Choosing the right time to undergo thyroid surgery
Date:
05/07/2011
Thyroid gland is responsible of secreting thyroid hormone, something of critical importance for the metabolism. These hormones are responsible for regulating the metabolic rate of cells. In a way it is this hormone that dictates how fast cells function.
Fundamentally we can separate thyroid gland diseases into tow groups: functional and structural. Both groups contain a great variety of illnesses. Functional disorders, the first group, are caused by anomalies in hormone levels. Patients in this group may experience an overworking or under working thyroid gland effecting hormone secretion levels which in return cause certain problems in the body. The second group is related to illnesses caused by structural changes in these glands. Patients presenting nodules, benign and malign (cancerous) tumours in thyroid glands are considered in the latter group.
Surgery is a treatment option for thyroid gland diseases. However performing surgery on the patient at the right time requires knowledge and skill whilst the success of surgery with minimum side effects calls for special talent and experience. Anadolu Medical Centre (AMC) General Surgeon Professor Metin Çakmakçı, M.D. answers our questions on thyroid surgery.
Which thyroid patients can undergo surgery?
Basically we consider the surgery option in thyroid diseases for three basic groups: First group of patients are those who have been diagnosed with thyroid cancer by fine needle biopsy or those whose biopsy results are considered suspicious in terms of cancer by the pathologist.
Second group of patients are those presenting compression symptoms or cosmetic concerns due to growing nodule size. We might go for the surgery option if we notice a change in nodule size in patients under observation for suspicion of cancer.
The third group consists of hyperthyroid patients - a condition where thyroid glands overproduce this hormone. We recommend surgery for hyperthyroid patients unresponsive to medication or radioactive iodine treatment as well as for cases of recurring hyperthyroidism. Surgery is also considered for patients with side effects to medication or radioactive iodine treatment or those unable to receive such treatment due to concerns like pregnancy.
What determines the treatment method in hyperthyroid patients?
We can treat hyperthyroidism using three different methods – medication, radioactive iodine treatment or surgery. Medication is used to inhibit thyroid hormone production by reducing the speed these glands function. Radioactive iodine reduces hormone producing tissue volume by damaging thyroid gland cell structure. Surgery, on the other hand, involves the partial or complete removal of thyroid gland, stripping the body from excess thyroid hormone producing tissue for treatment. We make our decision following careful assessment on which treatment will benefit patients most. For this we give consideration to factors like age, gender, previous treatment, accompanying illnesses together with screening tests results like ultrasonography and scintigraphy.
What kind of treatment method is preferred for patients planning to have children?
Radioactive iodine treatment is not an option if patient is still in her active fertility period or plans to have children. We use medication treatment or surgery for such patients.
What are the chances of recurrence in medication treatment?
Initially we always prefer medication treatment for hyperthyroid patients. However the biggest problem in medication is recurrence at the end of treatment. Recurrence is seen in many patients within one year after finishing the course of drugs. On the other hand only 20 percent of patients remain healthy 5 years after the end of medication treatment. Furthermore, some patients cannot use any medication at all due to the significant side effects. Medication related side effects mean that many patients are left with no other option but surgery.
What procedure does surgery involve?
The basic principle of hyperthyroidism surgery is reducing the volume of hormone producing thyroid gland. Thanks to this method most patients are left with normal thyroid gland functions after surgery. However a small number of patients do experience recurring hyperthyroidism and this can cause problems in treatment. Moreover there is the risk of developing hypothyroidism if the remaining thyroid tissue is unable to produce adequate amounts of the hormone needed by the body. Nonetheless the chances of such a complication is rather small and controlling hormone levels with medication support is very straightforward.
Experience coupled with advances in technology including new energy sources has opened the path for safer and more effective hyperthyroid surgeries. This development has increased the popularity of total thyroidectomy surgery, a method involving complete removal of the thyroid gland eliminating the chances of recurrence.
What is the frequency of coming across thyroid nodules?
Research suggests that the rate of people with thyroid gland nodules is around 10%. Autopsy studies indicate a higher frequency.
Are all thyroid nodules an indication of cancer?
Although the chances of coming across nodules are rather high the rate of thyroid cancer is relatively low. In other words, people should not think all nodules mean cancer. Actually we have to accepts that most nodules are benign.
Is surgery the only solution for any kind of thyroid nodule?
Yes, surgery is not required for any nodule identified in the thyroid gland however, all nodules should be taken seriously and investigated carefully. Approaching patient’s nodule we must give consideration to complaints, medical background, examination findings and screening results. Basically, nodules smaller than 1 cm with no radiological risk are kept under observation. We recommend fine needle aspiration biopsy for nodules larger than 1 cm, that fall in the risk group. Lately, fine needle biopsy has gained popularity parallel to developments in cytology (discipline studying cells) and interventional radiology. Thanks to fine needle biopsy nodules reported as suspicious or cancerous by pathologists are removed by surgery immediately. Today thyroid cancers remain as one of the few types cancers effectively treatable using surgical methods.
Is surgery an option for benign nodules?
Surgery is also an option even if a nodule is benign. Large or growing nodules can cause complaints like difficulty in swallowing and pain. Their size might cause cosmetic concerns for their visibility. Surgery can be applied on these patients as well. We prefer to remove the thyroid gland in its entirety in thyroid cancer cases and hyperthyroid patients. Surgery is kept limited in patients presenting benign conditions. In such cases we remove the section containing the largest nodule. The intention is to leave as much as healthy tissue as possible for the body to continue producing adequate amounts of thyroid hormone. If necessary we perform a quick pathological examination at one stage of the surgery and decide the rest of the operation accordingly.