The Thyroid Gland
The thyroid is a butterfly-shaped gland located at the base of the neck. It produces thyroid hormone, which controls our bodies’ overall metabolism. Thyroid diseases, whether functional (hypothyroidism, hyperthyroidism) or structural (nodule, goiter, cancer), are very common in both women and men.
Thyroid Diseases
Thyroid Nodules
A nodule is an area of abnormal growth within the thyroid gland. These growths are very common, particularly in women. They can be solid, fluid filled, or mixed. Some people have a single nodule while others have multiple nodules within their thyroid gland. Thyroid nodules can be tiny to very large in size.
Most thyroid nodules are non-cancerous, do not cause symptoms and do not need any treatment. However, in some cases because of the size, appearance on radiology tests, or symptoms caused by the nodule further evaluation and treatment is needed.
Nodules can lead to the development of a goiter, can contain a thyroid cancer, or lead to hyperthyroidism.
Some nodules are cancers and need therapy. Other nodules are big enough to cause a goiter, leading to symptoms like difficulty swallowing or breathing. In some cases the nodule can be overactive, making too much thyroid hormone (hyperthyroidism).
Depending on which problem a thyroid nodule is causing, treatment may include medicine or surgery. In most cases the first step in determining the need for treatment will be a blood test of the thyroid hormone level. An ultrasound test to examine the thyroid will often also be ordered.
Goiter
Goiter is a term used to describe an enlarged thyroid gland. There are many potential causes for the growth of a goiter. In some parts of the world goiters develop because of a lack of iodine in peoples’ diets. However, in the United States where iodine is added to foods, goiters are most often caused by other problems. A single or multiple nodules, Graves’ disease, and hyperthyroidism can all lead to the development of a goiter.
In early growth stages goiters may be evident only on physical examination by a doctor. As they enlarge goiters may become more obvious, causing the neck to bulge or swell. As goiters become bigger they can put pressure on the trachea (windpipe) or esophagus (food pipe), causing symptoms like difficulty swallowing, difficulty breathing (particularly when lying down), a choking sensation or pressure in the neck.
When patients start to experience symptoms from a goiter treatment is often offered. The exact type of treatment is based on the cause of the goiter and the patient’s preferences. In some cases thyroid surgery is the best treatment option.
Thyroid cancer
The thyroid is a butterfly-shaped gland located at the base of the neck. It produces thyroid hormone, which controls our bodies’ overall metabolism.
Thyroid cancer is increasingly common in the United States, particularly in women. It is now one of the most common cancers found in women. While thyroid nodules are very common, only approximately 5% of thyroid nodules are found to be cancerous. In most patients thyroid cancer does not cause any symptoms, though it sometimes can lead to difficulty swallowing, voice changes or a lump in the neck. Often thyroid cancers are found within nodules that are either felt by the patient or their doctor. These nodules are also frequently found incidentally, when the patient has a radiology test not related to thyroid.
If based on the physical exam and ultrasound a nodule has a certain size and appearance a biopsy may be performed. The most common biopsy is called a fine needle aspiration (FNA) biopsy. In FNAs a small needle is used to remove cells from the nodule to try to determine if it is cancer or not. In some patients, a biopsy may show a cancer before surgery and in others a cancer may only be found after surgery is completed.
There are several types of thyroid cancer. The vast majority of thyroid cancers are not aggressive and have an excellent prognosis. While most patients with thyroid cancer do extremely well, it is critical to be treated appropriately.
Different thyroid cancers may require different treatments:
- Papillary Thyroid Carcinoma (PTC): The most common form of thyroid cancer. This type of cancer, which tends to grow slowly, has an excellent prognosis. It is most often treated with thyroid surgery. For advanced, high-risk cases, radioactive iodine is given postoperatively. For select low-risk cases of micropapillary thyroid cancer, active surveillance is an option.
