What is the Thyroid Gland and Where is it?

Thyroid is the Greek word for shield. It is a small gland situated in the neck, just below the “Adam’s apple”. It sits directly in front of the trachea or wind pipe. It is a gland that makes thyroid hormone. This hormone regulates other hormones throughout the body.

There are several reasons why the thyroid gland may need surgical treatment. Such treatment may include biopsies to see if cancer of the thyroid exists. The thyroid gland may become enlarged and still be benign, a condition still commonly known as a “Goiter”.

The thyroid may have one or more enlarged nodules. The issue centers around whether these nodules are fluid filled or solid. Fluid filled nodules or cysts are most often benign. Solid nodules are still most often benign, but the potential for cancer is much higher.

Diagnosis

A thorough and accurate cancer diagnosis is the first step in developing a thyroid cancer treatment plan. Ultrasound is the most commonly used method to evaluate the size and nature of a thyoid mass or enlarged thyroid. Radioactive tests such as I131 can be used to evaluate the thyroid gland and its function. At times CT scans may be useful as well.

A needle biopsy is the simplest way to obtain cells to examine in the laboratory. A Fine Needle Aspiration (FNA) can be done in your doctor’s office or at the laboratory. A slightly larger needle may be used to obtain a core needle biopsy. A core of thyroid tissue can be more useful in making a diagnosis than a FNA prior to surgery.

Your doctors will use these and other advanced diagnostic tests and tools to evaluate the disease, and plan your individualized treatment. If you are diagnosed with a thyroid cancer, Dr. Simon will coordinate with your primary doctor and/or endocrinologist to use imaging and laboratory tests to establish the location and the size of the tumor(s), monitor your response to treatment, and modify your treatment plan when indicated.

Surgical Treatment

There are a few different types of surgeries that may be used to treat benign thyroid disease as well as thyroid cancer.

Lobectomy

For small, well differentiated tumors that have not spread beyond the thyroid gland, a lobectomy may sometimes be performed. In this type of thyroid cancer surgery, the lobe containing the cancer is removed, leaving the other healthy lobe behind. This can reduce the need to take thyroid hormone treatment after surgery, since a functioning part of the thyroid remains.

However, more often than not, the proper treatment of any thyroid cancer is to remove as much thyroid tissue as possible on both sides of the neck. By removing both lobes, the patient is typically left with a situation where his or her doctors can then more easily manage the needed thyroid hormone supplements post surgery.

Thyroidectomy

Both lobes of the thyroid gland are removed. In this procedure, most or all of the thyroid gland is removed by surgery. Fine nuances exist in the type of surgery, so terms such as total thyroidectomy, near-total or subtotal thyroidectomy may be used. For proven thyroid cancer, one of these forms of thyroidectomy is most often recommended. Because very little or no functioning thyroid tissue is left behind, patients will need to take daily thyroid hormone replacement pills afterwards. This is well tolerated and not felt to be troublesome by most patients.

Lymph Node Removal

When the surgeon suspects that the thyroid cancer cells have spread to nearby lymph nodes, they will remove the enlarged or suspicious nodes from the nearby neck. This is done to prove or disprove that such spread has occurred. It is also performed in order to remove as much of the cancer as possible. This thyroid cancer surgical procedure is usually performed at the same time as the surgery on the primary tumor. Removal of neck lymph nodes is known as cervical lymphadenectomy.

Treatment After Surgery

After surgical therapy is completed, the patient is typically given a few weeks to recover from the surgery. Further therapy may then be completed by the administration of radioactive iodine. It is typically given as a single pill in a dose large enough to destroy any minute areas of thyroid cells that might remain. The patient will then be placed on routine thyroid hormone pills and followed one a year by his medical team, including his primary doctor, endocrinologist, and surgeon.