Go to Top

Thyroid

Thyroid

The thyroid is a small gland in the root of the neck that controls the rate at which the body works and is a very important gland. It has four associated glands called the parathyroids and these control the level of calcium in the blood. Calcium is a very important element as it helps regulate muscle action including heart beat. This page will give information about most thyroid conditions, please click on the links below for the condition or information you are interested in.

Over Active Thyroid

If the thyroid produces too much thyroid hormone then the body’s rate of working increases. This results in a fast heart rate, a tremor, a feeling warm and weight loss. This is often caused by the body forming antibodies to the thyroid and is a condition called Grave’s Disease, named after Robert Graves, the Irish Physician who first described it. The condition needs to be brought under control to allow the body to function properly. In the first instance this is with drugs, such as Carbimazole. Once it is under control the condition often remits and is self limiting, occasionally this doesn’t happen and then definitive treatment is needed. Definitive treatment for over active thyroid consists either of surgery or radioactive iodine.

Surgery
Surgery for overactive thyroid involves removing most or all of the thyroid gland.

Total Thyroidectomy
This involves removing the whole of the thyroid gland. The advantages of this is that the over active thyroid cannot recur as there is no thyroid left. The disadvantage is that you would need to take Thyroxin life long.

Sub Total Thyroidectomy
This involves taking most of the gland out and trying to leave enough thyroid so you will have normal thyroid function. However it can be quite difficult to leave the right amount of thyroid gland.If too little is left the gland will be underactive and you would need thyroxine. If too much is left the gland will still be overactive. This wouild then require further treatment. The advantages are if it all works properly then you will not need to take Thyroxin for life.

Under Active Thyroid

An under active thyroid gland does not produce enough thyroid hormone. The effects are largely opposite to that of overactive thyroids; the metabolism slows down, there is a degree of weight gain, a feeling of coldness and heart rate can slow down. The diagnosis is made by blood tests to get the level of thyroid hormones and it is treated with Thyroxin. These cases are usually dealt with by Physicians specialising in Endocrinology.

Lump in Thyroid

Lumps appearing in the thyroid gland are a relatively common occurrence. These appear low in the neck usually as painless lumps. A full evaluation in the clinic together with blood tests to assess the thyroid function. The main investigation of a thyroid lump is to use a small needle to take a sample of cells out, this is called a fine needle aspiration biopsy (FNAB) this gives us a good idea of the nature of the lump and whether or not further action is required. Most lumps will also have an ultrasound scan which also gives an idea of the size of the lump and whether it is a solid lump. Depending on the results of these tests depends what happens to the lump. A lot of lumps are removed surgically to get an accurate diagnosis of the nature of the lump, but some can be safely left alone. The main aim of all the investigations is to differentiate benign lumps that could be left against cancerous lumps which need to be removed.

Thyroid Cancer

Thyroid cancer is a rare condition with only approximately 1,000 new cases per year in the United Kingdom. It takes many different forms, but the commonest forms have a very good prognosis with a 90 to 95% cure rate.

Thyroid cancer presents as a painless lump in the thyroid and occasionally with other lumps in the neck. It can rarely affect the voice giving a croaky hoarse voice. The diagnosis is by an ultrasound scan and a fine needle aspiration biopsy (see lump in thyroid). The treatment of thyroid cancer depends on many factors, these include the size of the tumour, the sub type of the tumour, but generally requires an operation to remove the whole of the thyroid gland and any affected lymph nodes in the neck. Radioactive iodine may also be required to make sure there are no surviving cancer cells. Following successful treatment most thyroid cancers have a very good survival rate.

Goitre

A goitre by definition is an enlargement of the thyroid gland. The most common cause is what is known as a multi nodular colloid goitre and this is where the structure of the thyroid gland enlarges and is a benign process. Most of these can be safely left alone, although occasionally they cause compression of the windpipe (trachea) and need to be removed.

Parathyroid

The parathyroids are four small glands that are situated behind the thyroid. Their role is to regulate the amount of calcium in the blood which is an important element for the functioning of muscles and to maintain strength of bones. Occasionally the gland can produce too much parathyroid hormone leading to a raised level of calcium in the blood. This is often discovered on incidental blood tests.

A raised level of calcium can cause problems such as osteoporosis (weak bones), kidney and bladder stones, muscle aches and pains and tummy aches and pains and also mood change.

The commonest cause for an over active parathyroid gland is a benign (non cancerous) tumour of the parathyroid gland called parathyroid adenoma. If the calcium is quite high or there are symptoms these are best treated and the treatment is surgical removal. Often the gland is localised using special scans.

The operation to remove the parathyroid gland is virtually the same procedure as for a thyroid gland, through the same incision and normally the calcium will return to normal very quickly.

For more information on Thyroid conditions, please visit the ENT UK website.