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The thyroid gland is a butterfly-shaped hormone-secreting (endocrine) organ located in the neck in front of the esophagus and trachea, and has two parts, the right and left lobes. The thyroid hormone it secretes contributes to the regulation of the body's metabolic rate. Congenital thyroid hormone deficiency or absence leads to growth and mental retardation, so thyroid hormone must be checked in every newborn baby.

 

HASHIMOTO THYROIDITIS

 

Hashimoto's thyroiditis can be considered as a slow progressing inflammation of the thyroid. Surgery has no place in its treatment. It is tried to control its course with thyroid hormone treatment.

THYROID NODULES

 

Thyroid nodules are the main subject of General Surgery in terms of treatment approach among thyroid diseases.  Nodules are mass structures within the thyroid tissue but do not function like normal thyroid tissue. Since thyroid cancer also manifests itself as masses located in the thyroid tissue, just like nodules, it should be investigated whether the nodules contain cancer or whether they will turn into cancer in the future.

Nodules that are suspected or at risk of cancer should be treated surgically and the relevant part of the thyroid should be removed. Nodules that are not suspected of cancer are followed up with thyroid hormone therapy. Thyroid nodules may regress in size with thyroid hormone therapy. If the size of the nodule enlarges, it may create a cosmetically unsightly swollen appearance on the neck, and sometimes it may cause pressure on the trachea due to the large volume, making it difficult for the patient to breathe. For these two reasons, patients can undergo surgery.  

Criteria considered in the evaluation of thyroid nodules:

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  1. Whether the thyroid nodule produces thyroid hormone – If the nodule produces thyroid hormone, it causes hyperthyroidism, that is, the level of thyroid hormone is higher than normal, it is called a functional nodule.

  2. The size of the thyroid nodule - The follow-up of nodules over 2.5 cm is not recommended.

  3. Number of thyroid nodules - Single nodules that do not produce thyroid hormone are thought to be slightly more likely to transform into cancer, so surgery may be considered. If there are many thyroid nodules, the above-mentioned problems may arise due to the volume, and surgical option may be considered because there will not be any healthy thyroid tissue left behind.

  4. Radiology of thyroid nodules – Findings suggesting cancer risk or suspicion in the internal structure of thyroid nodules evaluated by ultrasonography (increased blood flow in the nodule, calcification, irregular borders, etc.)

  5. Pathology of thyroid nodules – Needle biopsy is performed from the thyroid in patients deemed necessary. Surgery is considered if there is a suspicion or risk of cancer as a result of examining the removed part under a microscope.   

HYPERTHROID

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Hyperthyroidism is a condition in which the thyroid gland works overtime and produces more thyroid hormone than necessary. It can happen in two ways:

  1. Toxic (hyperactive) thyroid nodule – A nodule inside the thyroid gland overworks, causing an excess of hormones. Whether the thyroid nodule produces hormones or not is confirmed by thyroid scintigraphy. In the treatment, first of all, after the thyroid hormone is reduced to normal levels with medication, the relevant side of the thyroid gland or both sides are removed if necessary.   

  2. Basedow-Graves Disease – It is an autoimmune disease that causes the thyroid gland to overwork due to the antibodies the body's immune system develops to the thyroid gland. After the diagnosis is made, the thyroid gland is completely removed after the thyroid hormone levels are reduced to the normal level.

THYROID CANCER

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Among the cancers in the body, it is among the cancers that respond best to treatment. There are four variants:

  1. Papillary cancer – The most common type of cancer and the one with the best prognosis. After the diagnosis is made, it is treated by removing the thyroid gland, depending on the stage of the disease, radioactive iodine (atom) treatment and/or removal of the lymph nodes in the neck may be required in addition to the removal of the thyroid gland. In general, the thyroid is removed bilaterally, but if the diseased tissue is small, unilateral removal of the thyroid may be sufficient in some patients. 

