THE THYROID GLAND’S VARIOUS LUMPS
There are often various types of lump in the thyroid. It is important to get a precise diagnosis. As well as the clinical examination of a lump, ultrasound scan of the neck is also part of the basic examination. A fine-needle aspiration biopsy of the lump is also often taken in conjunction with the ultrasound scan.
The most common are benign goitres. In which case, there are usually several lumps on the thyroid and these lumps often contain fluid.
Benign tumours (adenomas) usually occur individually.
It is not always possible to distinguish between goitres, adenomas or malignant tumours with a fine-needle aspiration biopsy, which is why a further sample is taken or the lump is removed surgically when an adenoma is suspected.
In recent years, the number of cases of thyroid cancer has increased globally, which is why it is extremely important to find the cancerous lumps among those that are benign.
A SURGEON SPECIALISING IN THYROID SURGERY DETERMINES WHETHER AN OPERATION IS NEEDED
The final decision about whether to operate is made by the patient and the surgeon together. This decision is influenced by the size of the lumps and the patient’s symptoms. A family history of thyroid cancer supports a decision to operate. When it is a cancerous tumour, the treatment is always surgery. The surgery involves removing the entire thyroid gland (a total thyroidectomy). Depending on which type the cancerous tumour is and how large it is, it is also treated with radioactive iodine.
FUNCTIONAL DISTURBANCE AND LUMP IN THE THYROID
Sometimes there are both functional disturbances and lumps in the thyroid. In which case, the internal medicine specialist and surgeon work together. The internal medicine specialist treats the functional disturbance and then the surgeon operates.
Grave’s disease, i.e. hyperactive thyroid, which also involves bulging eyes, is now often treated with surgery. This involves the removal of the entire thyroid. By removing the thyroid, the antibody reaction to the thyroid tissue and the resulting eye problem are inhibited. The hyperactivity itself ceases when the thyroid is removed.
AFTER THE OPERATION
As soon as the day after the thyroid is removed, thyroxine substitution therapy is commenced in order to prevent symptoms of under-activity. It is now possible to begin thyroxine treatment immediately after thyroid surgery.
If there is one individual benign thyroid lump, it is sufficient to only remove the one affected lobe of the thyroid. In which case, there is no need for thyroxine treatment. Following the surgery, the pathologist examines the lump again and the thyroid values are checked.
Even though the aim is to obtain the correct diagnosis prior to the surgery, it is possible that the final diagnosis is only revealed once the pathologist has examined the specimen.