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The thyroid gland is an important part of the body's endocrine system. Located in the front of the neck just below the larynx (voice box), the thyroid gland produces thyroid hormone, which is important for regulating the body’s metabolism.
Dysfunction of the thyroid gland can result in the under-production (hypothyroidism) or over-production (hyperthyroidism) of thyroid hormone.
Symptoms of hypothyroidism may include:
- weight gain
- cold intolerance
- depression
- fatigue
- difficulty sleeping and concentrating
Symptoms of hyperthyroidism may include:
- weight loss
- heat intolerance
- nervousness, jitteriness, irritability
- Difficulty concentrating
Both types of thyroid dysfunction may also manifest through changes in the skin, hair and nails, changes in weight, goiter (an enlarged thyroid), and, rarely, protrusion of the eyes called exophthalmos.
Causes & Diagnosis
The most common causes of thyroid dysfunction are autoimmune, in which a person's own antibodies attack the thyroid directly (Hashimoto's thyroiditis) or stimulate thyroid hormone receptors to over-produce thyroid hormones (Grave's disease).
The function of the thyroid gland and the production of thyroid hormone can be measured by a simple blood test. Treatment can then be started based on these findings and is often managed medically, although surgery is indicated in some cases. In many cases, it is only necessary to take daily medication and periodically check the thyroid hormone level.
A common finding within the thyroid gland is a nodule. These are detected either during a physical exam or by ultrasound. The majority of these nodules are benign, but some harbor a thyroid cancer. For this reason, most nodules require further evaluation.
The test of choice for the diagnosis of a thyroid nodule is a fine needle aspiration biopsy (FNA). In this procedure, a thin needle is inserted into the mass to draw out a tissue sample. The sample is then looked at under a microscope to examine the cells.
A benign nodule can often be observed. Occasionally the FNA is non-diagnostic or indeterminate, in which case the FNA is either repeated or surgery is recommended. If the sample is shown to be cancerous, it is necessary to remove the entire thyroid gland surgically. If there is suspicion that the cancer has spread to other areas of the neck, it is also necessary to dissect the involved areas to examine the lymph nodes. After surgery, additional cancer treatment with radioactive iodine is instituted and lifelong thyroid hormone replacement medication is necessary.
Treatment Options
Conventional thyroid surgery is done under general anesthesia, requires hospital admission, and generally requires a hospital stay of one to two days.
However, minimally invasive surgery can provide a more convenient alternative. At UCSD Medical Center, Dr. Kevin Brumund specializes in performing minimally invasive thyroidectomy on patients who meet certain criteria.
Instead of the conventional 8 cm incision and admission to the hospital, the minimally invasive thyroidectomy is performed through a 3 cm (1 inch) incision as an outpatient procedure. The reduced size of the incision during the operation results in less pain and much faster healing. Recovery takes a few days, as opposed to a few weeks for a conventional thyroidectomy. In addition, given the much shorter length of the incision, the ultimate cosmetic result is superior to that of conventional surgery.
For more information on this procedure, to arrange an appointment or to refer a patient, please call (858) 822-6197 or email Eddy Orona, eorona@ucsd.edu.
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