THYROID

The thyroid gland is a small, butterfly shaped organ in the lower neck which controls our metabolism by secreting thyroid hormone. A thyroid nodule is a lesion (adenoma, cyst, or tumor) within the thyroid gland. (The terms “thyroid lesion,“ “thyroid mass,” and “thyroid nodule” are used interchangeably.) These nodules are common, especially in women, and many patients have no symptoms. At times, patients can have symptoms of compression, such as difficulty breathing, swallowing or voice changes which can require surgery. Other nodules overproduce thyroid hormone, causing hyperthyroidism. The majority of thyroid nodules are benign (non-cancerous), but some are cancerous.

Thyroid Nodules

A thyroid nodule is a lump or growth inside of the thyroid gland. It may be benign (non-cancerous) or malignant (cancerous)
Majority of thyroid nodules are benign (over 90%), which means that they are not cancers
Most nodules in the thyroid gland are small and unlikely to be picked up on a physical exam or cause symptoms
Thyroid nodules become more common with age
50% of people over age 65 have at least one thyroid nodule
Most thyroid nodules are found on routine physical exams or by imaging done for unrelated reason, ie heart wise screening exams
In children and teenagers, up to 20-30% of thyroid nodules can be cancerous
Early stage thyroid cancer is painless and usually without any symptoms

Fine Needle Aspiration (FNA) of Thyroid Nodules

To find out if your thyroid nodule is benign or cancerous one usually begins with the Fine Needle Aspiration (FNA biopsy). Make sure that your doctor performs genetic testing and gives numbing medicine if needed for the thyroid nodule biopsy. Nodules in the thyroid that will likely be biopsied include:

size greater than 1.5cm according to ATA (American Thyroid Association) guidelines
suspicious ultrasound characteristics ( solid nodules, irregular borders, calcifications, nodule extending beyond the thyroid gland, shadowing of solid nodules)
patient with family history of thyroid cancer or history of radiation exposure
enlarging or painful nodules
enlarged lymph nodes near the thyroid or in the neck area

*****PATIENTS WHO HAVE HAD A BIOPSY SHOWING FOLLICULAR CELLS OR FOLLICULAR NEOPLASM**** PLEASE READ THIS SECTION

As stated previously, the vast majority of thyroid nodules are benign….probably over 90% benign. YES even nodules with follicular cells!!! Therefore if you have a thyroid biopsy by another doctor or surgeon which shows follicular cells, this only means that the physician doing the FNA biopsy hit the thyroid gland. The normal thyroid is made up entirely of follicular cells, therefore ALL thyroid FNA biopsies should show some follicular cells assuming they biopsied the correct organ. PLEASE do NOT have surgery without genetic testing evaluation for these type of lesions/nodules as it can rule out cancers and an operation is NOT needed for diagnosis. If you are feeling pressured by your surgeon to have your thyroid removed for follicular lesion/ neoplasm to rule out a follicular cancer, it is VERY important to get a second opinion! Ask the doctor if the biopsy includes genetic evaluation if needed for your nodule before you go for consultation. It is also important to inquire if they use numbing medicine or lidocaine for the biopsy procedure. DO NOT let them tell you that “it is not needed”. In our opinion, these biopsies can be uncomfortable at times and we ALWAYS take the time to give local anesthesia or lidocaine to numb the skin before the biopsy.

Thyroid Goiter

A goiter is simply an abnormally enlarged thyroid gland. It may contain multiple nodules and can produce too much hormone (hyperthyroid), too little hormone (hypothyroid) or normal amount of hormone (euthyroid).

Most common causes:

Multi-nodular goiter
Grave’s Disease (patients are typically hyperthyroid)
Hashimoto’s Disease

As goiters enlarge with time, they can cause difficulty breathing, swallowing problems, or voice changes. At times, goiters need to be removed surgically.

Thyroid Cancer

The incidence of thyroid cancer is increasing in the United States. In fact, thyroid cancer rates are rising faster than any other cancer in the United States. Thyroid cancer is now the fastest growing cancer worldwide! There are different types of thyroid cancer, including papillary, follicular, Hurthle cell, medullary, and anaplastic. Most thyroid cancers have an excellent prognosis and are not typically aggressive. Patients can be treated with minimally invasive surgery to remove these cancers and surrounding lymph nodes with smaller scars and easier recovery.

Symptoms that may appear in patients with thyroid cancer (remember that majority of patients do not have any symptoms and the thyroid blood tests are normal):

* large lymph node (swelling) in the neck that does not go away

* Hoarseness

* Difficulty breathing (especially when lying flat) or swallowing

* .Sensation of a “lump” when swallowing

* Unexplained throat clearing or cough

The primary treatment for almost all thyroid cancers is surgical removal or thyroidectomy. It is VERY important to have a surgeon who specializes in thyroid surgery performing these operations to lower risks of complications. Patients with thyroid cancer typically have an excellent prognosis after their operation. At times, patients will need therapy with radioactive iodine after surgery to treat their cancer. Long-term thyroid hormone replacement may also be necessary.

Graves’ Disease

Graves’ disease is an autoimmune process that causes the thyroid to overproduce thyroid hormone. It is more common in young women and can cause enlargement of the thyroid gland. Possible triggers for Graves’ Disease are thought to be viral or bacterial infection as well as a genetic link.

Symptoms of Graves’ hyperthyroidism:

Muscle Weakness
Irritability
Tremor
Thinning hair or hair loss
Increased appetite
Infertility
Anxiety
Emotional problems
Difficulty concentrating
Diarrhea
Weight loss
Problems sleeping
Rapid heart rate
Bulging eyes (exophthalmos)

How is it diagnosed?

High free T3 or T4 (thyroxine) levels
Low thyroid stimulating hormone (TSH) levels
High levels of thyroid stimulating hormone (TSH) receptor antibodies

Graves’ disease can be treated with medications, radiation, or thyroid surgery.

Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis is the most common inflammatory disease of the thyroid. It occurs when a patient’s own antibodies attack their thyroid gland. Hashimoto’s thyroiditis is more common in women ages 45-65, but can be seen in patients of any age. Hashimoto’s disease is also known as chronic lymphocytic thyroiditis.

Symptoms of Hashimoto’s Thyroiditis:

Constipation
Pale, dry skin
Puffy face
Increased sensitivity to cold
Muscle aches
Painful joints
Prolonged menstrual bleeding
Infertility