Thyroid Gland Diseases and Surgery
October 25, 2021 / By Nihat.Gulaydin-2021 / Posted in General Surgery
The thyroid gland is a butterfly-shaped organ located in front of and on both sides of the trachea in the midline of the neck, which secretes thyroid hormones (T3, T4) into the body. Hypothyroidism occurs as a result of the gland secreting too little hormone, and hyperthyroidism, popularly known as toxic goiter, occurs when the gland secretes too much hormone. A mass called nodule and related cancers may develop inside it. Apart from these, there are inflammatory diseases called thyroiditis of autoimmune origin (Hashimato thyroiditis, Basedow Graves) or microbial origin.
While inflammatory and autoimmune diseases are treated with medications, toxic goiters that do not respond to treatment, large cancer-suspicious nodules and nodules diagnosed with cancer are treated surgically.
The most important reason for the formation of nodules is iodine deficiency in water.
Nodules are evaluated mainly by neck ultrasonography and fine needle aspiration biopsy (FNAB).
In the presence of nodules diagnosed as cancer or suspicious, surgical treatment must be performed.
Depending on the location and size of the tumor and nodules, patients undergo bilateral total thyroidectomy or unilateral total thyroidectomy. If cancer spreads to the lymph nodes in the neck area, neck dissection surgeries should be performed to clean the glands in the neck.
The thyroid gland is an important surgery due to the vocal nerves adjacent to it and the presence of 4 lentil-sized parathyroid glands that manage bone metabolism. If the vocal nerve is injured, permanent hoarseness and shortness of breath may develop, and if the parathyroid glands are not protected, permanent medication use and osteoporosis problems may occur. In order to prevent these problems, meticulous surgery and the use of a monitoring device that shows the nerves are required. Surgical experience is critical at this stage.
Surgical treatment can be performed open and closed, namely laparoscopic surgery (TOETVA). In the closed method, thyroid surgery is performed through the mouth. The aim of this method is to not leave any visible scars on the neck. Nowadays, cosmetic surgeries are preferred by patients.
What awaits patients after goiter surgery?
Patients must be prepared for surgery, including thyroid hormone tests. For surgery, hormone levels must be normal. The surgery takes approximately 2 hours. Nerve monitoring is definitely performed during the surgery. Patients who stay in bed for 1 day after the surgery are discharged if no problems are observed, their drains are removed.
The pathology result is evaluated approximately one week later.
Patients diagnosed with cancer are directed to Nuclear Medicine centers for Radioactive Iodine treatment (Atomic therapy).
Those whose pathology results are clear are started on thyroid hormone medication and are followed up.
Parathyroid gland diseases and surgery
They are 4 lentil-sized glands located above the thyroid gland, two on the right and two on the left, that secrete parathyroid hormone (PTH). They regulate the body's calcium metabolism. It is the hormone that plays the most important role in bone formation and destruction.
These glands must be protected during thyroid surgery. In addition, there are adenomas of the parathyroid gland that cause enlargement and excessive hormone secretion, and their treatment is surgery. Surgical removal of structures called adenomas provides definitive treatment.
Its treatment is performed by open surgery or closed laparoscopic method. It is critical to remove the correct gland and protect the nerves during surgery.