What is the Thyroid Gland?

The thyroid is a butterfly shaped gland located in the lower part of the neck, in front of the windpipe. It produces and secretes thyroxine, a hormone responsible for regulating many of our bodily functions.

What are Thyroid Nodules?

Thyroid nodules are abnormal lumps that develop in the thyroid gland. They can be single or multiple and can usually be seen and felt. They can be of different sizes and some of the very large nodules can compress on the windpipe and gullet causing difficulty breathing or swallowing. The small nodules are not obvious and are detected by scans.

The majority of thyroid nodules are benign cysts or swellings caused by thyroid inflammation. Some nodules secrete an excessive amount of thyroxine causing a condition known as hyperthyroidism. Thyroid cancers are fairly common with majority being papillary or follicular thyroid carcinomas that have good cure rates. The most aggressive variant, anaplastic carcinoma, is rare, more commonly seen in the elderly and is usually incurable. There are several tests that can be performed to assess a patient with thyroid nodules.

Tests for Thyroid Nodules:

1. Fine Needle Aspiration Biopsy (FNAC)

A minor procedure performed in the clinic where a fine needle is used to extract some cells from the thyroid nodule. These are then sent to a pathologist to determine whether the cells are malignant. If the cell yield is sufficient, FNAC is an accurate method to differentiate benign from cancerous nodules. However in 20% of patients, either the cell yield is insufficient to obtain a diagnosis or the pathology report does not allow the diagnosis of cancer to be completely excluded.

2. Ultrasound of the thyroid gland (U/S)

This is a painless test that uses sound waves to create images of they thyroid gland. The patient is lying down with the neck extended while the ultrasound technician moves a lubricated transducer over the neck. Although not as accurate as the FNAC, there are certain features seen on the U/S thyroid that can suggest a malignancy. This test also provides information on the exact size of the nodule , its content (solid or cystic) and the presence of other nodules that cannot be felt.

3. Blood Tests

A thyroid function test is performed to assess how much thyroxine is produced by the thyroid. Thyroid antibody tests are sometimes done to check for autoimmune thyroid disorders causing thyroid inflammation.

Treatment of Thyroid Nodules

Surgery

Surgery involves either removing one lobe of the thyroid (hemithyroidectomy) or removal of the whole gland (total thyroidectomy). If we are dealing with thyroid cancer that has spread to the neck nodes, a neck dissection operation to remove the neck nodes is performed.

Surgery is performed for:

– Thyroid cancer or suspected thyroid cancer

– Large thyroid nodules compressing the windpipe or gullet

– Thyroid nodules producing excessive amounts of thyroxine in selected patients

Observation

Thyroid nodules that are low risk of being cancerous are observed for a period of time. Observation involves regularly assessing the size and nature of the nodule and repeating the FNAC procedure or offering surgery if there are suspicious charges.

Radioactive Iodine Treatment

This radiation treatment is administered orally. Radioactive iodine concentrates in the thyroid gland and destroys both normal and abnormal thyroid cells. It is used for treating hyperactive thyroids (hyperthyroidism) and is administered after thyroid surgery for thyroid cancers.