How to observe Thyroid Adenoma?
Aug 18 , 2015 10 am

How to observe Thyroid Adenoma?

Thyroid gland is located in the front of the neck. When there are any abnormalities, the gland will be larger and can be detected as a single adenoma or groups of adenoma. The important thing is that this mass will move up and down when we swallow.  


 

Hyperthyroidism and Non-toxic Thyroid Nodule

There are 2 major groups of Thyroid disorder; Hyperthyroidism and Non-toxic Thyroid Nodule. Hyperthyroid is a condition when the thyroid gland has excess synthesis and secretion of thyroid hormone which lead to dysfunction of other systems in the body. Symptoms are palpitation, nervous, sensitive to heat, easy to sweat, eat a lot but do not gain weight or even weight lose. Some people have damp skin. Some people have diarrhea. Some people have exophthalmos. In case of non-toxic thyroid nodule, only the thyroid glan becomes larger with no other symptoms. There is often misunderstanding and confusion between hyperthyroidism and thyroid carcinoma. Hyperthyroidism is not a cancer. It is commonly found that those with hyperthyroid do not have thyroid carcinoma. 

What can the mass be?

Mostly found thyroid disorder is a single mass at the thyroid gland. This mass can be may diseases including thyroid carcinoma. It is therefore imperative for the physician to provide a diagnostic diagnosis for the appropriate treatment plan. Patients with a single thyroid adenoma may have following disease.  

1. Thyroid adenoma, which can be found 20-30% 

2. Toxic adenoma can produce thyroid hormone (normal thyroid adenoma does not produce hormone) and it is rarely found. 

3. Thyroid carcinoma is found 10-15%. In the initial stage, the adenoma will be single and small. It will be larger gradually before spread to many adenomas in thyroid gland or to other location such as lymph node or bones etc.

4. Nodular Goiter is found 50-60% of single adenoma in Thyroid gland. In the initial phase, the adenoma is a single one, but when the time passes by the Thyroid Gland will be larger and spread to many adenomas or both side of the neck will be larger. 


Thyroid Surgery

   Indications for Thyroid Surgery

1. Thyroid nodules is suspected to be Thyroid carcinoma.

2. Thyroid gland becomes larger in size with the symptoms of hyperthyroidism.

3. Thyroid adenoma hits the bronchi.

4. Thyroid adenoma is presented after facial radiation exposure.

การรักษาด้วยการผ่าตัด สามารถทำได้  2 วิธีคือ

1. การผ่าตัดต่อมไทรอยด์ด้วยวิธีปกติ วิธีนี้ แพทย์จะลงแผลตามแนวนอนบริเวณกลางลำคอ และเข้าไปตัดต่อมไทรอยด์ในข้างที่มีก้อนออก หรืออาจตัดออกทั้ง 2 ข้าง ในกรณีพิสูจน์ได้อย่างแน่ชัดว่าเป็นมะเร็ง

Surgical treatment can be done in two ways.

1. Normal Thyroid Surgery, the doctor will open the wound horizontally in the middle of the neck and remove the adenoma in thyroid gland or may be remove both sides in the case of it is clearly a case of cancer.

Picture of the scar from Thyroid Laparoscopic Surgery at the armpit


  Scars from open thyroid surgery are shown in the picture.

2. Laparoscopic Surgery for Thyroid with minimal invasive surgery at the armpit or chest. The laparoscope and equipment are inserted to remove the thyroid gland which has adenoma. The advantage of this surgery is that the wound is hidden under the garment. Anyhow the drawback is that it cannot be done with big adenoma or it cannot be done is in the case of Thyroid carcinoma is suspected. 

 


     
Postoperative treatment depends on the result of biopsy

• In case of Goitres, the physician may follow up the treatment or medicate the patient with Thyroid hormone for 6 months approximately. 

• In case of Cyst, no additional treatment is not required.

• In case of Thyroid adenoma, no additional treatment is required. The physician may follow up from time to time.

• In case of Toxic adenoma, the treatment depends on characteristic and type of adenoma. In some case, the follow up is required. In some case, the second surgery is required in order to remove both Thyroid Gland. In some case, Radio-iodine Therapy is necessary after the surgery.

