Several conditions can lead to a referral to for thyroid surgery. Often, these conditions overlap, and other conditions are relevant to decision-making related to thyroid assessment and surgery.
Common problems include:
- Thyroid nodules or cysts
- Thyroid cancer
- Hyperthyroidism (overactive gland)
- Oversized thyroid gland
- Other thyroid problems
These are the most common indication for a visit with a thyroid surgeon. Thyroid nodules are common, and thyroid cancer is rare. One of the greatest challenges is determining which thyroid nodules need more attention and which are benign.
Ultrasound can reveal clues about the status of a nodule but is rarely definitive. Fine needle aspiration (FNA or needle biopsy) is a very useful tool in assessing a thyroid nodule, but even with the latest gene analysis techniques, FNA does not always yield a definite result. Dr. Wright takes all the clues and combines them to make an assessment for the need for removal of a nodule.
The bulk of thyroid cancer is comprised of two types: papillary thyroid cancer (80% of cases) and follicular thyroid cancer (20% of cases). Both are classified as Well Differentiated Thyroid Cancer (WDTC).
Much more rare types include medullary and anaplastic cancer of the thyroid. In some cases, work-up of a thyroid mass will yield a convincing diagnosis of cancer. According to the American Thyroid Association guidelines, WDTC measuring greater than 1 cm in size is best managed with total thyroidectomy.
The thyroid gland is considered the master of metabolism control. Nearly every tissue in the body can be affected by the thyroid hormone, which is under very tight regulation through a complex control system.
For some patients, this control system malfunctions, resulting in a “runaway thyroid gland.” Also known as hyperthyroidism, this condition results in the gland wildly overproducing thyroid hormone, causing major metabolic malfunction. This can be controlled with medications in some cases; unfortunately, however, these medications are frequently ineffective, toxic or otherwise unworkable.
When medications fail, options of radiation treatment or surgery are considered. If the gland is quite large – as it frequently is with Grave’s disease – compressive effects of the oversized gland can cause problems with swallowing and pressure sensation.
Frequently, surgery is deemed the best option. Because of the changes of the gland related to hyperthyroidism, surgery is somewhat more complicated in this setting; it is crucial to have an experienced surgeon for thyroid surgery of hyperthyroidism.
Sometimes the thyroid gland will simply grow too large. This can occur as a result of many nodules gradually enlarging or as a result of the substance of the gland simply expanding over time. There is almost no limit to how large a gland can get.
Thyroid goiter formation can occur as a result of iodine deficiency, as had occurred before iodized salt was introduced. In most cases in the U.S., however, the cause is unknown.
Other thyroid problems
Frequently, different thyroid problems can overlap – a suspicious nodule within a goiter, a compressive gland with Grave’s disease, a single overactive nodule causing hyperthyroidism, etc. Each thyroid story is unique, especially when considered in the context of the individual patient.