The thyroid is a gland that consists of two main lobes, located on the trachea, and weighs approximately 15-20 grams. It is a highly vascularized organ.
It is the most well-vascularized organ per gram in the human body. The thyroid produces hormones.
Thyroid hormones should be at normal levels in the human body. Overproduction or underproduction of these hormones is an undesirable condition that requires treatment.
The thyroid is an organ located below the structure known as the Adam's apple in the throat, just above the trachea.
The hormones secreted by the thyroid gland are endocrine substances that influence the body's metabolic processes through the circulation of blood. Excessive activity of the thyroid gland leads to a condition called hyperthyroidism, while reduced activity is known as hypothyroidism. In both cases, medical treatment is necessary, and patients are monitored at regular intervals to check their hormone levels.
Hypothyroidism is a condition caused by a decrease in hormone production by the thyroid gland, leading to a slowing down of all body functions and metabolism. It results in symptoms such as fatigue, weakness, constipation, dry skin, flaky skin, menstrual irregularities, weight gain, intolerance to cold, anemia, insomnia, among others.
Hyperparathyroidism is a condition characterized by an increase in hormone production, leading to an acceleration of metabolism. It causes symptoms such as palpitations, hand tremors, weight loss, excessive irritability, sweating, intolerance to heat, hair loss, fatigue, tiredness, menstrual irregularities, diarrhea, and other signs. For these reasons, the hormones produced by the thyroid glands should be at normal levels in the body.
When assessing thyroid gland disorders, thyroid function is examined through blood tests. This involves measuring thyroid hormones in the blood, and structural changes in the thyroid gland are evaluated using ultrasound (USG).
There may be an enlargement of the thyroid gland, which is referred to as a goiter. USG can also assess the formation of nodules in the thyroid gland, with nodules being either single or multiple.
There are several types of thyroid diseases, including:
Simple goiter refers to the enlargement of the thyroid gland, and it is often caused by iodine deficiency. It is commonly seen in regions with iodine deficiency (endemic goiter). It can be treated by adding iodine to the diet and, in appropriate cases, by administering thyroid hormone.
Multinodular goiter is a condition characterized by the growth of multiple nodules in various parts of the thyroid gland. It is one of the most common thyroid gland disorders. Typically, thyroid hormone levels are normal. Surgical intervention is considered if the patient experiences compression symptoms (such as difficulty breathing),if there is suspicion of cancer, if there is excessive thyroid hormone production, or if there are aesthetic concerns.
If a single nodule is detected in the thyroid gland without overall enlargement, and imaging methods reveal that the nodule is solid and hypoactive, with a diameter exceeding 2.5-3 cm, a thyroid biopsy is performed to assess the risk of cancer, and surgery may be planned as needed. If the solitary nodule is hyperactive, it can lead to symptoms of hyperthyroidism (toxic goiter) due to excessive hormone secretion. This can be controlled with medication, and subsequent treatment may involve surgery or radioactive iodine therapy.
Thyroiditis is an inflammatory disease of the thyroid gland. Inflammatory thyroiditis due to pathogenic agents is rare, while the majority of cases are classified as Hashimoto's thyroiditis, which is an autoimmune condition (involving the body's immune system reacting against its own thyroid cells). Initially, thyroid gland function may be excessive, but as thyroid cells lose their function, it returns to normal, and in subsequent stages, a decrease in hormone secretion leads to hypothyroidism. Medication may be administered when necessary. Surgical treatment is generally not required, but individuals with thyroiditis should be closely monitored for the possibility of thyroid cancer.
Graves' disease is a condition characterized by increased hormone production due to an autoimmune reaction (toxic goiter). The thyroid gland enlarges, leading to symptoms of hyperthyroidism. It can also manifest with protruding eyes (exophthalmos). Patients are initially treated with medication to normalize thyroid hormone levels, followed by surgical planning if necessary. If treatment is delayed, the eye changes may not resolve after surgery, and additional surgical interventions may be needed for cosmetic purposes.
Toxic multinodular goiter is a condition that involves both hyperthyroidism and the presence of thyroid nodules. The goal of treatment is to normalize thyroid hormone levels, and it often requires surgical intervention.
Thyroid nodules are masses that form within the thyroid gland and are one of the most common thyroid disorders. They come in different sizes and quantities and are generally benign, but regular monitoring is necessary. The frequency of occurrence increases with age. Not all nodules found in the thyroid are cancerous. If there is suspicion of cancer, a biopsy is needed.
Thyroid nodules are more common in women. Nodules that are 1 cm or larger can often be felt during a physical examination. For smaller nodules, ultrasound can be helpful for diagnosis. Approximately 5% of thyroid nodules may be cancerous, and most of these cancers occur in solitary or hypoactive nodules. Ultrasound-guided needle biopsy can assist in making a diagnosis. In cases where there are compression symptoms, hyperthyroidism, or a suspicion of cancer, diagnosis and treatment should be promptly arranged.
Suspicious thyroid nodules observed during an examination and ultrasound should be evaluated with fine-needle aspiration biopsy to rule out cancer. It should be remembered that the majority of nodules are benign. It is known that thyroid nodules that occur during adolescence have a higher chance of being cancerous.
In thyroid nodule surgery, the entire gland can be removed (total thyroidectomy),a single lobe can be removed (unilateral total thyroidectomy),or total thyroidectomy can be performed along with the removal of regional lymph nodes (for nodules diagnosed with cancer). Thyroid surgeries typically last around 2 hours, and patients are usually brought back to their rooms after the operation. They are encouraged to eat about 4-5 hours later and are often discharged the following day.
The vast majority of thyroid cancers are well-differentiated tumors originating from follicular cells.
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Prof. Dr. Sezai AydınGeneral Surgery Turkey
PROF. DR. SEZAI AYDIN
