What is the Thyroid Gland?
The thyroid is situated in the neck on both side of the windpipe below the Adam’s apple and above the level of the collarbone. It is one of the largest endocrine glands in the body.
The thyroid produces hormones Thyroxine (T4) and Triiodothyronine (T3) which controls metabolism and influence growth and the function of other systems.
Calcitonin which affects Calcium levels in the body
When does one suspect a thyroid problem?
- When there is an enlargement of the thyroid. This tends to be subtle at first but over time become obvious. The enlargement may be one sided or on both sides. When the enlargement becomes very large, it can compress on the surrounding structures and cause difficulty in swallowing, speech and breathing.
- When there is hyperactivity (over active thyroid) or hypoactivity (under active thyroid).
- Hyperactivity symptoms include weight loss, increase appetite, anxiety, fatigue, being afraid of heat, hyperactivity, increase thirst and sweating, palpitation, hand tremours
- Hypo activity include fatigue, weakness, weight gain, coarse dry hair, dry rough skin, hair loss, being afraid of cold, constipation, depression, irritability, abnormal menstrual cycles, decrease libido.
Often thyroid abnormalities is picked up in health screening through examination or a blood test.
What do I do when I suspect a thyroid problem?
Any suspicion of thyroid abnormalities should be evaluated. Consult your doctor early. Many of the thyroid problem are amenable to treatment.
What will my doctor do?
Your doctor will examine you to determine the size of the thyroid and also to determine if you have any signs of abnormal thyroid function. In addition, the following tests are performed:
- Thyroid function test (Blood): this will detemine the hormal status of the thyroid.
- Ultrasound Scan: this will document any abnormal enlargement of the gland. It can determine the size and nature of this enlargement. Sometimes the nature of the ultrasound can determine the diagnosis.
- Nasoendoscopy: This will help assess if the vocal cord are functioning properly as the thyroid is in front of the voice box.
- Fine Needle Aspiration: a small amount of cells can be aspirated from suspicious lump in the thyroid and this can be examine under the microscope to help determine the cause of the thyroid problem. This is very much like blood taking.It can help us determine if the lump is benign or malignant or if there is inflammation and hence the planning of definitive treatment.
What are the common thyroid diseases?
Thyroid diseases can be divided into the following categories:
- Endocrine Disorders where thyroid either under or over produces the thyroid hormones. Treatment is generally by medication either to replace deficient hormones or to suppress an overactive thyroid.
Occasionally surgery or administration of radioactive iodine is needed to reduce the hyperactivitity should medication not be effective.
- Inflammatory Disorders such as Hashimoto’s thyroiditis, Dequervain thyroiditis, Graves’ disease and Multinodular Goitre. Typically the management is medical to support or suppress the hormonal level. In situation where MNG is very large or causing compressive symptoms, surgery may be required.
- Tumours may be benign or malignant. Tumours are fairly common in our population. Up to 10% of the population can develop thyroid lump that can be felt or seen. Of these the majority is benign (95%). To determine if a lump is benign or malignant, fine needle aspiration cytology is necessary.
Malignant tumours include papillary, follicular, anaplastic and medullary tumours. The first two has better prognosis. The factors associated thyroid tumours include extremes of age (<20y >70y), male, family history, history of irradiation and associated lumps in the neck.
What are the types of thyroid surgery?
As there are 2 halves (lobes) of the thyroid gland, surgery can either remove half the gland (hemi-thyroidectomy) or the full gland (total thyroidectomy). Indications would depend on the nature of the disease. In general, benign condition only recur the involved side to be removed while in malignancy; the entire gland needs to be removed.
In malignancy, the surrounding lymph nodes need to be cleared as well.
Hemi-thyroidectomy can be a day surgery procedure while in total thyroidectomy, the patient has to be hospitalized for 2 to 3 days.
Take home message:
All Thyroid problems should be evaluated by a doctor as the majority are treatable and curable.
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