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Thyroid Diseases
The thyroid gland, which controls metabolism and growth,
is located beneath the Adam's apple. Thyroid diseases
are very common, affecting millions of Americans.
A
healthy thyroid is important because it helps to regulate
and control the rate of physiological functions in your
body.
Signs
of an underactive thyroid gland, or hypothyroidism,
include puffy eyes or gradual forgetfulness, a dull
facial expression and changes in hair (sparse, coarse,
dry) and skin (coarse, dry, scaly).
Symptoms
of an overactive thyroid gland, or hyperthyroidism,
are goiter (enlargement of the thyroid gland), bulging
eyeballs, fast heart rate, moist skin, frequent bowel
movements, tremor, jumpiness, sensitivity to heat, and
insomnia.
Both
conditions can be treated with medications. Sometimes
with hyperthyroidism, radioactive iodine is used to
slow down the thyroid when medications cannot be taken.
If surgical removal of the thyroid is required, the
patient should be on hormone replacement pills for rest
of his/her life.
While
the entire thyroid gland may be enlarged in certain
disorders, there may also be other situations where
discrete, localized growths in the thyroid gland occur.
These can be malignant and sometimes require removal.
Most thyroid cancers can be removed and typically there
is a long survival rate. There are exceptions, however,
and certain thyroid cancers have the same lethal potential
for spread as do other cancers.
Lumps
in the thyroid gland may appear gradually or very rapidly,
and can either be benign or malignant. All thyroid "lumps"
(nodules) should generate suspicion and a prompt visit
to the doctor. Patients who had radiation to the head
and neck as children for acne, adenoids, or other reasons
are more prone to develop thyroid cancer later in life.
Most lumps are benign and usually treated with medication
known as “suppression" therapy to shrink the
lump.
In
many cases, the thyroid mass will be removed. Thyroid
surgery is an operation to remove part or all of the
thyroid gland. It is performed in the hospital, and
general anesthesia is usually required.
When
choosing a doctor for this surgery, a patient should
look for someone who often operates in the area and
understands the complexities of thyroid endocrine conditions.
There are two primary reasons. First, the nerves to
the voice box go just underneath, and these need to
be preserved. If these are damaged, the patient will
have voice changes. Second, the important glands that
regulate calcium metabolism are often attached to the
thyroid and must be protected. Finally, a doctor must
know how to look at vocal cords before surgery to know
if there's already a problem with the nerves. For these
reasons, you need to see an otolaryngologist-head and
neck surgeon.
Risk
factors
In
thyroid nodules, several risk factors tend to point
to the possibility of malignancy
Age:
Although thyroid cancer occurs in people of all ages,
it is more common in younger people. In the elderly,
however, the prospect for re- covery is worse. Men over
40 and women over 50 have a poorer prognosis.
Gender:
Thyroid disease is common in women, but thyroid cancer
is more common in men. At all ages, women also have
better survival rates.
Irradiation:
Malignancy rate in thyroid nodules in those with a history
of irradiation is about half. For that reason, patients
who have had low-dose external beam radiation to the
neck should be watched for the development of thyroid
nodules.
Environment:
In the United States, multinodular goiters are rare,
while this is not true for regions in Europe, the Himalayas,
South America, and the Middle East.
Characteristics:
Watch for hard, fixed, fast-growing nodules.
Metastases:
Metastatic lymph nodes in the neck and vocal cord paralysis
indicate cancer.
Pressure
effect: Distortion of the windpipe from thyroid
masses that compress the airway is cause for immediate
surgical intervention.
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