All about thyroid gland
Thyroid gland is an important endocrine organ. Thyroid gland secrete Thyroxine hormone which has effects on all organs of body and its secretion is regulated by Pituitary. The thyroid gland is situated the neck and effected by a large number of diseases.
What are the different diseases that affect thyroid gland??
These are abnormal overgrowths of tissue in thyroid gland. May be solid or cystic. Quite common. Mostly are benign , not causing any symptoms. However sometimes causes hyperthyroidism. Large nodules causes difficulty in swallowing , breathing, hoarseness and neck pain.
Enlargement of thyroid gland is called goiter. It can be diffuse or nodular.
The most common cause is iodine deficiency. It may be asymptomatic or manifest as hypothyroidism/ hyperthyroidism.
it’s caught early, thyroid cancer is one of the most treatable forms of cancer. There are 4 types of thyroid cancer:
If you have thyroid cancer, you probably have this type. It’s found in up to 80% of all thyroid cancer cases. It tends to grow slowly, but often spreads to the nymph nodes in your neck. Even so, you have a good chance for a full recovery.
It can spread into your lymph nodes and is also more likely to spread into your blood vessels.
Medullary cancer is found in about 4% of all thyroid cancer cases. It’s more likely to be found at an early stage because it produces a hormone called calcitonin, which doctors keep an eye out for in blood test results.
4.Anaplastic thyroid cancer
Anaplastic thyroid cancer can be the most severe type, because it’s aggressive in spreading to other parts of the body. It’s rare, and it is the hardest to treat.
If you have thyroid cancer, you probably didn’t notice any signs of it in the early stages.
But as it grows, you could notice any of the following problems:
- Neck, throat pain
- Lump in your neck
- Difficulty swallowing
- Vocal changes, hoarseness
Thyroid cancer is more common in women than men. Women tend to get thyroid cancer in their 40s and 50s, while men who get it are usually in their 60s or 70s.
How do we diagnose thyroid disorders??
1. FNAC from the thyroid swelling
2. Ultrasound of neck
3. CT/ MRI of neck
4. Thyroid scan
1. hemithyroidectomy or lobectomy: it involves removal of half of thyroid gland with the isthmus. Usually done in thyroid nodule or low risk thyroid cancer.
2. near total thyroidectomy: it involves removal of almost complete thyroid gland , only remaining a side part of the gland.
2. total thyroidectomy: complete removal of thyroid gland.
You need atleast 10 days from work.
You will be admitted one ger prior to the surgery. No solid food or liquids allowed 8 hours prior the surgery. Premedication with an antacid and anti anxiety.
Anesthesia: done under general anesthesia
An incision is made in the skin two finger breadths above the sternal notch between the medial borders of the sternocleidomastoid muscles (two muscles make a V shape in front of the neck). The width of the incision may need to be extended for large masses, or for a lateral lymph node removal.
Subcutaneous fat and Platysma (triangle sheet of muscle at both sides of the neck) are divided, and asubplatysmal dissection is made above the incision up to the level of the thyroid cartilage above, and thesternal notch, but remaining superficial to the anterior jugular veins.
The fascia between the sternohyoid, omohyoid and sternothyroid muscles (strap muscles ) is divided along the midline and the muscles retracted laterally. This is an avascular plane but care must be taken not to injure small veins crossing between the anterior jugular veins.
The thyroid gland is rotated medially (using the surgeons fingers). The important vascular structure to identify is the middle thyroid vein (it will be tightly stretched by the medial rotation of the gland), which is then ligated. This permits further mobilisation of the gland and moving the bulk of the lobe out the wound.
Identify the superior laryngeal artery as close to the superior pole of the thyroid parenchyma as possible. Great care should be taken while ligating the superior laryngeal artery so as to avoid injury to the external laryngeal nerve. In some patients the external branch of the superior laryngeal nerve lies on the anterior surface of the thyroid lobe.
The superior parathyroid gland is normally located in a posterior position, at the level of the upper two thirds of the thyroid and approximately 1 cm above the crossing point of the recurrent laryngeal nerve and the inferior thyroid artery. It is orange yellow in colour, but is difficult to identify. The gland must remain in situ with blood supply intact.
The inferior parathyroid glands are normally located between the lower pole of the thyroid and the isthmus, most commonly on the anterior or the posterolateral surface of the lower pole of the thyroid. Care must be taken to preserve it in situ and to avoid damaging its inferior thyroid artery.
The recurrent laryngeal nerve is located between the common carotid artery laterally, the oesophagusmedially, and the inferior thyroid artery superiorly.
When doing a thyroid lobectomy, the isthmus, which is crossing between the two thyroid lobes, is divided.
You may resume most of your normal activities the day after surgery. However, wait for at least 10 days (or until your doctor gives you permission) to engage in strenuous activities such as high-impact exercise.
Your throat will probably feel sore for several days. You may be able to take an over-the-counter pain medications.
After your surgery, you may develop hypothyroidism. If this occurs, your doctor will prescribe some form of levothyroxine to help bring your hormone levels into balance. It may take several adjustments and blood tests to find the best dosage for you.
Risks and complications of thyroid surgery
- The biggest complication is the max chances of the having hypothyroidism after the surgery. Yes! This is because of the thyroid gland removal, Thyroidectomy leads to scarcity of the thyroid hormone production, thus causing a underactive thyroid gland or Hypothyroidism.
- There occurs laryngeal nerve injury in most of the surgeries of the thyroid gland. It can result into voice damage or a hoarse voice. In some cases of the surgery, a surgical emergency or an urgent tracheostomy may also be needed.
- It may also follow anesthetic complications
- The thyroidectomy can also cause infection, an increased risk with chronic pre-operative steroid use.
- A hemorrhage or hematoma, during the surgery, may compress the airway. It becomes life-threatening.
- There can also be a permanent scar on the throat of the patient who has undergone a surgery of the thyroid gland.
- After thyroidectomy, the biggest complications expected is the Nerve Palsy. It happens because of the nerve injury during the surgery.