The thyroid gland is a butterfly-shaped organ that secretes thyroid hormones (T3, T4) into the body, located in the midline of the neck in front of and on both sides of the trachea. Hypothyroidism occurs when the gland secretes too little hormone and hyperthyroidism, commonly known as toxic goiter, occurs when it secretes too much. A mass called nodule and related cancers may develop inside. Apart from these, there are inflammatory diseases of autoimmune origin (Hashimato thyroiditis, Basedow Graves) or microbial thyroiditis. 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 mainly evaluated by neck ultrasonography and fine needle aspiration biopsy (FNAB).
- In the presence of nodules diagnosed as cancerous or suspicious, surgical treatment should be performed.
- Depending on the location and size of the tumor and nodules, patients undergo bilateral total thyroidectomy or unilateral total thyroidectomy.
If the cancer has spread to the lymph nodes in the neck, neck dissection surgeries should be performed to remove the nodes in the neck.
Thyroid gland is an important surgery due to the presence of vocal nerves in its neighborhood and the presence of 4 lentil-sized parathyroid glands that manage bone metabolism.
In case of injury to the vocal nerve, permanent hoarseness and shortness of breath may develop, while if the parathyroid glands are not protected, permanent drug use and bone resorption problems may be encountered.
In order to prevent these problems, it is necessary to use a monitoring device that shows the nerves as well as a meticulous surgery. Surgical experience is critical at this stage.
Surgical treatment can be open and closed, i.e. laparoscopic surgery (TOETVA). In the closed method, thyroid surgery is performed through the mouth.
The aim of this method is not to leave a visible scar on the neck. Today, cosmetic surgeries are preferred by patients.
What awaits patients after goiter surgery?
Patients are prepared for surgery including thyroid hormone tests. Hormone levels must be absolutely normal for surgery.
The surgery takes approximately 2 hours. Nerve monitoring is performed during the surgery.
Patients who are hospitalized for 1 day after the surgery are discharged by removing the drains if no problems are seen.
- After about a week, the pathology result is evaluated.
- Patients diagnosed with cancer are referred to Nuclear Medicine centers for Radioactive Iodine treatment (Atom therapy).
- Those with clear pathology results are started on thyroid hormone medication and followed up.
Parathyroid gland diseases and surgery
They are 4 lentil-sized parathyroid hormone (PTH) secreting glands, two on the right and two on the left above the thyroid gland. They regulate the body’s calcium metabolism. It is the hormone with the most important role in bone formation and destruction.
These glands must be protected during thyroid surgery. In addition, there are adenomas that cause the parathyroid gland to enlarge and secrete excess hormones, and their treatment is surgical. Surgical removal of the structures called adenomas provides definitive treatment.
The treatment is performed by open surgery or closed laparoscopic method. It is critical to remove the correct gland and protect the nerves.