The thyroid gland is a gland in the neck in front of our windpipe, below the Adam's apple.
It is shaped like a butterfly, it's got a lobe on the right side, a lobe on the left
side, with a bridge of tissue connecting the two. The gland produces a hormone called thyroxine
which is necessary for metabolism, that is, it helps the cells function at the right speed,
so if too much of the hormone is produced the cells work faster, the body starts working
faster, or if too little is produced the body slows down. There are generally two sets of
disorders that can be associated with the thyroid gland. One as I mentioned earlier,
too much of the hormone can be produced which we call an overactive thyroid, or too little,
that is an underactive thyroid. These problems are generally dealt with by the GPs or sometimes
they are referred to a separate group of consultants called endocrinologists. We, as thyroid surgeons
get involved if there is a swelling of the thyroid gland, which we sometimes call a goitre
or if there is a nodule within the thyroid gland and we normally recommend surgery if
there are symptoms due to the size of the thyroid gland due to increase in size or if
there is any concern that the swelling could be malignant.
Most patients with thyroid cancer present with a painless lump in the region of the
thyroid gland that is below the Adam's apple, generally in the midline or occasionally on
one side or the other of the midline. Occasionally, the thyroid cancer within the thyroid itself
may be too small to be visible and patients may present with a swelling of the lymph gland
and in that case, patients will present with a swelling on the side of the neck rather
than around the midline and then once we investigate the swelling in the lymph gland we realize
that it is actually arising from a tiny cancer within the thyroid gland.
One must remember though that the majority of the thyroid lumps that are seen are benign,
but we often investigate them by doing an ultrasound scan or sometimes a test called
FNAC – a small biopsy with a needle to ensure that we don't miss an early malignancy. The
most common cause of neck lumps are swollen lymph glands in the neck, as a result of any
minor infection or inflammation in the head and neck region, it could be a skin abrasion
or a common cold. We all have hundreds of lymph glands in the neck and they swell up
as a result of any infection or inflammation, but any lump in the neck that persists for
more than about 3 to 4 weeks or any lump which is growing in size without any obvious signs
of inflammation or infection should be investigated further.
Thyroid cancers are generally divided into stages, we call it T1, T2, T3 or T4. Based
on the size of the tumour within the thyroid gland or whether they have spread to the surrounding
structures such as muscles or nerves, the windpipe or the food pipe. We also stage them
based on whether they have spread to the lymph glands in the neck or to distant sites such
as lungs or bones. The most common form of thyroid cancer that we encounter is called
papillary cancer or follicular cancer, can be effectively treated with an excellent chance
of cure, and treatment generally involves surgery. Early thyroid cancers, that is T1
cancers or some T2 cancers can be treated surgically by removing only one-half of the
thyroid gland, the half that is involved and by preserving the other half. For advanced
cancers of the thyroid, we recommend removal of the entire thyroid gland called total thyroidectomy
and sometimes we also remove the groups of lymph glands that are involved at the same
time. Patients who need removal of the entire gland, that is a total thyroidectomy often
need some additional treatment in the form of radiation but we give these patients a
very targeted form of radiation called radioiodine treatment which specifically targets thyroid
cells and cancer cells and minimises damage to the other cells of the body.
The operation is done under general anaesthesia. We either remove one half of the thyroid gland
or the entire gland based on the underlying condition. An incision is made in one of the
lower neck skin creases so that the scar is hidden within the skin crease. There are a
lot of important structures around the thyroid gland, many blood vessels that supply the
glands and important nerves and we take care to carefully identify these structures. The
blood vessels are all carefully identified and tied off. Special attention is given to
preserve some important nerves in the neck which are closely related to the thyroid gland.
These nerves supply the voice box and make the vocal cords move. We gently separate these
nerves from the gland and the gland is removed. Small drainage tubes are inserted into the
neck which drains away any excess fluid after the surgery and these tubes are generally
removed after 24 to 48 hours. The wound is closed either with dissolvable stitches or
sometimes with skin clips and the scars generally heal well.
In the postoperative period, patients may experience some discomfort or pain in the
neck and this can be controlled with painkillers. If the entire thyroid gland is removed, we
tend to monitor the calcium levels after the surgery because there are tiny glands very
close to the thyroid gland which maintain the calcium levels of the body and these may
be bruised during the procedure and the calcium levels could drop in a small percentage of
patients. Once we are certain that the calcium levels are normal and once the drainage tubes
are out, the patients can go home usually one to three days after the surgery.