What are the diagnostic tests?
  • Blood Tests- check the level of thyroid hormones
  • Ultrasound- sound waves to examine the structure of the thyroid gland
  • Fine Needle Aspiration- sampling cells for cancer
  • CT scan- to detect if gland extends into the chest
  • Nuclear Medicine scan
When is surgery needed?
  • Large thyroid or multi-nodular goitre
  • Solitary nodule thyroid adenoma
  • Thyroid cancer
  • Graves’ disease
  • Recurrent thyroid cyst
Types of surgery?
  • Hemithyroidectomy
  • Total Thyroidectomy
What is the Thyroid Gland?

Thyroid gland is a small endocrine gland situated in the front of the neck that releases hormones in the bloodstream. The hormones, Thyroxine (T4) and Triiodothyronine (T3) reach the body cells and are responsible for regulating the metabolic rate.

What are Thyroid nodules?

Swelling in the thyroid gland is called a goitre and can be due to general enlargement of the gland for formation of discrete lumps. Most are harmless and found to be more common in females.

What test do I need?

Any nodule or swelling you find should be investigated straightaway. Your GP will do some basic tests and refer you to a specialist.

  • Blood Tests– These involve checking your level of thyroid hormones to determine if the thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism)
  • Ultrasound– this is painless and uses sound waves from a probe to examine the structure of the thyroid gland.
    • The whole gland is enlarged or if discrete lumps are present.
    • Is it just one lump or multiple lumps scattered in the gland.
    • It will characterise each lump to determine if it is benign or if there is a possibility of cancer in the lump.
    • Search for any other lumps in the neck.
  • Fine Needle Aspiration (FNAC)– If the Ultrasound scan raises even a slight possibility of harbouring cancer in any of the lumps this will be sampled for cells with a fine needle. The cells from the lump will be aspirated in a syringe and examined under a microscope to check for cancer cells. Approximately in one out of twenty cases the biopsy shows that the lump is cancerous.
  • CT scan– If the thyroid gland is very large and you have trouble with your breathing, a CT scan may be performed to detect if any portion of the gland extends into the chest (retrosternal goitre) thus compromising the airway.
  • Nuclear Medicine scan– If you have a hyperactive thyroid this scan is used to determine if the whole scan is overactive or one of the nodules is hyperactive (toxic nodule).
Will I need Surgery?

If all the investigations are reassuring and the thyroid lump or swelling is not causing any problems, then no treatment may be required. Sometimes, the size of the lump may be monitored by follow-up scans. Surgery is the recommended treatment for several disorders of the thyroid gland. These may include one of the following:

  • Large thyroid or multi-nodular goitre (a goitre is an enlarged thyroid gland) causing obstructive symptoms of breathing or swallowing difficulties
  • Solitary nodule thyroid adenoma (a benign tumour)
  • Thyroid cancer
  • Graves’ disease (hyperthyroidism or thyrotoxicosis)
  • Recurrent thyroid cyst
What are the types of Surgery?
  • Hemithyroidectomy
    If the investigations are inconclusive in ruling out cancer, we will need to take out half of the thyroid gland to excise the lump and send it for detailed examination under the microscope to check for any cancer cells. Need for any further surgery (completion thyroidectomy) will be determined by the results of the histological analysis.
  • Total Thyroidectomy
    In some cases with hyperactive thyroid not controlled with mediation or in glands which harbour a large cancer the whole of the gland will need to be excised. After total thyroidectomy your body won’t be able to produce any thyroid hormones and you will need to take hormone replacements for all your life.
What are the risks of surgery?

The surgery for thyroid is safe with a low complication rate.

  1. Bleeding (1%) -Bleeding after thyroid surgery usually occurs in the first 6 hours. It is particularly serious as the hematoma (blood clot) can if large can compromise the air passage and will need to be removed with immediate surgery.
  2. Nerve injury (1%)- Important nerves that control the movements of the vocal cords run in close proximity to the thyroid gland. They can sometimes have an unusual anatomical course and get injured during the surgery and result in hoarseness of voice.
  3. Low parathyroid hormone levels (10%)- The parathyroid glands control the blood calcium and lie in close proximity to the gland. These can be damaged during total thyroidectomy leading to low blood calcium levels and you may need calcium supplementation for life.

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