Mastering Thyroid Harmony Insights into Gland function and advanced Treatments 2024

Mastering Thyroid Harmony

 Mastering Thyroid Harmony Insights into Gland function and advanced Treatments

The Thyroid Gland

The thyroid gland lies in the back of the neck and in the lower part of the throat, the shape of the thyroid resembles that of the butterfly, and plays an important role in the release of important hormones to the body.

It ensures the release of hormones that ensure the body’s regular functioning and access to organs. Thyroid diseases cause serious health problems for the body.

Thyroid nodules prevent it from functioning properly and prevent it from releasing thyroid hormone.

Formed nodules can be removed by surgical procedures and the healthy performance of the thyroid can be ensured.

Nodules formed on the thyroid can be benign or malignant. The resulting nodules are diagnosed by doctors as a result of tests, whether benign or malicious.

Surgery is not required for benign nodules in the thyroid. A biopsy must be carried out to understand whether the nodules formed were benign or malignant.

Thyroid surgery is applied to treat certain cancers or non-cancers of the thyroid.

Definition of Thyroid Gland

The thyroid gland is a butterfly-shaped organ and is located in the neck. Thanks to the hormones it secretes, it regulates many functions in the body.

In case of shortage or excess it can cause quite serious discomfort and complaints.

Thyroid problems that are more common in women than in men can cause many diseases.

Also in general the functions of the thyroid gland are very important for the health of the body.

Because the imbalance in the level of thyroid hormone negatively affects the work of other organs and systems.

Also, the irregularity of the thyroid hormone causes symptoms such as fatigue, weight loss and inability to lose weight, and also reduces the quality of a person’s life.

The name thyroid is a word of Latin origin and is named in this name because it resembles a shield used in wars.

In this context despite also being called a “shield cloth” in some dictionaries, its shape can be said to be somewhat reminiscent of a butterfly.

When viewed from the front of the neck, the thyroid gland is located below the lower jaw, below the protrusion of cartilage called the Adam’s Apple, which appears more prominently in men.

It is an organ that is located on both sides and partially in front of the trachea (trachea).

The parts located on the sides of the trachea are called the right and left parts (right lobe, left lobe or right thyroid gland, left thyroid gland).

The thyroid gland is an endocrine gland. His role is to produce hormones called t٣ and t٤ and release them into the blood.

The main task of these hormones, which must be present at sufficient levels in the blood, is to control all processes related to the metabolism in the body and ensure that they function properly.

What is goiter

Goiter can be found in various forms. In goiter without nodes both thyroid glands are enlarged symmetrically and the face of the thyroid gland is smooth and soft.

But in nodular goiter the thyroid gland swells, but it has one or more nodes. The face of the node consists of bumps and protrusions.

Thyroid nodules

Thyroid nodules are quite common, but 4 – 20% of them are at risk of developing thyroid cancer. In particular, the gradual growth of one small node, its stiffness and adherence to its surroundings lead to an increased suspicion of cancer. And the risk of developing cancer is lower in multi-nodules .

The Endocrinology, radiology, nuclear medicine and pathology units work together with the surgical team in the evaluation of thyroid nodules.

On the one hand, thyroid nodules are examined by ultrasound to determine whether they carry a risk of cancer or not, on the other hand the scintigraphy carried out by the Nuclear Medicine Unit and the hormone values in the blood are differentiated whether they are working or not.

In small, risk-free nodules, drug therapy and a follow-up option are applied instead of unnecessary surgical application.

And fine-needle thyroid biopsy has been standardized in Cancer Research in thyroid nodules.

This procedure is performed by an experienced general surgeon and interventional radiologist, along with a pathologist.

In necessary cases these units come together at the time of surgery to give an example of teamwork.

What are the causes of sub-nodular goiter

Hypothyroidism occurs when the thyroid does not produce enough of the body’s thyroid hormone. As thyroid hormones land in the body, thyroid cells are stimulated by the brain to produce more hormones. Stimulating thyroid cells multiply and grow to produce more hormones.

How nodular goiter is formed

Sometimes some cells in the thyroid gland perceive stimuli coming from the brain more, as a result of which they multiply more than other cells.

These proliferating cells form lumps in the thyroid gland called nodules.

Thyroidectomy surgery

As a result of examination of the nodules formed in the thyroid gland the decision of surgery is made depending on whether they are benign or malignant.

Also a biopsy is performed to understand whether the units formed on the thyroid gland are benign or malignant.