  2. Follicular cancer – Second most common, treatment principles are similar to papillary cancer.

  3. Medullary cancer – It develops from cells in the thyroid gland that secrete the hormone Calcitonin, which regulates calcium metabolism. Surgical treatment principles are similar to other types of cancer, but radiotherapy (radiation therapy) may also be required in the treatment of medullary cancer.  

  4. Anaplastic cancer – It is the rarest and worst prognosis cancer. Treatment principles are similar to other types of cancer, but the results are not very promising.

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THYROID SURGERY PROCESS

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In patients who will undergo surgery due to thyroid disease, preoperative examinations are performed after the decision is made. These tests and preoperative anesthesia examination can be completed in one day. If the patient's thyroid hormone levels are normal, surgery can be scheduled immediately. If thyroid hormone levels are low or high, these values are brought back to normal with treatment in about 2 weeks, and then surgery is planned.  _cc781905-5cde-3194-bb3b-136bad5cf58

The operation is made through a necklace-shaped incision on the neck, parallel to the body lines. The patient, who is planned to stay in the hospital for one night after the surgery, can go home the day after the surgery.

Injury of the nerve that feeds the vocal cords during the surgery is the biggest problem that may arise during the surgery. Hoarseness or vocal fatigue may occur as a result of nerve injury. These problems are mostly temporary and are treated with medication (cortisone) in the postoperative period. The second possible problem is a decrease in parathormone levels and low calcium as a result of injury to the parathyroid glands. In this case, it may be necessary to use calcium pills for a while in the postoperative period. Second operations may be required due to bleeding that may develop in the early period after the operation. These surgeries do not cause any harm to the patient in the long term. 

Patients who have had thyroid surgery will have to use thyroid hormone as a pill for a lifetime or for a while, depending on the type of surgery. This situation does not cause any negative changes in the patient's life.    _cc781905-5cde-13659cbadc-bb31994 bb3b-136bad5cf58d_

 

PARATHYROID DISEASES

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The parathyroid glands are 4 millimeter-sized organs located very close to the thyroid gland. They take according to the regulation of calcium metabolism in the body along with other mechanisms. In the presence of disease, high blood parathyroid hormone (parathormone) levels, and accordingly, calcium excess develops. Calcium excess manifests itself with problems such as kidney stone formation, weakness in the bones, and is occasionally detected incidentally in examinations performed for other reasons. We can roughly classify parathyroid diseases in three groups:

  1. Parathyroid hyperplasia – Usually develops in response to another disease. For example, in patients with chronic renal failure, there is an increase in parathyroid hormone levels in the long term, the treatment is to remove three of the four glands completely and half of the remaining one (three and a half parathyroidectomy). 

  2. Parathyroid adenoma – An enlargement of one of the parathyroid glands by secreting too much hormone. In the treatment, the growing gland is removed.    

  3. Parathyroid cancer – A malignant transformation of a parathyroid adenoma. In treatment, the tumor is removed.  

PARATHYROID SURGERY PROCESS

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In patients who will undergo surgery due to parathyroid disease, preoperative examinations are performed after the decision is made. These tests and preoperative anesthesia examination can be completed in one day, after which the surgery is planned.  

The surgery is performed through a small incision made on the neck, parallel to the body lines. The patient, who is planned to stay in the hospital for one night after the surgery, can go home the day after the surgery. Parathormone levels are measured momentarily during the operation and it is seen that they decrease and it is ensured that the mass is removed.

Since the parathormone levels of the patient will decrease very quickly, it may be necessary to use calcium pills for a while after the surgery. Just as with thyroid surgeries, injury to the nerve supplying the vocal cords during surgery is possible, although less likely. Hoarseness or vocal fatigue may occur as a result of nerve injury. These problems are mostly temporary and are treated with medication (cortisone) in the postoperative period.  Second operations may be required due to bleeding that may develop in the early period after the operation. These surgeries do not cause any harm to the patient in the long term. 

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