Thyroid Surgery Adelaide – What is the Thyroid Gland?
The thyroid gland is a small, butterfly-shaped gland that wraps around the windpipe just below the larynx (Adam’s apple). It is part of the endocrine system.
What does the Thyroid Gland do?
The role of the thyroid gland is to convert the iodine from food into thyroid hormones, which are needed for the healthy development and functioning of the body and brain. These hormones, known as triiodothyronine (T3) and thyroxine (T4), influence the activity of all cells and tissues in the body. They also regulate body temperature, energy levels and metabolic functions (the rate at which the body produces and uses energy from nutrients and oxygen).
How common are Thyroid Disorders?
Thyroid Disorders are much more commonly found in women worldwide, with ten times more women than men being diagnosed with some form of disorder. It is also more common for disorders to develop in older people, especially hypothyroidism (an underactive thyroid gland). Australia has recently seen an increase in the number of people who are not getting a sufficient amount of Iodine in their diet, so more cases of goitre, which is swelling and enlargement of the thyroid gland, are expected to occur.
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What could be the cause of a Thyroid Lump?
There are a number of reasons why a thyroid lump may appear.
Thyroiditis, meaning inflammation of the thyroid gland, often results in the gland becoming enlarged. The most common cause of thyroiditis is when the body’s immune system attacks the thyroid gland, damaging it and reducing its ability to produce hormones. This is known as autoimmune thyroiditis, or Hashimoto’s disease.
The presence of a bacterial or viral infection is another cause of thyroiditis. Known as subacute thyroiditis, it involves acute inflammation and swelling of the thyroid gland causing severe pain and tenderness in the neck area where the gland is located.
Iodine Deficiency Disorder (IDD), caused by not consuming enough iodine in the diet, can also result in thyroiditis. The lack of necessary iodine causes the thyroid gland to increase in size (a goitre) and hypothyroidism can occur.
Thyroid Nodules are lumps that form within the thyroid gland due to abnormal growth of thyroid cells. They may either be filled with fluid or thyroid gland cells and can occur in any part of the gland. Nodules are extremely common and in the vast majority of cases are benign (non-cancerous). It is possible for only a single nodule to form, or for them to appear throughout the gland, which is often referred to as a multi-nodular goitre. Most nodules go undetected until either signs and symptoms develop, they enlarge, or they’re found by a doctor during a routine physical examination of the neck or imaging of a nearby area. Less commonly they cause swelling, coughing, pain in the throat area, or difficulty swallowing or breathing.
Thyroid Cancer is the result of thyroid cells dividing in an abnormal way and becoming malignant. The most common symptoms include the development of a lump in the neck, problems with swallowing, throat or neck pain, swollen lymph nodes, coughing, and hoarseness or changes in the voice. In some instances, an increased risk of developing thyroid cancers can be genetically passed on at birth.
There are four types of thyroid cancer:
- Papillary cancer. This is the most common and represents around 70% of all cases diagnosed. It develops from the cells in the thyroid gland that are responsible for the production and secretion of thyroid hormones (follicular cells).
- Follicular cancer. This is the second most common type of thyroid cancer, accounting for about 25% of cases. This cancer also develops from the thyroid’s follicular cells.
- Medullary cancer. This type of thyroid cancer is much less common, and represents only around 4% of diagnosed cases. This cancer develops from the C-cells, the cells that produce a hormone called calcitonin, which regulates calcium levels in the blood.
- Anaplastic cancer. This is a very rare form of thyroid cancer and represents only 1% of all cases. Most common in elderly people, this type of cancer may develop from the follicular cells, or from undiagnosed papillary or follicular thyroid cancer.
How is a thyroid lump investigated?
There are several tests and procedures that can be used to investigate a thyroid lump. Your thyroid surgeon or doctor may request one or more of these to be carried out in order to obtain a correct diagnosis. Your thyroid surgeon may recommend thyroid surgery as part of the ensuing treatment plan.
The first tests your doctor may request is one or more blood tests. These tests show whether the thyroid hormone level in the blood is too high or too low, and also detect the presence of autoimmune thyroid disease, in particular Hashimoto’s Disease.
A thyroid ultrasound measures the size, shape and texture of the thyroid gland and detects any nodules or cysts. This is a non-invasive and painless procedure where high energy sound waves are generated by a hand held probe, which is moved around over the neck area. The returning sound waves generate an image that is studied by a Surgeon or Radiologist (specialist imaging doctor).
A CT Scan may be performed, which is useful for identifying tumours and checking whether a goitre is pressing on other parts of the neck. The CT scan is a medical imaging procedure that uses x-rays and digital computer technology to image every type of body structure at once, including bone, blood vessels and soft tissue. It requires an injection of iodine, but is otherwise a non-invasive, painless and relatively safe procedure.
A Radionuclide Scan may be used to determine a diagnosis. This involves injecting the patient with a small amount of radioactive isotope similar to iodine, and imaging the area with a gamma camera. This assesses the functionality of a thyroid gland.
Fine needle biopsy
Fine needle biopsy (FNB), also known as fine-needle aspiration cytology (FNAC), is used in the diagnosis of nodules and in particular to identify cells that may be cancerous. It is usually carried out with the aid of ultrasound by a specialist doctor, and involves inserting a very fine needle into the thyroid gland to extract tissue from a nodule(or nodules). This tissue is then sent to a pathologist for testing.