The thyroid gland lies in front of the neck just below the Adam’s apple and is butterfly shaped. The right and left wings (lobes) are joined by a small bridge of thyroid tissue (body) called the isthmus. The two lobes lie on either side of the windpipe. The thyroid gland manufactures hormones, which are chemicals that circulate in the bloodstream and affect the function of the cells and tissues in the body. Thyroid hormones are essential for survival.
What is goitre
Any enlargement of the thyroid gland is called goitre. When the whole gland is diffusely enlarged it is called a diffuse goitre. If there is a single nodule, it is termed a solitary nodule. The majority of goitres are not cancerous. However, a small proportion of goitres may harbour cancer cells and this is the reason why I recommend investigations for all thyroid swellings (goitre).
Investigation and treatment of thyroid lump
During the initial consultation, we will take a detailed history of your problem and assess you. This is followed by an ultrasound scan, which is performed by an expert radiologist. During the ultrasound scan, a needle may be inserted into the lump to collect a sample of cells, this is called fine needle aspiration cytology test (FNAC). These cells are then analysed under the microscope by the pathologist who will determine the nature of the swelling.
There are other tests, such as a CT scan, MRI scan or nuclear isotope scan which may be required in some cases. Often no treatment may be necessary for the thyroid lump (goitre) and you will be advised to adopt a ‘watch and wait policy’. Alternatively, surgery may be advised. This is commonly undertaken when there is a suspicion of cancer, pressure symptoms, uncontrolled over activity, and cosmetic concerns. The surgery is called thyroidectomy and is discussed briefly below.
Thyroidectomy
There are many different terms used to describe thyroid surgery. Total thyroidectomy implies removal of all the thyroid gland, whereas a hemi-thyroidectomy or lobectomy only part of the gland is removed. You will be advised about the exact procedure you will need based on your problem.
The operation is performed under a general anaesthetic, which means you will be asleep throughout the procedure. A skin cut (incision) is made across the midline in the neck over the gland. This cut is usually placed along a crease line, so when it heals it is barely visible. The required part or the entire gland is removed after making sure all important nerves, blood vessels and parathyroid glands are preserved. At the end of the operation, a drain (plastic tube) is placed through the skin in order to prevent blood collection in the operated area. Most patients usually spend 24hours in hospital after the operation. The drain is removed before leaving hospital and the stitches are usually removed after 6 days.
