Thyroid Disorders – Symptoms, Treatments, Surgery and Complications

The thyroid gland is located in our neck, just above the collarbone, and it plays an important role in our body. Its main job is to release hormones into the bloodstream, which helps our metabolism work properly. Sometimes, the thyroid gland doesn't produce enough hormones, and this is called hypothyroidism. On the other hand, there are cases where the thyroid gland produces too many hormones, and this is known as hyperthyroidism. Thyroid problems can cause various issues such as fatigue, weight gain, slow metabolism, and even thyroid cancer. That's why it's really important to be aware of the early symptoms of thyroid issues and seek treatment promptly.

In this blog, we'll cover topics like the need for surgery in thyroid tumours, different types of thyroid procedures, surgical options for thyroid cancer, whether complete removal of the thyroid is necessary, the effectiveness of keyhole surgery for thyroid procedures, and potential complications and side effects of surgery.

Do You Have These Symptoms?

Thyroid problems can affect people of all ages, from infants to the elderly. In many cases, these problems can run in families, passing down through generations. It's important to be aware of the symptoms that may indicate future thyroid issues, such as extreme fatigue, constipation, sudden weight gain, body soreness, hoarse voice, and frequent muscle soreness. By recognizing these symptoms early on, we can take appropriate measures to address potential thyroid problems.

Is Surgery Necessary for Thyroid Tumours?

Thyroid tumours are prevalent in our society, and while many cases do not require surgery, several factors indicate the need for surgical intervention.

Case 1: Tumour Size

If the tumour exceeds 4 centimetres in size, surgical removal is recommended as the optimal treatment option.

Case 2: Hormone Overproduction

When the tumour leads to excessive hormone production, surgery is considered the treatment of choice to restore hormonal balance.

Case 3: Elevated Cancer Risk

If the injection and ultrasound results indicate a higher risk of cancer or suggest suspicious characteristics, thyroid surgery is recommended as a precautionary measure.

Case 4: Invasive Growth

When the tumour extends into the chest or exhibits signs of aggressive growth, surgical removal becomes necessary to address the condition effectively.

Even in the case of small tumours, the potential for future cancer development or the presence of undetected cancer cannot be ruled out without further diagnostic procedures. Unfortunately, ultrasound and fine-needle aspiration (FNA) are not viable options for assessing these tumours. Therefore, surgery is typically advised to mitigate potential risks and ensure proper management.

Types of Thyroid Surgery Procedures

When it comes to surgical intervention for thyroid conditions, there are primarily two types of procedures commonly employed.

Procedure 1: Total Thyroidectomy

Total thyroidectomy involves the total removal of the thyroid gland. This procedure is typically performed in cases where there are significant concerns regarding cancer, large tumours, or certain thyroid disorders. By removing the entire thyroid gland, the aim is to eliminate the source of the problem and address any potential risks or complications associated with the organ.

Procedure 2: Partial Thyroidectomy

Partial thyroidectomy, also known as hemithyroidectomy, involves the removal of only a portion of the thyroid gland. This procedure is typically recommended when there are localized nodules or smaller tumours present. By removing the affected portion while preserving the healthy tissue, partial thyroidectomy aims to address the specific issue while maintaining normal thyroid function to the best extent possible.

Both of these procedures can be performed using different surgical techniques: open surgery or endoscopic surgery.

Open Surgery:

Open surgery refers to the traditional approach, where an incision is made in the neck to access the thyroid gland. This allows the surgeon a direct view and manual access to perform the procedure accurately.

Endoscopic Surgery:

Endoscopic surgery, also known as minimally invasive or keyhole surgery, involves the use of specialized instruments and a small incision or multiple tiny incisions. A thin, flexible tube with a camera (endoscope) is inserted through the incision(s), providing a magnified view of the surgical site. This approach offers the advantage of reduced scarring, less tissue trauma, and potentially faster recovery compared to open surgery.

The choice between open surgery and endoscopic surgery depends on various factors, including the specific case, the surgeon's expertise, and patient considerations.