The biopsy procedure is understood as the result of examination by taking a piece of the node formed by a thin needle.  If the biopsy results show that the tumor is malignant, surgery is performed.  Benign tumors can be reduced with drug treatments.

If the result of the biopsy is a malignant nodule, it should be ensured that the thyroid gland is restored to its healthy working order by surgery. Thyroidectomy surgery is an operation to remove part or all of the thyroid gland under general anesthesia.

Why do we perform thyroidectomy

The most important reason for sending patients to the surgeon is the discovery of a nodule in the thyroid gland, and as a result of fine needle biopsy, which is often performed from the node, directly affects this decision.

  • Surgical intervention of needle biopsy is usually recommended for the following results:
  • Cancer
  • The likelihood of developing cancer (follicular, hortel tumors)
  • Benign conditions: benign nodule surgery is usually performed in the presence of a large nodule, in the case when the nodule grows gradually or when it causes various complaints ( pain, difficulty swallowing, feeling of pressure ).

In addition, surgical interventions are an important treatment option in diseases in which the thyroid gland works hard and secretes excessively.

Surgery is an important treatment method in patients with a large goiter, as well as in patients with multiple nodules .

Mastering Thyroid Harmony

Indications for the thyroid operation

Depending on the indication for thyroidectomy (necessity and cause of the operation), the volume of surgical intervention will change.

We can evaluate thyroidectomy operations as follows :

  • The presence or suspicion of thyroid cancer is an absolute indication for surgery.
  • Large nodules: although they do not carry the risk of cancer, large nodules can cause compressive and cosmetic problems. In addition, since it is possible to miss a small focus of cancer in a large node with a needle biopsy, surgery can be performed on nodules that are more than 4 cm high.
  • Hyperthyroidism: it is a condition that occurs as a result of excessive work of the entire gland, in case the condition does not respond to medication or radiation therapy, then surgery can be performed.

What are the types of thyroid surgery

As with all surgical techniques many labels have been made and it can be a bit confusing.

The most understandable, simple and most commonly used classification today is as follows:

Unilateral thyroidectomy (lobectomy- removal of the thyroid gland) :

it is the least acceptable thyroid surgery today.

It should be borne in mind that the risks listed below will be less or not at all in unilateral thyroidectomy operations.

It is often the approach of choice for benign thyroid tumors.

The thyroid tissue remaining after the operation may provide a sufficient amount of the hormone to the patient and the patient may not have to use medications.

Total thyroidectomy:

this surgical technique should be preferred in diseases such as thyroid cancer and multinodular goiter involving the entire thyroid gland.

The risk factors listed below are generally identical to this operation. In order to replace the thyroxine secreted by the excised thyroid gland, the patient must take oral thyroxine for life.

Total thyroidectomy- lymph node dissection:

(only with central lymph nodes or lateral cervical lymph nodes (located on the side of the neck): these are the methods that should be applied at some stages and some rare subtypes of thyroid cancers.

Thyroidectomy is an operation performed with a planned skin incision according to the size of the thyroid gland in the neck and whether a lymph node dissection will be performed. Making a skin incision suitable for the patient’s neckline, if any, provides better wound healing.

Thyroid surgery procedure

Incision in the skin:

it is classically inserted by means of an incision approximately 10 cm long in the midline at the bottom of the neck .

in recent years, the length of the incision has decreased to 5 cm or even 4 cm in experienced hands.

Thus, it is possible to end the operation with a very limited surgical scar.  It will always be possible to remove the thyroid gland, provided that it is not too large, through a 5 cm incision.

Dissection method-devices for sealing vessels:

the standard method is performed using conventional surgical instruments, unipolar and bipolar electrosurgical techniques, as well as controlling bleeding using suture ligaments.

Some electrosurgical methods, also known as “vessel sealing” devices, have also increased in popularity in recent years.

The most important advantage of these devices: control bleeding and thereby facilitates the entire procedure and shortens the procedure time.

In this sense, these devices may indirectly have benefits in terms of performing the entire surgery or reducing complications, but the surgeon’s experience and understanding of the surgical approach are important here.

Finding and maintaining the following signs of pathology is important to avoid postoperative complications.

Important points in thyroidectomy operations

Protection of the nerves of the vocal cords :

there are two nerves originating from the same root that are responsible for the function of the vocal cords, called the upper and lower laryngeal nerves. These functions are associated with the production of sound and the movement of the vocal cords for breathing, the main one is the lower laryngeal nerve.