 

Frequently Asked Questions about Thyroid Surgery

1. Will it be no voice after Thyroid Surgery?

Normally, the thyroid gland is placed on the nerve to the larynx above the bronchi closely. Thyroid surgery has the potential for injury to both nerves, with a chance of 1-5% chance depending on the size of the adenoma.  The greater the adenoma or the more inflammation is, the greater the chance of injury to the nerves. Traditional open surgery and Laparoscopic surgery have indifferent chance of injury. If the said nerve is injured, the voice will be hoarse (not having no sound at all). The voice may be temporary hoarse (3-6 months if only some part is injured or bruised or permanent hoarse (in case the nerve is cut). Anyhow, the surgeon will do the best to keep the nerve safe from being injured, except the case of accidentally injury. 

2. What is the different between normal and Laparoscopic Thyroid surgery? 

The most obvious advantage of laparoscopic surgery in comparison with traditional open surgery is that there will be no wound at the neck. The wound will be at the location where the cut is such as laparoscopic surgery thru the armpit, the wound will be at the fold of armpit. If the cut is at the nibble, the wound will be at the connection between nibble and skin. If the laparoscope surgery is performed thru the mouth, the wound will be between the bottom teeth and lower lip. Therefore there will be 100% no wound on skin. In addition, laparoscopic surgery will lead to faster recovery and less pain than traditional surgery. 

3. Will it be numbness and the calcium must be consumed after Thyroid Surgery? 

Parathyroid gland produces parathyroid hormone that affects the levels of calcium in the blood. The parathyroid gland is located adjacent to the thyroid gland on two thyroid glands in each side. If the thyroid surgery is only at one side, it usually does not cause this problem because the other side still has parathyroid gland. The problem usually occurs with people who have to undergo thyroid surgery on both sides, which the parathyroid hormone may cut off causing low calcium in the bloodstream followed by numbness. Surgeons will try to keep the four parathyroid glands. Another case is the storage of parathyroid gland but because during the surgery, the blood vessels to the parathyroid gland will be enucleated and this may cause temporary blood transfusions, causing the gland working not so efficient temporarily. When the time passes by, it will return to normal.

4. Does the patient need to take medication after Thyroid Surgery?

If only the surgery is undergone with only one side, it is not necessary to take hormone because one Thyroid gland can also work normally (actually only 4 grams of thyroid hormone is workable). In the case, it is necessary to remove both of them, the patient has to a take a small white pill of Thyroid hormone forever. 

5. How big is the adenoma that cannot use Laparoscopic Surgery?

Laparoscopic Surgery thru armpit is suitable for the adenoma that is not larger than 6-7 cm. The surgery can only undergo in the case of one side Thyroid gland. If on both side, the operation must be performed on both armpits. Remember that as larger the adenoma is, the more difficult the surgery and the lesser chance of successful the Laparoscope Surgery. 

6. Can hyperthyroid be surgery? 

For Hyperthyroid, it is recommended to take the medicine for 2 years. The surgery will be considered when

- The patient has taken the medicine for 2 years but hormone level is still high. 

The patient has exophthalmos or other complication caused by Hyperthyroid

- The patient is allergy to medicine or cannot take the medicine 

- Others

7. Can the patient returns home after the surgery and what is the expense? 

After laparoscopic surgery, the patient will be hospitalized for about 3 days before returing home. The expense for Thyroid Laparoscopic is 200,000 Baht approximately.  



แผลผ่าตัดไทรอยด์ผ่านกล้องผ่านทางรักแร้
 

8. What to do before and after the surgery? 

Before Thyroid Laparoscopic Surgery, the patient can eat normal. There is no food to be abstained. Anyhow thromboembolism and fish oil supplements must be abstained because it is often bleeding easily. Before surgery, try to avoid the community at risk of catching a cold because if the patient catches a cold, he/she cannot be anesthetized. The first 24 hours, the patient needs to avoid hawk or heavy cough or shout because it is easy to have bleeding.  Other activity can be done normally. 

 



พว.วนิดา  วิปุลานุสาสน์
Head of Laparoscopic Surgery Center
Bangkok Hatyai Hospital 

พว.วนิดา วิปุลานุสาสน์ Head of Laparoscopic Surgery Center Bangkok Hatyai Hospital