirth.
Iodine deficiency: Inadequate intake of iodine, necessary for thyroid hormone synthesis.
Congenital hypothyroidism: Thyroid gland dysfunction present from birth, often due to abnormal development or genetic factors.

Causes of Hyperthyroidism:

Graves' disease: An autoimmune disorder causing the thyroid gland to produce excessive hormone.
Thyroid nodules: Abnormal growths in the thyroid gland that produce excess hormone.
Thyroiditis: Inflammation of the thyroid gland causing the release of stored hormone.
Excessive iodine intake: Consuming too much iodine, leading to increased hormone production.
Certain medications: Some medications, such as amiodarone, can cause hyperthyroidism due to their iodine content.

Identifying the underlying cause of thyroid dysfunction is essential for appropriate treatment and management of thyroid disease.

What causes Thyroid Disease?

Assoc. Dr. Mutlu Ünver graduated from Ege University Faculty of Medicine. Mutlu Ünver, who completed his specialty training at Ege University Faculty of Medicine, Department of General Surgery, serves his patients in his own clinic.

Assoc.Prof.

Mutlu Ünver

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Treatment for thyroid disease varies depending on whether it involves hypothyroidism or hyperthyroidism:

Hyperthyroidism Treatment:

Anti-thyroid drugs: Medications like methimazole and propylthioracil can inhibit the thyroid from producing excess hormones.
Radioactive iodine therapy: This treatment involves taking radioactive iodine orally, which selectively destroys thyroid cells, reducing hormone production.
Beta-blockers: These medications help manage symptoms like rapid heart rate and tremors by blocking the action of adrenaline.
Thyroidectomy: Surgical removal of part or all of the thyroid gland may be necessary in severe cases or if other treatments fail.

2. Hypothyroidism Treatment:

Thyroid hormone replacement therapy: Synthetic thyroid hormone medications like levothyroxine are used to supplement low thyroid hormone levels and restore normal function.
Regular monitoring: Periodic blood tests are performed to ensure thyroid hormone levels remain within the desired range and adjust medication dosage if necessary.

It's essential for individuals with thyroid disease to work closely with their healthcare provider to determine the most appropriate treatment plan based on their specific condition, symptoms, and overall health.

Yes, there are different types of thyroid removal surgery, also known as thyroidectomy. The choice of procedure depends on various factors such as the condition of the thyroid gland and the patient's overall health. The two main approaches to thyroidectomy are:

Conventional Thyroidectomy:

This procedure involves making an incision in the front of the neck, typically along a natural skin crease, to access the thyroid gland.
The surgeon removes part or all of the thyroid gland through this incision, depending on the reason for the surgery.
Conventional thyroidectomy allows for direct visualization of the thyroid gland and precise removal of tissue.

2. Transaxillary Thyroidectomy:

In this approach, the incision is made in the armpit (axilla) instead of the front of the neck.
The surgeon uses specialized instruments and endoscopic techniques to access and remove the thyroid gland through this remote incision.
Transaxillary thyroidectomy offers the advantage of a scar hidden in the armpit, resulting in a potentially less visible scar on the neck.

The choice between these techniques depends on factors such as the size and location of the thyroid gland, the presence of nodules or tumors, and the patient's preferences regarding scarring and cosmetic outcome. It's essential for patients to discuss these options with their healthcare provider to determine the most suitable approach for their specific situation.

Are there different types of thyroid removal surgery?

The incision on the front of your neck is more of the traditional version of a thyroidectomy. It allows your surgeon to go straight in and remove the thyroid. In many cases, this might be your best option. You may need this approach if your thyroid is particularly big or has a lot of larger nodules.

Alternatively, there is a version of thyroid removal surgery where your surgeon makes an incision in your armpit and then creates a tunnel to your thyroid. This tunnel is made with a special tool called an elevated retractor. It creates an opening that connects the incision in your armpit with your neck. The surgeon will use a robotic arm that will move through the tunnel to get to the thyroid. Once there, it can remove the thyroid back through the tunnel and out of the incision in your armpit.

This procedure is often called scarless because the incision is under your armpit and out of sight.

However, it’s more complicated for the surgeon and the tunnel is more invasive for you. You may not be a candidate for this type of thyroid removal if you:

Are not at a healthy body weight.
Have large thyroid nodules.
Have a condition like thyroiditis or Graves’ disease.

Talk to your healthcare provider about all of your treatment options and the best type of surgery for you.

With an incision on the front of your neck.

Recovery from thyroid surgery, also known as thyroidectomy, typically takes a few weeks. During this time, it's important to follow your healthcare provider's instructions carefully to ensure proper healing. Here are some key points about recovery from thyroid surgery:

Duration of recovery: Recovery generally lasts for about two weeks, during which time you should avoid certain activities such as submerging your incision under water, lifting heavy objects (over 15 pounds), and engaging in strenuous exercise.
Return to normal activities: After the initial two-week recovery period, you can gradually return to your normal activities. However, it's essential to listen to your body and avoid overexertion.
Partial thyroid removal: In some cases, only part of the thyroid may be removed during surgery, leaving the other part intact. This approach is more likely when dealing with thyroid nodules. About 75% of people who undergo partial thyroid removal can still produce enough thyroid hormone without the need for medication.

Overall, recovery from thyroid surgery involves allowing your body time to heal and adjusting your activities accordingly. It's essential to follow your healthcare provider's recommendations closely to ensure a smooth recovery process and optimal outcomes.

How Long Does It Take To Recover From Thyroid Surgery (thyroidectomy)?

How is Hyperthyroidism and Hypothyroidism Treated?

