Who should undergo thyroid surgery and when?
The thyroid gland produces crucial hormones that have important effects on the metabolism. These hormones in a way determine the metabolic speed of all cells; in a way they govern how fast they work. Thyroid gland diseases are categorised into two main groups: functional and structural. Many different types of thyroid illness exist in both groups.
One of the treatment methods for thyroid gland diseases is surgery. However selecting surgery as an option for the suitable patient at the right time requires knowledge and experience. It also demands special talent and understanding if the potential of side effects is to be minimised. Anadolu Medical Center Medical Director and General Surgery Specialist Prof. Dr. Metin Cakmakci answers our questions concerning thyroid surgery.
What kind of thyroid patients can undergo surgery?
Basically we discuss surgical treatment for thyroid diseases with three main groups of patients: The first group consists of patients proven to have thyroid cancer by means of a fine needle biopsy or patients whose biopsy results have found to be suspicious by a pathologist. The second group of patients are those with enlarged glands causing pressure or with nodules presenting aesthetic problems. Another reason for surgery might be gradually growing nodule sizes seen in patients initially under observation for the nodules but not yet diagnosed with cancer.
The third group consists of hyperthyroid patients who have an overworking thyroid gland. If hyperthyroid patients cannot be treated with medication or radioactive iodine or if the hyper-functioning continues after treatment we might consider the option of surgery. Surgery is also considered as an option for patients who develop side effects to medication and radioactive iodine treatment or patients unsuitable to receive this type of treatment such as pregnant women.
What determines the treatment method for hyperthyroid patients?
Hyperthyroid patients can be treated in three different ways: medication, radioactive iodine and surgery. Medication suppresses the hormone producing functions by reducing the activity of the gland. Radioactive iodine on the other hand reduces the volume of hormone producing tissue by damaging the structure of the thyroid gland cells. Surgery removes most or all of the thyroid gland and reduces thyroid hormone producing tissue, thereby treating the patient. Patient’s age, gender, previous treatments, accompanying illnesses and findings from ultrasonography – cyntigraphy results should be carefully considered in deciding the best treatment method for the patient.
What treatment options are available for individuals wishing to have a baby?
Radioactive iodine is not a treatment option if the patient is fertile and wishes to have a baby. Such patients will either have medication treatment or undergo surgery.
Can the illness relapse after medication treatment?
The predominant difficulty of medication treatment, which actually is our first choice for hypothyroid patients, is a relapse of the illness after ceasing medication intake. It is quite common for the symptoms to reoccur within the first year of ending medication treatment. As a matter of fact only one fifth of patients using medication treatment can remain normal at the end of the fifth year. Meanwhile it is practically impossible to use medication all the time due to its side effects. We often have to operate on patients as most of them develop medication-induced side effects.
What does surgery involve?
The basic principal of hyperthyroid surgery is reducing the volume of the hormone producing thyroid gland. Most often, this intervention results in the normalisation of thyroid functions after the operation. However there are exceptional patients where hyperthyroid relapses and creates problems in the treatment process. There also is the chance of the patient developing hypothyroidism as a result of the remaining thyroid gland being unable to produce sufficient hormones. Having said that the chance of this complication is very low and it is extremely easy to control with medication. Accumulation of know-how and technological breakthroughs has allowed hypothyroid surgery to become much safer to execute. Such improvements have resulted in total thyroidectomy surgery (involving complete removal of thyroid gland) becoming much more popular as it totally eliminated the chances of relapse.
How frequent is the occurrence of thyroid nodules?
Studies indicate that the chances of people developing nodules in their thyroid gland are around 10 percent. However studies based on autopsy result indicate higher percentages.
Do thyroid gland nodules mean cancer?
We frequently come across nodules however thyroid cancer is not a common illness. In other words not every nodule we identify means that you have cancer. On the contrary most nodules have found to be benign.
Is surgery necessary for every thyroid nodule?
Although surgery is not necessary for all thyroid gland nodules all nodules should be taken seriously and considered carefully. How the nodule is approached must be shaped after assessing the patient’s complaints, history, examination findings and work up. In general practice nodules smaller than 1 cm with no clinical ad radiological risk are kept under observation. For nodules larger than 1 cm and patients in the risk group we recommend fine needle aspiration biopsy for the nodules. Parallel to developments, clinicians have come to use needle biopsy much more frequently in cell science known as cytology and interventional radiology. We also operate on patients whose nodules have been considered suspicious or malign by pathologists as a result of a needle biopsy. Today, thyroid cancer is one of the few forms of cancer that can successfully be treated with surgical methods.
Can benign nodules also be operated?
If nodules are continuing to grow or causing the patient difficulty in swallowing, pain or esthetically bothering the individual we can still operate although we are sure they are benign. We also operate on patients with multiple large nodules. Whilst we prefer to totally remove the thyroid gland for thyroid cancer or hyperthyroid patients we limit the extent of tissue removal for cases known to be benign. We remove the entire side of the thyroid gland presenting the large nodule. We also give great attention to leave enough thyroid tissue to make sure the patients’ bodies can produce enough thyroid hormone for the rest of their lives. In some cases we conduct a quick pathological examination during surgery and decide what to do with the rest of tissue during the operation.