- Follicular Thyroid Carcinoma: This type of thyroid cancer also has an excellent overall prognosis. It is typically treated with thyroid surgery. Postoperative radioactive iodine is often recommended.
- Medullary Thyroid Carcinoma: Medullary thyroid cancers are far less common, and can be inherited as part of rare familial syndromes. The cell of origin for these cancers is different than that of papillary or follicular cancers, and the prognosis is not as favorable. Treatment for medullary thyroid cancer is primarily surgery. For advanced cases, new systemic options are available.
- AnaplasticThyroid Carcinoma: This is the least common but the most aggressive, type of thyroid cancer. This cancer often grows very quickly.Treatment often is a combination of surgery, radiation, and/or systemic therapy depending on the case.
The main treatment for most thyroid cancer is surgery. This surgery will involve removing the thyroid and in some patients lymph nodes that may have cancer in them. After thyroid surgery for cancer, some patients may need additional therapy with radioactive iodine and thyroid hormone medication to complete their treatment. For select papillary thyroid cancers that are <1cm, active surveillance is a reasonable management option.
After treatment for thyroid cancer, it is important to be followed by a physician to be certain that the disease does not return. Different tools may be used to monitor patients for signs of recurrence, including: blood tests, physical examinations, and radiology tests.
If it is determined that thyroid cancer has returned more tests are performed to determine what additional treatment, if any, should be done.
As with all diseases, the proper treatment for recurrent thyroid cancer is one that is customized or tailored to each individual patient.
Hyperthyroidism
In hyperthyroidism, the thyroid gland is producing too much hormone. This excess of thyroid hormone causes the metabolism to be overactive. Patients with hyperthyroidism can experience a number of symptoms, including a racing heart, tremors, feeling anxious, weight loss, feeling hot all the time and difficulty sleeping. A simple blood test can diagnose hyperthyroidism.
Hyperthyroidism can be caused by a number of different problems with the thyroid gland, including:
- Graves’ disease – an autoimmune disorder that leads to over activity of the whole thyroid gland.
- Toxic nodule – a disorder that may develop when a thyroid nodule produces too much thyroid hormone.
- Toxic multinodular goiter – A disease in which multiple thyroid nodules form within the thyroid gland and produce excess thyroid hormone.
Treatment for hyperthyroidism includes medications, radioactive iodine or thyroid surgery. The best therapy depends on the cause of the hyperthyroidism and the preferences of the patient.
Graves Disease
In hyperthyroidism, the thyroid gland is producing too much hormone. This excess of thyroid hormone causes the metabolism to be overactive. A simple blood test can diagnose hyperthyroidism.
Graves’ disease is one type of hyperthyroidism. Graves’ disease is an autoimmune disease in which the body mistakenly causes the whole thyroid gland to become overactive and produce too much thyroid hormone.
The other symptoms of Graves’ disease are the same as with any type of hyperthyroidism:
- Anxiety
- Diarrhea
- Heat intolerance
- Heart palpitations
- Sleep problems
- Unplanned weight loss
In addition to the thyroid gland, the eyes can be affected. The eyes can start to bulge, become dry and itchy and vision can become blurry.
Possible treatments for Graves’ disease include medications, radioactive iodine or thyroid surgery. Therapy depends on the response of the patient to treatment, the presence of eye symptoms and the preferences of the patient.
Thyroid Surgery
Thyroidectomy is thyroid surgery in which all or part of the thyroid gland is removed. During thyroidectomy a number of important structures, including the laryngeal nerves, the parathyroid glands and large blood vessels, are found just behind the thyroid. Successful thyroid surgery removes the thyroid gland while leaving these other structures behind without injury.
There is good news if thyroid surgery becomes necessary. Over the last decade there have been major advances in the way thyroid surgery is performed. Improvements in technologies and techniques have now made thyroid surgery very safe, effective and relatively easy to recover from.
Different types of thyroid surgery are now available to patients, including minimally invasive procedures that cause less pain, allow easier recoveries, and result in smaller incisions.