When is surgical intervention required in thyroid diseases?

Surgical intervention for thyroid diseases may be recommended in various situations to address specific concerns or conditions. Here are some scenarios in which surgery may be required:
Nodule Size: If a thyroid nodule is larger than 1 cm in diameter, surgical intervention may be considered. Larger nodules may pose a greater risk of malignancy or may cause symptoms such as difficulty swallowing or breathing.
Biopsy Results: If a biopsy of the thyroid nodule reveals suspicious or malignant cells, surgery may be necessary to remove the affected tissue and prevent the spread of cancer.
Compression Symptoms: Thyroid nodules or enlargement of the thyroid gland (goiter) can sometimes exert pressure on the surrounding structures, including the windpipe (trachea) and esophagus. If the nodule or goiter is causing compression symptoms such as difficulty breathing or swallowing, surgical intervention may be recommended to relieve the pressure.
Cosmetic Concerns: In some cases, the presence of a visible swelling or enlargement of the neck due to thyroid disease may be a source of cosmetic concern for the individual. If the appearance of the neck bothers the patient, surgery may be considered to address the cosmetic issue.

Thyroid Cancer Risk Factors

Thyroid cancer risk factors can vary, and understanding them is crucial for early detection and appropriate management. Here are some common risk factors associated with thyroid cancer:

Gender: Thyroid cancer is more prevalent in women compared to men. Women are at a higher risk of developing thyroid cancer.
Radiation Exposure: Exposure to high levels of radiation, whether from medical treatments (such as radiation therapy to the head and neck), environmental sources (such as nuclear accidents or weapons testing), or occupational exposure, is a known risk factor for thyroid cancer.
Genetic Syndromes: Certain inherited genetic syndromes, such as familial adenomatous polyposis (FAP), Cowden syndrome, and familial non-medullary thyroid cancer, can increase the risk of developing thyroid cancer.
Family History: A family history of thyroid cancer or certain other types of cancer may predispose individuals to an increased risk of thyroid cancer. Familial predispositions to thyroid cancer can be genetic in nature and may influence an individual's risk profile.
Presence of Thyroid Nodules: While most thyroid nodules are benign, the presence of nodules, especially if they are large or exhibit suspicious characteristics on imaging studies such as ultrasound, may increase the risk of thyroid cancer. Regular monitoring and evaluation of thyroid nodules are essential for early detection.
Personal History of Goiter: Individuals with a history of goiter (enlargement of the thyroid gland) may have an elevated risk of developing thyroid cancer, particularly in cases where the goiter is associated with underlying thyroid disease or nodularity.
Iodine Deficiency or Excess: In regions where there is either insufficient or excessive iodine intake, the risk of developing thyroid cancer may be affected. Both iodine deficiency and excess have been implicated in thyroid disorders, including cancer.
Age: While thyroid cancer can occur at any age, it is more commonly diagnosed in adults between the ages of 30 and 60 years. Aging may be a risk factor for the development of thyroid cancer.

It's essential for individuals with known risk factors or symptoms suggestive of thyroid cancer to undergo regular screenings, including physical examination, imaging studies, and possibly biopsy, to detect and manage the condition at an early stage. Early diagnosis and appropriate treatment can significantly improve outcomes for individuals with thyroid cancer.

Thyroid Cancer Symptoms

Thyroid gland cancer usually does not cause symptoms. It may occur in patients who are being followed up for goiter or incidentally during tests performed for another disease. Rarely, neck mass, voice hoarseness, difficulty swallowing; Very rarely, it may occur with bone fractures or hyperthyroidism (toxic goiter). Facial flushing, diarrhea and fatigue may occur in 30 percent of patients with medullary cancer. In recent years, due to the advancement of diagnostic methods in thyroid diseases and the development of technical facilities, thyroid ultrasonography and fine needle aspiration biopsy can be performed in many cases. For this reason, the possibility of diagnosing even incipient thyroid cancers is very high today. However, it is worth noting that thyroid nodules are detected at a rate of 50 percent in autopsy studies. In other words, there are still thyroid nodules in the society that cannot be detected even with ultrasound.

After detecting a nodule in the thyroid gland, if there is any doubt, a fine needle aspiration biopsy of the nodule determines whether the thyroid nodules are malignant or not. Fine needle aspiration is a low-risk, fast-yielding and easy-to-perform method in good hands. If the biopsy result is benign and the patient has no other complaints, thyroid nodules can be followed. If the biopsy result is suspicious or malignant, the treatment phase begins.

Who is at Risk of Thyroid Cancer?

People with thyroid diseases such as goiter, thyroid nodule, thyroid cancer and thyroiditis in their family,
People who have previously had surgery for thyroid nodules,
Smokers,
Women in menopause,
People who receive radiation therapy (radiotherapy) for the head and neck should have regular check-ups and follow-ups.

Thyroid Cancer Treatment

Thyroid hormone medications are used in treatment. There is no possibility of complete recovery in patients whose thyroid gland has shrunk too much. The points that patients should pay attention to in this process can be listed as follows;

Iodized salt and iodized cough syrup should not be used.

Selenium support may be useful in this process.
Drinking hormone medications on an empty stomach increases their effect.
If the medicine is not taken on time, it should be taken with the next meal. However, care should be taken not to take any other medication during the meal in which the hormone medication is taken.
Patients who are considering becoming pregnant should definitely consult a specialist. The use of thyroid medications will continue during pregnancy, otherwise the risk of miscarriage increases. Medicines have no harm to the baby. Since pain occurs in the disease, painkillers or hormone medications are used depending on its severity. The treatment of the disease is done with medication, surgical treatment is not applied.