Diagnosis & Surgery For Thyroid Lumps (Goitres)
The thyroid gland is an ENDOCRINE gland that is located low down at the front of the neck just above the breast bone (manubrium). Endocrine glands produce hormones; which are substances produced or secreted in tiny amounts which have effects on many of the bodies organs or functions (Insulin which is important in diabetes, is also a hormone).
The thyroid gland is about the size of the palm of your hand. It is shaped like a 'bow tie' and is not easily felt unless it is enlarged. If it is enlarged it may be visible or may push on nearby structures such as the trachea (windpipe). The term GOITRE is a commonly used term for enlargement for the thyroid gland
Thyroid disorders are common and patients may be seen initially by surgeons, general practitioners or hospital doctors.
What treatment (if any) that is required will depend on the particular problem.
- Lumps (lumps or nodules in the gland which may be benign or malignant which means harmless or cancer). Lumps in the thyroid are very common. They may need investigation and this is usually carried out by a surgeon familiar with head and neck diseases. This is particularly important if your GP suspects a cancer of the gland.
- Function (Hyper or Hypothyroidism, meaning over or under activity). These problems are usually managed by endocrine doctors and general practitioners but occasionally surgery may be required.
- Developmental disorders (problems you may be born with, that may or may not require treatment). These are usually managed by a team of doctors that could include an endocrinologist, a surgeon and your GP.
Your doctor will want to take a history relevant to your problem. This may include information about a family history of cancers or disorders of the thyroid. It will include general symptoms that may be related to thyroid disease such as weight gain or loss, temperature tolerance, tremor of the hands, irregular heart beat or palpitations. They will want to know about lumps in the thyroid gland or neck, changes in your voice and breathing problems. Your doctor will also enquire about you general health and other relevant medical problems.
A specialist will examine your neck and thyroid gland . They might ask you to have other tests done:
- BLOOD TESTS may be taken to assess whether your thyroid is working properly and producing the correct amounts of hormone, which is the purpose of the gland.
- ULTRASOUND (a painless imaging test similar to that done for pregnacy) of the gland may be carried out to assess the size, shape and consistency of the gland.
- BIOPSY is a way of sampling the gland and finding out whether it contains any cancer tissue. It can also confirm the harmless nature of a lump. This test is done with a fine needle and is relatively painless. It is called Fine Needle Aspiration biopsy (FNA). The tiny tissue sample gives very valuable information that will guide the need for further tests or treatment. This test is sometimes done the same time as an ultrasound to ensure the correct area of the gland is sampled.
- CT/ MRI: Your specialist may ask for other tests such as a CT(computer tomograph) scan or MRI (magnetic resonance image) scan. These are specialist investigations that allow doctors to closely look at the shape, structure and consistency of the gland.
- Others. there are many more specialist tests such as RADIONUCLEOTIDE scans; but these probably require explanation by your specialist in person.
TREATMENT OF THYROID LUMPS
Remember that many lumps require no treatment if investigated thoroughly.
The thyroid gland may naturally have a lumpy consistency and if investigations suggest this is harmless no treatment is required.
On occasion, tests cannot give a definate answer as to whether a lump is safe to leave or whether it is a cancer. In this case it is usually advised to remove the lump. The lump is generaly removed with the gland surrounding it . The operation is called a thyroid lobectomy or hemi-thyroidectomy. This means that half of the gland is removed. This is the safest and most thorough way to test the lump and can provide relief as to the nature of the lump.
Removal of half of the gland rarely results in any problem with hormone levels. It is only if the whole gland needs to be removed that the hormones that the gland produces need to be replaced. This is done with THYROXINE. Even then, this means a small is tablet taken each day.