The thyroid gland, a butterfly-shaped organ at the base of the neck, regulates the body’s metabolism. It produces hormones influencing heart rate, body temperature, and energy levels.
Thyroid Cancer
Thyroid cancer is a primary reason for surgically removing the thyroid gland. Papillary and follicular thyroid cancers are the most common forms. Papillary thyroid cancer accounts for up to 80% of cases and has an excellent prognosis. Follicular thyroid cancer makes up about 10% to 15% of diagnoses and has a good prognosis, though it carries a slightly higher risk of spreading to distant sites like bones and lungs.
Medullary thyroid cancer is less common (about 2% of cases) and can sometimes be hereditary. Anaplastic thyroid cancer is a rare, aggressive form (1% to 2% of diagnoses), and is more challenging to treat due to its rapid growth and tendency to spread quickly. For most thyroid cancers, surgery is the initial and definitive treatment.
The extent of thyroidectomy depends on the cancer’s type, size, and spread. A total thyroidectomy is performed for most thyroid cancers, especially if the tumor is large, present in both lobes, or has spread to lymph nodes. For smaller, low-risk papillary thyroid cancers confined to one side, a lobectomy (removal of only half the thyroid) is an option. After a total thyroidectomy, patients require lifelong thyroid hormone replacement therapy.
Unmanaged Hyperthyroidism
Hyperthyroidism occurs when the thyroid gland produces excessive hormones. While medications and radioactive iodine therapy are common treatments, surgery is an option in specific situations. This includes cases where alternative treatments are ineffective, contraindicated, or cause adverse reactions.
Surgery is chosen for individuals with severe Graves’ disease, an autoimmune condition, especially if it does not respond to other therapies. Large goiters causing hyperthyroidism also necessitate surgical removal. Patient preference and ability to adhere to long-term medication regimens also play a role.
Obstructive Goiters
A goiter refers to an enlarged thyroid gland, which can occur for various reasons and does not always indicate abnormal thyroid hormone levels. When a goiter grows significantly, it exerts pressure on surrounding neck structures, impairing normal bodily functions.
Large goiters compress the trachea, causing difficulty breathing or a persistent cough. They also press on the esophagus, causing swallowing problems. Some goiters extend downwards into the chest cavity (substernal goiters), exacerbating obstruction. Beyond functional concerns, a prominent goiter is also removed for cosmetic reasons if its size significantly alters neck appearance.
Indeterminate Thyroid Nodules
Thyroid nodules are lumps within the thyroid gland; many are benign, but some require further evaluation. When a fine-needle aspiration (FNA) biopsy yields inconclusive or “indeterminate” results, meaning cells are not definitively cancerous or clearly benign, surgery is recommended to obtain a definitive diagnosis.
Removal of the nodule or part of the thyroid is primarily for diagnostic purposes, not confirmed cancer treatment. Pathologists then examine the entire nodule to determine if malignant cells are present, which is crucial for guiding subsequent treatment decisions. This approach helps rule out malignancy when suspicious features are noted on imaging or if repeat biopsies remain unclear.