Thyroid gland diseases and Goiter

Thyroid gland is an organ in the shape of a butterfly and weighs approximately 15-20 grams. It occurs while still in the womb and starts to secrete hormones. Thyroid hormone;

• Provides both growth and intelligence development of the baby in the womb,
• Provides contraction of muscles in adults,
• Supports the breakdown of fats and carbohydrates,
• Increases protein synthesis,
• It also contributes to the development of intelligence in adults.

What is a goiter? What are the types of goiter?

Goiter is the name given to the enlargement of the thyroid gland in short. This growth can occur with the emergence and growth of the lumps called nodules, as well as the growth of the entire thyroid gland without nodules. As a result of this growth, the thyroid gland sometimes begins to secrete excessive thyroid hormone. This condition is called hyperthyroidism. Sometimes, the thyroid gland remains normal and grows without any increase in hormones. This condition is called euthyroidism. The condition in which the thyroid gland secretes less hormones than its normal values is called hypothyroidism. It can be detected in many disorders and situations. The most common example is Hashimoto’s thyroiditis, one of the inflammatory diseases of the thyroid gland. Thyroiditis is the general name given to the inflammatory disease of the thyroid gland.

 

How is goiter diagnosed?

Reasons for consulting a physician; swelling in the neck, palpitations in the case of hyperthyroidism, shortness of breath, getting tired quickly, weight loss, fatigue, exhaustion, hair loss and weight gain in the case of hypothyroidism. When the patient applies to the physician with these complaints, the thyroid hormone values are checked first and an ultrasound is performed for the thyroid gland. If necessary, thyroid scintigraphy helps the diagnosis. In the examinations, it is evaluated whether the thyroid gland is enlarged, whether there is a nodule and whether the gland secretes excessive hormones. In the next stage, if there is a suspicion of cancer in the nodules, a biopsy is taken from the suspicious nodule with an ultrasound-guided needle. If there is no suspicion of cancer, medication is started according to the hormone status and the patient is followed up.

Who should have surgery for goiter?

Not every goiter patient needs surgery. When a goiter is detected in a patient, he usually performs, treatment is initiated and / or the patient is followed up by an endocrinologist. The patient with goiter should undergo surgery in the following cases;

• Cancer or suspicion of cancer in the needle biopsy,
• Enlarged thyroid gland compressing the windpipe,
• Enlarged thyroids extending down from the breastbone,
• Cosmetic reasons,
• Family history of thyroid cancer,
• Generally, surgery is recommended for thyroid nodules larger than 4 cm, as it becomes difficult to detect cancer cells with needle biopsy.

Apart from these cases, patients with goiter recently can be tested for the risk of thyroid cancer by performing a gene test. If there is a high risk in the gene test, it is useful to remove the thyroid tissue with surgery.

How is goiter surgery and treatment?

In patients who are decided to have surgery, the thyroid gland is completely or completely removed, or almost completely. Goiter surgery can be performed generally openly, very rarely laparoscopically in selected patients. In open surgery, the 6-7 cm longitudinal cut-off thyroid gland is removed. The patient stays in the hospital for one night and is discharged the next day after the controls are completed. Since the thyroid gland is removed after surgery, thyroid hormone should be taken orally for life.

 

What are the complications that may occur during and after goiter surgery?

The thyroid gland is one of the body’s most blood-drenched organs and is also located just above the nerves that stimulate the vocal cords. In addition, parathyroid glands that secrete calcium into the blood are located just near the thyroid gland. Depending on the complications that may occur; 

• Bleeding occurs in the first hours after surgery. It can be prevented with careful surgery, but no matter how careful it is, it can be seen with 1-2% possibility after surgery.
• Infection is very rare. It usually occurs with the development of a reaction to the suture materials used in surgery.
• Damage to the vocal nerves can be unilateral or bilateral. Unilateral vocal nerve damage is 2-3%, and bilateral nerve damage is much less common. There may be permanent or temporary hoarseness after surgery. If the nerve damage is bilateral, shortness of breath may develop.
• Calcium deficiency is caused by accidental removal of the parathyroid gland or its malnutrition during surgery. It can be temporary or permanent. It is treated by oral calcium and vitamin D.
• Permanent thyroid hormone deficiency (hypothyroidism) occurs after the thyroid gland is removed due to its inability to secrete hormones. The patient must use oral thyroid hormone for life.

Can’t the complications that may occur during surgery be prevented?

It is possible to reduce the risk of complications that may occur during surgery with the help of special tools to be used in surgery. The risk of bleeding can be eliminated by using devices that connect the vessels by burning, and the risk of hoarseness by using devices that show the location of the vocal nerve. However, the use of these devices unfortunately increases the cost of surgery a little.