Thyroid

The thyroid gland is an organ located in the neck, which has a role in regulating the body’s metabolism. Thyroid gland diseases can develop both structurally and functionally.
Overall enlargement of the thyroid gland and the nodules (lumps) that form in it are the conditions that develop due to functional disorders,  under-active thyroid gland (hypothyroidism) or overactive thyroid gland (hyperthyroidism).

FUNCTIONAL THYROID DISEASES

HYPOTHYROID

  • It is a condition of inflammation and insufficient functioning of the thyroid gland (Hashimoto’s thyroiditis)
  • Congenital lack of thyroid gland and hormone
  • Insufficiency of the thyroid gland after thyroid surgery performed due to thyrotoxicosis (toxic goiter) or thyroid cancer
  • Insufficiency of the thyroid gland that develops after the treatment of the thyroid gland with radioactive iodine (atom).

HASHIMOTO’S THYROIDITIS is the most common form of the disease

Symptoms
Weakness
Intolerance to Cold
Weight Gain
Constipation
Dry Skin
Hypothyroidism may cause mental and physical deceleration in adults, and if its treatment is neglected, it may cause hypothyroidism coma called myxedema. If hypothyroidis of the baby in the womb is not treated during pregnancy, it may cause mental retardation in the expected baby.

For its diagnosis; Thyroid hormones and thyroid ultrasonography are needed.
Treatment: It is treated by administering the drug called levothyroxine, which is a thyroid hormone preparation.

HYPERTHROID
It is a condition with excessive amount of thyroid hormone caused by over-functioning of the thyroid gland.

Causes:
Basedow Graves’ disease: It is the MOST COMMON cause of hyperthyroidism. due to the antibodies produced by the body against the thyroid gland. It causes the release of excess hormones and the excessive growth of the thyroid gland.

Thyroid nodules: Overactive single or multiple nodules may cause hyperthyroidism. Excess thyroid hormone intake into the body

Symptoms
Palpitation
Sweating
Heat Intolerance
Diarrhea
Weight Loss
Irritability

Diagnosis: Thyroid hormones, thyroid ultrasound and scintigraphy are planned. Overactive nodules on scintigraphy are considered hot nodules.

Treatment

  1. Drug Therapy
    2. Radioactive (ATAOM) Treatment
    3. Surgical Treatment

Drug therapy is the primary treatment option. Radioactive substance treatment can be performed for patients whose thyroid glands are not too large, whose thyroid glands do not contain nodules, and who have no ocular findings. In cases where a cold nodule is found, surgical treatment can be performed on those with eye symptoms and large thyroid glands. The treatment modality may vary depending on the case and the patient.

STRUCTURAL THYROID DISEASES

If there are nodules in the thyroid, NODULAR THYROID diseases are mentioned. It is one of the most common thyroid diseases. There are MULTIPLE and SINGLE nodular thyroid diseases.
If these nodules are not overactive nodules, they usually progress without causing complaints and appear on diagnostic images of the neck intended for other reasons. Those which have grown excessively may cause complaints such as the feeling of suffocation, shortness of breath, and difficulty in swallowing due to the resultant pressure on the trachea and esophagus. In addition, the complaints of hyperthyroidism may also be observed in nodules, which are nıt overactive.

Diagnosis
Evaluation of Thyroid Hormones
Thyroid Ultrasonography
Thyroid Scintigraphy

WHEN AND FOR WHOM SHOULD A NEEDLE BIOPSY BE PERFORMED?

Needle biopsy is not necessary for all patients. In particular, needle biopsy should be performed on patients with nodules larger than 2 cm in diameter and patients with calcification even if their nodule diameter is smaller.
A thyroid fine-needle biopsy is the process of taking sample from the thyroid tissue by inserting needles directly or in company with ultrasound. Follow-up examination with a biopsy is useful for preventing unnecessary surgeries. However, it is a method that has limitations in terms of reliability.
In order to ensure the biopsy to fully reflect the current condition, it is usually necessary to insert a needle into many places, many times. However, in approximately one out of every four biopsies, the tissue sample taken is not adequate to give a definitive result.

