Understanding Thyroid Disorders

Disorders of the thyroid gland are very common, affecting millions of Americans. Your thyroid gland is part of the endocrine system that makes hormones to regulate physiological functions in your body, like metabolism (heart rate, sweating, energy consumed). Your thyroid is located in the middle of your lower neck below the voice box (larynx), and wraps around the front half of the windpipe (trachea).

The most common thyroid problems include:

Patients with a family history of thyroid cancer, or who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons, are more prone to develop thyroid cancer. If you develop significant swelling in your neck and have difficulty breathing or swallowing, you should call your ENT (ear, nose, and throat) specialist, or otolaryngologist, or go to the emergency room.

How is a Thyroid Disorder Diagnosed?

Typically, your doctor will take your medical history and perform a physical examination, including asking you to lift your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps your doctor feel the thyroid and any mass in it. They may order blood tests or imaging scans (e.g., chest X-ray or a CT or MRI scan), and may or may not perform a perform a fine needle aspiration.

Other tests your doctor may order include:

  • Evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope
  • An ultrasound examination of your neck and thyroid
  • A radioactive thyroid scan

When is Thyroid Surgery Required?

Many common thyroid problems are managed with medications and are not treated surgically. For example, Hashimoto’s thyroiditis, in which scarring and inflammation of the thyroid cause it to not make a sufficient amount of hormone, is treated with hormone pills.

However, other thyroid disorders do require surgery for optimal treatment. Your ENT specialist will determine whether thyroid surgery is recommended to remove part, or all, of the thyroid gland. Instances when thyroid surgery may be required include:

  • the fine needle aspiration is indeterminate, suspicious, or suggestive of cancer
  • imaging shows that nodules have certain characteristics, or that nodules are getting bigger
  • the windpipe or esophagus is compressed because one or both lobes are very large

Surgery is usually performed in the hospital under general anesthesia to remove the lobe of the thyroid gland that contains the lump. Your ENT specialist will determine if the rest of the thyroid gland should be removed during the same surgery. The amount of the thyroid gland that should be removed (half or whole) is determined by your condition. Some disorders, such as Graves’ disease, require the whole gland to be removed. However, other situations may only need half of the gland to be taken out. This is an important question you should discuss with your surgeon, including all options, before the operation.

What Happens after Thyroid Surgery?

First 24 hours—After surgery, you may have a tiny piece of plastic tubing inserted to prevent fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the next day. Complications are rare but may include bleeding, hoarseness, difficulty swallowing, numbness of the skin, or other situations that your surgeon will discuss with you.

At home—Your surgeon will discuss any necessary medications with you prior to your discharge, and give you specific instructions to take home with you. This may include thyroid hormone replacement medications, or calcium and/or vitamin D replacement.

Some symptoms may not become evident for two or three days after surgery. If you experience any of the following, call your surgeon or seek medical attention:

  • Numbness and tingling around the lips and hands
  • Increasing pain
  • Fever
  • Swelling
  • Wound discharge
  • Shortness of breath

If a malignancy is identified, thyroid replacement medication may be withheld for several weeks. This allows a radioactive scan to better detect any remaining microscopic thyroid tissue, or spread of malignant (cancerous) cells to lymph nodes or other sites in the body.

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The information on ENThealth.org is provided solely for educational purposes and does not represent medical advice, nor is it a substitute for seeking professional medical care.