These nerves are bilateral right and left and there are a total of 4 nerves.

The sound quality of the upper laryngeal nerve :

it has duties related to the slimming and thickening of the voice. These nerves always run very close to the thyroid gland, so they must be found and protected very sensitively during surgery.

During thyroidectomy, the nerve is monitored with a special device to protect the nerve vocal cords

  • Voice changes: are often temporary (hoarseness, deterioration of voice quality, etc.) And occur due to nerve damage. If the operation is under the supervision of experienced hands, the incidence of permanent hoarseness is less than 1%. Nerve monitoring during the operation is an important factor that reduces the likelihood of permanent hoarseness.
  • Parathyroid glands: secretes parathormone, which is one of the most important hormones that control calcium metabolism in the body. The number of these glands is 3, 4 or 5, their size is about 1 × 1 cm and they are in close relationship with the thyroid gland. And even just one presence is enough for the continuation of calcium metabolism.
  • In the case of its complete absence, the level of calcium in the blood drops significantly, then it may be necessary to take calcium pills and sometimes artificial parathormone .

During the operation, a pathological sample is taken to determine the level of the operation : it is the process of evaluating the lobe removed during surgery or a suspicious lymph node using the method of rapid preparation in pathological pathology.

It provides information about whether the evaluated part is cancer and helps the surgeon how to follow the operation plan.

It is very accurate, but it does not give a one hundred percent accurate result, so the final result is determined at the main pathology examination.

The period after the thyroid operation

  • The duration of thyroid surgery is about two hours. There is usually no pain that bothers the patient after surgery. The feeling of mild pain in the throat disappears after 24 hours.
  • After the operation, follow – up in the department within 6-8 hours after the operation, the patient begins to eat and can walk easily. Most patients are discharged from the hospital within the first 24 hours after surgery.
  • Patients do not immediately start using thyroid hormone medications until a satisfactory result is obtained, especially in patients with tumors or in patients with suspected tumor
  • Thyroid hormone medication is not started until the satisfactory result is obtained, especially in patients with tumors or in those who are suspected of having a tumor.
  • After the result of the biopsy, the patient is started taking hormonal medication and a program is made to determine the blood hormone after one month.
  • Patients should not particularly restrict the movements of the head and neck, otherwise neck pain can reach alarming proportions.

Complications and problems caused by thyroid diseases

  • Have you found that your heart rate is too high or too low (under 60 or over 100)
  • Do you feel tightness and tension in your neck
  • Do you often suffer from sweating and hair loss
  • Recently have you suddenly gained or lost excess weight
  • Is your skin scaly, dry, or dull-looking
  • Do you experience sudden nervous attacks or drowsiness during the day
  • Do you have swelling in your legs
  • Has your intolerance to cold and heat increased recently
  • Do you experience bouts of constipation, diarrhea, or abdominal pain
  • Do you suffer from forgetfulness or are you prone to depression
  • If you suffer from many of these situations, you should definitely consult a specialist.

Are there other therapeutic methods that can be used

A thyroid cancer operation should definitely be performed for all patients with thyroid cancer or the possibility of thyroid cancer.

If there is no possibility of thyroid cancer, there are other treatment options depending on the diagnosis.

However, these options should be determined by talking with the patient and the doctor.

Radioiodine therapy can be used in patients who have an overactive thyroid gland and whose age is large instead of undergoing surgery.

How should I be examined before surgery

As in all other operations, in proportion to patients planning to have thyroid surgery, the patient’s medical history and background should be known and a complete physical examination should be performed including a cardiac examination in the preoperative period.

In general and patients with heart disease ECG examinations and chest X-rays are performed for patients over 45 years of age.

Blood tests may be ordered for patients with bleeding problems, and a repeated hormonal test may be required before surgery.

Also in the preoperative period patients with voice changes and patients who have undergone a previous thyroid operation are examined for the detection of vocal cords (vocal cords). It is important that the nerves that move the vocal cords are intact before surgery.

Will I be able to continue my normal life after the operation

Yes, after the expiration of the effects of the thyroid operation, that is, after the recovery period, you will be able to do everything that you can do as you were before the operation. In many patients, hormone levels decrease after thyroid surgery and hypothyroidism develops in them.

This is especially common in patients who have undergone surgery for thyroid cancer.

In the postoperative period hormone replacement therapy is performed and the dose of the drug to be taken is adjusted. In addition, your doctor may recommend before starting hormone therapy with radioactive iodine during the postoperative period.

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