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Thyroid Diseases - Is Surgery Needed? (June 2010)
(Reproduced from our Archives)

Thyroid is a butterfly shaped gland belonging to the group called "Endocrine Glands" or "Ductless Glands". These glands produce powerful and essential chemicals called "Hormones", which are conveyed into the blood stream directly - not through ducts. The thyroid produces a hormone called "Thyroxin", which is essential for proper level of functioning of all organs of the body.

Deficiency of thyroxin hormone at or even before birth results in stunted growth of body and brain too, a condition called "Cretinism". Deficiency in an adult produces obesity with slowing down of functioning of several organs and mental faculties too. "Joe" of Charles Dickens "Pickwick Papers" is a typical hypothyroid person. On the other hand, excessive production of hormones, which occur in some thyroid diseases causes excessive functioning or accelerated activity of all organs. In its typical form it produces a condition called "Grave's Disease", wherein the affected person eats like a glutton, but loses body weight, has a "Staring look", is highly irritable fighting with everyone and several other remarkable symptoms. Between these two extremes, there are several gradations or degrees of disease and it is not always easy to diagnose.

Apart from these, various types of "Tumours" including "Malignant" Tumours or Cancers also affect thyroid from early to late in life - almost in all age groups.

Iodine in thyroid diseases:
Iodine in our water and food is an essential component of Thyroxin hormone. Deficiency of iodine in our food will produce reduced functioning of thyroid resulting in "Hypothyroidism". Himalayan foothills areas are known to be markedly deficient in iodine in drinking water. Thyroid diseases are also known to be more common in these areas. Iodine supplementation in cooking salt seems to be helpful.

Surgery in thyroid diseases:
Quite a few thyroid diseases do not need any surgical operation for cure. Simple administration of thyroid tablets, often on long-term basis or permanently is all that is needed in many cases of Hypothyroidism. Some patients with Hyperthyroidism often benefit by a surgical operation. A group of thyroid diseases characterized by enlargement of the thyroid gland and called, as "Deficiency Goitres" also need a surgical operation. In addition, whenever a Tumour or Cancer is "suspected", an operation is necessary either to establish exact nature of thyroid swelling and even as a method of cure. A general guideline is that any thyroid disease with enlargement of the thyroid gland, specially irregular or one-sided enlargement, generally comes in the surgical category.

Specific indications for Surgery:
Deficiency goitres due to long standing iodine deficiency or some other causes, often assume large size. In course of time, various complications due to pressure on adjacent vital structures or sudden hyperactivity or internal bleeding in thyroid or cancerous transformation are likely to occur. This condition is treated by "Subtotal Thyroidectomy", wherein most of the thyroid tissues on both sides are removed. A small amount of thyroid tissue is retained more to protect a pair of important glands called as Parathyroid glands. These patients usually need lifetime replacement with thyroxin, a very inexpensive tablet.

Hyperthyroidism, often in a form called "Grave's Disease", can sometimes be treated with medicines alone. The medicines have to be taken for several months or years and Could lead to harmful effects on the blood. Therefore, in many patients with this disease, medicines are given for a short period to temporarily bring thyroid activity to normal level and make them fit to undergo a surgical operation. A skillfully performed "Subtotal Thyroidectomy" in such patients gives permanent relief.

Neoplasms (Tumours) of thyroid may be "Benign" (Non cancerous) or "Malignant " or Cancerous. It is often an irregular, or one sided or hard swelling involving part or whole of thyroid gland. Thyroid cancer can occur in any age group, from childhood to old age. Some thyroid cancers are very slow growing and proper treatment, often including surgery gives almost normal life span. But some cancers are very fast growing and lead to a fatal termination in spite of treatment and surgery.

An experienced clinician or surgeon can usually make a diagnosis by detailed examination and some laboratory tests and some special investigations. To confirm whether a thyroid swelling is a "Tumour" and if so whether it is cancerous or benign several tests are done. Some form of "biopsy" like FNAC (Fine needle aspiration cytology), or a "Trucut needle biopsy" MAY confirm diagnosis. If the surgeon strongly suspects cancer, even if FNAC and Trucut Needle Biopsy are inconclusive, Surgery is undertaken and the thyroid removed is examined pathologically to finally establish the diagnosis and give appropriate post operative treatments, like radiation, radioactive iodine, thyroxin or some other chemotherapy. In thyroid cancers, whenever possible, almost the entire thyroid gland is removed, called as "Total Thyroidectomy".

Thyroid Surgery is Special:
All thyroid surgeries are difficult and delicate and liable to various complications, unless skillfully performed. The thyroid gland is closely associated with windpipe and food passage (trachea and oesophagus), many important and delicate nerves, blood vessels and also another group of endocrine glands called as Parathyroid Glands. Often thyroid gland itself has a rich blood supply and hence there could be profuse bleeding unless the surgeon carefully ligates all blood vessels before cutting out the gland. Injury to any of the vital structures around the thyroid can lead to serious complications.

Thyroid Surgery at Dr UMR Memorial Hospital.
This is one of the common operations being performed in our Hospital for over 7 decades. Late Dr. U Mohan Rau was technically highly skilled and expert in thyroid surgeries. The current surgical team having had the benefit of learning from this master surgeon and later independently performing a variety of thyroid surgeries are well placed to give the best care for those needing treatment for thyroid diseases. This is one more area of strength of Dr. U Mohan Rau Memorial Hospital.

All the above description of thyroid diseases is an attempt to describe briefly in simple language a highly complex subject. If you wish to seek any further information please click on "Ask the Doctor" in the site.

** Additional information added in Sept, 2010.
In a small percentage of patients needing surgery for thyroid diseases, currently the Minimally Invasive Technology (as in Laparoscopic Abdominal Surgery) is being applied. This is performed by very few Surgeons in centers with specialized equipments. It is called as MIVAT – Minimally Invasive Video Assisted Thyroidectomy. Use of a Robotic Assistant at MIVAT surgery for Thyroid is another further innovation.


Additional matter added in May, 2011
Thyroid Symptoms and solutions –slide show:

With Best Wishes to Be Healthy,

Yours Sincerely,

Dr. M.Mohan Rao, MBBS, MS, FICS, MCH,
M.D. & Chief Surgeon,
Dr. UMR Memorial Hospital.
962, Poonamallee High Road, Chennai 600084.

Updated on 01.06.2010.



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