If the biopsy result indicates cancer, the result is almost certainly correct, but if it does not, the situation is a bit complicated, because it is technically not possible to detect all cancers with a biopsy. The biggest handicap is that when the needle is inserted into a point, it is possible to miss a small islet of cancer immediately around that point.
In one out of every 5-6 cases, the patient with needle biopsy results reported to be benign appears to have cancer in his/her future follow-up examinations. Retrospective examinations of operated patients, whose exact pathology was found to be cancer, showed that about one in every four patients has a needle biopsy report showing negative result in his/her file.

WHO NEEDS SURGERY?
1. Patients at the risk of developing cancer
2. Patients with complaints of compression (trachea and esophagus)
3. Patients with nodules larger than 2-3 cm in diameter
4. Patients with the signs of hyperthyroidism (toxic goiter)
5. Patients who needs cosmetic surgery
6. Patients with nodules that grow rapidly and develop suddenly
7. Patients in whom hormone suppression cannot be achieved despite the use of medication.

SURGERY (SINGLE SIDE, DOUBLE SIDE )

General anesthesia (complete unconsciousness of the patient) is necessary for the procedure. The procedure usually takes 90 to120 minutes. A one-day hospital stay is  necessary.

The operation is performed by making a 4-5 cm horizontal incision on the front side of the neck. After tying its blood vessels, the thyroid gland is cut off and totally removed. During surgery, it is important to carefully monitor and preserve the parathyroid glands and nerves related to the function of making sounds, which are close to the thyroid gland.

Any surgical technique involving the removal of nodules one by one is not suitable. However only one-sided surgery (right or left thyroid lobectomy) can be performed in patients whose one lobe in the thyroid gland appears to be completely normal during the examination and ultrasound.

The thyroid gland consists of two lobes that merge into the middle line of the neck. T may be necessary to remove one or both of these during surgery. The decision is made depending on certain criteria before or during surgery.

In cases where a disease exists on both sides, the gland is completely removed. This completely eliminates the risk of developing a thyroid-related disease in the future. On the other hand, the disadvantages of the procedure are that the nerves extending to the vocal cords on both sides are at risk of being affected during the operation, and that the patient has to take pills on a daily basis for life.

If the disease develops on one side, the disease-free side can be left in its place while removing the other side. In such a case, the advantages and disadvantages of the procedure that involves complete removal of the gland change places. The patient does not have to take pills for life, and not all the nerves extending to the vocal cords but only the ones in the operated side are at risk. The disadvantage of this procedure is that the possibility of recurrence of the same disease continues on the intact side.

POSTOPERATIVE PERIOD
It is adequate for the wound to be kept closed for 2 to 3 postoperative days. No dressing is required again after the third day. If the wound is closed by using self-dissolving sutures, there is no need to remove the sutures. If it is closed using non-dissolving sutures, the sutures are removed on the 3rd postoperative day.

There is no harm in taking a bath 3 days after discharge. The possibility of wound infection is less than 1 percent. There is no need for antibiotics. Painkillers can be used for the pain of the wound in the first few days after discharge.

In some cases, patients may complain of mild sore throat. In such cases, pastille-type drugs and warm herbal teas can be soothing.

A week of rest is usually adequate for patients to return to their daily life or work environment.

A malignant disease can be detected in about one out of every ten patients when examining a sample removed after operations performed with the expectation of a benign disease. Therefore, the thyroid gland removed during surgery should definitely be sent to a laboratory for a pathological examination. The result usually comes within a week. If the result is benign, it means that the treatment has been completed.

However, if a malignant disease is detected during the pathological examination, the patient’s follow-up and treatment are continued by the endocrinology, oncology and nuclear medicine departments.



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