Thyroid diseases: Hyperthyroidism
(overactive thyroid gland) Hypothyroidism
(underactive thyroid gland)

The thyroid is a butterfly shaped gland in the throat at the base of the neck that wraps around the windpipe (trachea). The thyroid has two lobes or wings, a right lobe (lobus dexter) and left lobe (lobus sinister) connected in the middle by the isthmus. The thyroid gland weighs just a few grams and normally can be barley felt in the neck. It secrets hormones that are essential to a person’s metabolism, especially for digestion, but also controls the rate the body burns energy, makes proteins and reacts to other hormones.

The thyroid gland is prone to several diseases (both benign and malignant) of which Hyperthyroidism (overactive thyroid) and Hypothyroidism (underactive thyroid) is the most common. The thyroid may also become enlarged, inflamed or cancerous. Surgical therapy is commonly used for treating thyroid diseases, often in conjunction with drug and radiological therapies.

Symptoms

Enlarged thyroid causes a Goiter (or British E. Goitre), sometimes called bronchocele, or by its Latin name, struma. This can occur without any noticeable symptoms or there may be a swelling of the neck around the larynx. In the case of swelling, the thyroid may press against nearby organs, especially the windpipe (trachea) and esophagus causing problems breathing or swallowing. Accompanied by hyperthyroidism (overactive thyroid gland), especially with Morbus Basedow syndrome, symptoms may include anxiety, nervousness, hyperactivity, sweating heart palpitations, and weight loss. A typical sign is retracted eyelids appearing as protruding eyes (hyperthyroid stare) or eyelid lag. Inflammation of the thyroid (thyroiditis) is accompanied by painful swelling and acute symptoms include fever. Radioactive iodine imaging shows a hot spot (active nodules) if the nodule is secreting hormones, and a cold spot (inactive nodules) if the nodule is not secreting hormones. The former is most likely to be benign, while the latter is most likely to be malignant.

Common thyroid diseases:

Euthyroid or bland Struma (Goiter with normal hormone production)
Euthyroid goiter constitutes 90% of all goiter diagnosed. It is accompanied by sometimes-visible swelling around the neck. The usually cause is iodine deficiency or endocrine stress with an unusual spike in hormone requirement.

Hyperthyroidism (overactive thyroid gland)
Hyperthyroidism occurs when the thyroid produces too much hormones causing an abnormal increase in the metabolism. Causes include autoimmune diseases, or adenoma (benign growths) that over produce hormones. Acute occurrence of hyperthyroidism can lead to so called "thyroid storm" (thyrotoxicosis) a potentially life threatening syndrome manifested as tachycardia, (racing heartbeat) hypertension and fever.

Hypothyroidism (underactive thyroid gland)
Typical causes of hypothyroidism are acquired or congenital defect of the thyroid gland. Acquired defects can be caused by thyroiditis (Inflammation of the thyroid gland), autoimmune diseases or exposure to radioactive materials. Conditions related to the pituitary gland and the hypothalamus, both of which are active in controlling the thyroid, can also cause hypothyroidism.

Diagnosis

A goiter can often be immediately seen on the neck. Palpitating the area with fingers and an ultrasound examination are the first means of judging the extent of the disease. The second step is examining the blood for specific parameter of the thyroid hormones.

• Measuring the level of Thyroid-stimulating hormone in the blood to determine the T3 andT4 levels.
• Scintigraphy to distinguish hyperthyroidism from thyroiditis.
• Ultrasound examination of the thyroid.
• Consultation with ENT (ear, nose and throat) physician.
• Fine needle biopsy of nodules.
• CT scan of the throat

Therapy

Conservative Therapy
Some findings can be treated with medication, for example thyroid hormones or thyroid gland inhibitors. A further option is treatment with iodine radiation therapy.

Surgical Procedures

Several different findings can lead to recommendation of surgical procedures. These include, goiter (enlarged thyroid gland), restricted trachea and esophagus causing problems breathing or swallowing, hyperactive thyroid caused by goiter or nodules, adenoma or goiter with cold nodules, or reoccurrence of goiter and other symptoms that do not react to radiation therapy. Patients with Morbus Basedow syndrome will require that normal tissue in the surrounding area be removed to prevent continued symptoms of hyperthyroidism. In cases of thyroid cancer with a malignant tumor, the best option is removal of the entire thyroid and the surrounding lymph glands.
Thyroid operations are preformed with the patient under general anesthetic. An incision is made at the base of the throat, usually from right to left. A partial (one lobe is removed) or full (both lobes removed) Thyroidectomy is performed according to the diagnostic findings. Thyroid conditions that do not involve malignant tumors require that all nodules be removed to prevent reoccurrence of goiter.

Prognosis

Malignant tumors can be treated according to the type, extent and whether there are metastases or not. Non-malignant thyroid conditions can be dealt with surgically with a low risk of complications when the surgeon is experienced in this procedure. The patient can be released from the hospital usually 2-3 days after surgery, and are allowed to work again usually after 1 week.
If the entire thyroid gland is removed, the patient must take replacement thyroid hormone for the rest of his/her life. Partial removal of the thyroid gland usually requires long-term supplemental thyroid hormone therapy. This will be determined by a laboratory blood examination approximately 6 weeks after the operation, and then once a year thereafter.

Notice: Preoperative preparation: Please inform your physician if you are taking blood thinning medication such as Aspirin® and Marcumar® as they may lead to complications during surgery.