Some patients would be hesitant when advised to undergo the thyroidectomy. This blog addresses those patients who really need the procedure.
Whenever I advise certain patients to undergo the thyroidectomy procedure, I get the question “Is it really necessary, doctor?”
And the answer is: your head and neck surgeon will recommend surgery for thyroid disease only if absolutely necessary. Remember, we always abide by the principle “Primum non nocere” or “First, do no harm”. Your head and neck surgeon will only recommend surgery if the benefits of the thyroid surgery outweighs the risks. (read: How safe is a thyroidectomy? )
Thyroidectomy is necessary usually for the following indications:
THYROID CANCER: THYROIDECTOMY
Thyroid cancer is the strongest indication for a thyroidectomy. If you have thyroid cancer, removing majority of, if not all, of the thyroid gland, will give you the highest chances of survival.
Any thyroid mass, with signs of aggressive clinical behaviour, such as a rapidly enlarging mass, and those with suspicious signs of cancer such as high TIRADS score on ultrasound, signs of extension to adjacent neck structures such as lymph nodes in the neck, and hoarseness also are an indication for a thyroidectomy procedure.
GOITER WITH SYMPTOMS OF OBSTRUCTION:THYROIDECTOMY
Any thyroid mass which is large enough to cause symptoms of obstruction such as difficulty in swallowing and breathing may also be an indication for a thyroidectomy as large thyroid masses usually do not respond well to medical management. In this picture, you will see a big thyroid mass that has occupied a large space in the neck. This patient came to my clinic complaining of difficulty of swallowing and neck discomfort especially when lying down.
UNCONTROLLABLE SYMPTOMS OF HORMONAL CHANGES DESPITE OPTIMAL MEDICAL TREATMENT
Hyperthyroidism is a condition where the body produces too many thyroid hormones which are “toxic” to the body. When the diseased thyroid causes dysfunction of the thyroid hormones, your endocrinologist or ENT doctor (Palawan) will do a trial of medical management which may last for a few months. However, when 1) your hormonal changes do not respond to medical management, 2) your thyroid hormones keep fluctuating, or 3) treatment has been taking too long, thyroidectomy may be an option.
WHEN MEDICAL MANAGEMENT IS NOT ADVISED
Thyroidectomy may also be advised for thyroid patients who plan to get pregnant and are concerned with radiation risks of radioactive iodine, as well as patients who have adverse drug reactions to anti-thyroid medications.
A little anxiety is normal especially when your ENT doctor explains the need to undergo a surgical procedure. It is important for you as a patient to understand the procedure, the benefits and the risks, before undergoing surgery. And always remember to work with a head and neck surgeon, as well as a team that you feel comfortable with.
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