Determining the Required Type of Thyroid Surgery

Thyroid surgery is a complex process that requires careful consideration. Once the decision to perform thyroid surgery is made, there are different approaches depending on the specific circumstances. The options typically involve either a total thyroidectomy (removal of the entire thyroid gland) or a hemithyroidectomy (removal of half of the thyroid gland). 

A total thyroidectomy is usually recommended in cases where there are tumours on both sides of the thyroid, advanced-stage cancer, or excessive hormone production. On the other hand, if the tumour is limited in size and the opposite side of the thyroid appears normal, a hemithyroidectomy may be performed.

However, it's important to note that even after the initial surgery, further intervention might be required if the biopsy results indicate the presence of cancer. The decision for a second surgery is based on the classification of the biopsy report as high risk, intermediate risk, or low risk. Additional surgery may be necessary to address any remaining cancerous tissue.

Should the Thyroid Gland Be Completely Removed?

In the past, there were surgical procedures known as subtotal thyroidectomy or Dunhill procedure, where a small part or one side of the thyroid gland was left intact. These techniques were developed in the 1920s and were commonly used for some time. However, the concept began to change in the 1970s based on findings from a follow-up study conducted by the Department of general surgery between 2004 and 2009.

The study revealed several important observations. First, it was noted that approximately 60% of individuals who underwent subtotal thyroidectomy required thyroxine supplementation again. This indicated that the remaining thyroid tissue was either ineffective or failed to function adequately. The second issue observed was the recurrence of tumours in the same area. Around 40% of individuals experienced tumour recurrence. Additionally, there were cases where patients underwent surgery for reasons other than cancer, such as large tumours or bronchial obstruction. Among these patients, approximately 14% were subsequently diagnosed with cancer.

As a result, subtotal thyroidectomy is no longer considered an appropriate surgical approach for cancer treatment. The primary goal in cancer surgery is to achieve complete removal of the affected tissue, as it offers the best chance of successful treatment. Consequently, modern-day leading medical centres do not perform subtotal thyroidectomy. This procedure is now considered outdated and not recommended.

Based on current understanding and advancements in cancer surgery, the emphasis is placed on the complete removal of the thyroid gland when necessary, ensuring the most effective and comprehensive treatment for thyroid cancer patients.

Is Keyhole Surgery Effective for Thyroid Surgery?

Keyhole surgery, also known as endoscopic thyroidectomy, is not highly recommended for thyroid surgery due to several reasons:

1. Limited space: Unlike abdominal surgeries where there is natural space to manoeuvre instruments, the neck lacks such space. Doctors have to artificially create space, making the procedure maximally invasive rather than minimally invasive.

2. Use of harmonic scalpel: During keyhole surgery, doctors employ a device called a harmonic scalpel, which generates heat. This heat transfer poses a small risk of damaging the calcium-regulating parathyroid glands and nerves.

3. Difficulty in detecting involvement of lymph nodes: If there is any cancerous growth in the thyroid, it often spreads to the lymph nodes below the thyroid gland in the neck. These nodes can be visually and tactilely assessed to ensure their involvement. However, this tactile assessment is not possible in endoscopic thyroidectomy, increasing the likelihood of missing affected nodes.

4. Potential for missed thyroid fragments: There may be small pieces of ruptured thyroid tissue present in the neck, which can be easily missed during endoscopic thyroidectomy.

Despite being occasionally performed for young girls, single nodules, and cosmetic reasons, endoscopic thyroidectomy is not recommended as the procedure of choice by any medical organization worldwide.

The Complications & Side Effects of the Surgery

Thyroid surgery involves risks to two main nerves: the recurrent laryngeal nerve (1 in 1000 risk of damage by untrained surgeons) and the nerve controlling voice pitch (1-2% risk of damage). Preserving the parathyroid glands is crucial for calcium regulation. When it comes to thyroid surgery, it is important to seek help from expert surgeons.