The thyroid is a butterfly shaped organ that lies over the airway in your neck, covered on its sides by neck muscles. It is responsible for making thyroid hormone, a regulator of many functions in the body such as metabolism, intestinal motility, temperature regulation, and many other actions.

An average thyroid is the size of a silver dollar on each half (the butterfly wings) and soft to the touch. Diseases of the thyroid entail over or underproduction of thyroid hormone, auto-immune diseases/inflammation of the thyroid, thyroid nodules, and thyroid cancer.

Diseases of the Thyroid

Nodules of the Thyroid

By the age of 70 over half the people in the country will have thyroid nodules. Nodules are the result of abnormal cellular growth, however over 90% of nodules are benign.

Nodules should be followed with yearly ultrasound exams to make sure they are not growing or develop worrisome characteristics. All nodules over 2.0cm should be biopsied, and smaller nodules with worrisome characteristics should also be biopsied.

Abnormal Thyroid Hormone Production

Thyroid hormone is made by thyroid cells through Iodine ingested in the diet. Regulation of hormone production is complex and can be related to not only diet, but stress levels, auto-immune disease, and thyroid nodules. Autoimmune diseases such as Graves Disease, or Hashimoto’s Thyroiditis when the body attacks thyroid cells causes the release of thyroid hormone and abnormal fluctuations in thyroid hormone levels. Some nodules can over-produce thyroid hormone as well.

Thyroid Cancer

Abnormal thyroid growth, genetic predisposition, and genetic syndromes can all lead to the development of thyroid cancer in addition to other risk factors. Different cancers develop from the various types of cells in the thyroid. The two most common types of thyroid cancer are Papillary Thyroid Cancer, and Follicular Thyroid Cancer. Additional types of thyroid cancers are Medullary Thyroid Cancer, and Anaplastic Thyroid Cancer.

Papillary Thyroid Cancer

Accounting for roughly 80% of all thyroid cancers, Papillary thyroid cancer typically is very slow growing and has an excellent prognosis if found and treated early. Up to 20% of patients with this cancer will have spread to lymph nodes at the time of diagnosis. However, even with positive lymph nodes patients have an excellent outcome when treated with both surgical and medical therapy.

Follicular/Hurthle Cell Cancer

The second most common type of thyroid cancer, more aggressive that papillary cancer. However, again if found and treated early patients have an excellent outcome.

Medullary Thyroid Cancer

Much rarer, this subtype of thyroid cancer arises from C-Cells of the thyroid. C-cells are responsible for making a hormone called calcitonin that down regulates calcium levels. Medullary thyroid cancer can be associated with genetic syndromes but also can occur sporadically. This cancer tends to be more aggressive however if found early and treated appropriately in the hands of a trained surgeon outcomes are also excellent.

Anaplastic Thyroid Cancer

The rarest and unfortunately most aggressive subtype of thyroid cancer. This cancer tends to grow and spread rapidly. However, in addition to surgical treatment there are emerging medical treatments that can be quite effective in treating this cancer.

Thyroid Treatments

As a fellowship trained Endocrine surgeon, I treat all aspects of endocrine disease which require an operation. I perform all standard open surgeries as well as minimally invasive approaches. Additionally I am also trained in non-surgical treatments such as radio-frequency ablation and perform ultrasound exams and ultrasound guided biopsy in my office.

Thyroidectomy/Hemithyroidectomy

This entails removing either half or the entire thyroid through a horizontal incision just below the adam’s apple. The blood vessels to the thyroid are sealed shut, and it is freed from all of the surrounding muscles and structures in the neck. The thyroid is then rolled up and off the windpipe. Behind the thyroid runs a nerve to your vocal cords – one nerve on each side of the neck. This nerve needs to be carefully protected because if injured can permanently result in a hoarse voice and difficulty swallowing. The nerve is protected through meticulous dissection. I also use a specialized nerve monitoring device to find and protect this structure.

Nerve Monitoring

Nerve monitoring uses a special breathing tube placed while you are asleep and getting anesthesia. This tube has electrodes across it that sense your vocal cords. A nerve stimulating probe, similar to a Q-Tip is then touched lightly against tissue during surgery to identify the nerve traveling to your vocal cords behind the thyroid, protecting and ensuring function of this nerve.

Hemithyroidectomy takes on average 1 ½ hours, total thyroidectomy takes 2 ½ hours.

Neck Dissection

A central neck dissection involves removing the lymph nodes from the area nearest to the thyroid. A lateral neck dissection involves removing lymph nodes further away from the thyroid under your neck muscles and around the carotid arteries and large blood vessels of the neck. There are hundreds of lymph nodes in the neck and removing them from limited sections has no long term consequences.

Thyroglossal Duct Cyst Excision

During development the thyroid originates from the tongue and descends down to its position in the middle of your neck through a bone called the hyoid and along the trachea. During its descent residual thyroid cells can be left behind and a cyst can develop from these. Sometimes bacteria from the mouth can travel through this tract and infect these cysts. The only way to fix this pathology is to surgically remove the cyst and tract of thyroid cells. This entails a small incision over the cyst to remove it and the central portion of the hyoid bone.

Radio Frequency Ablation

Radiofrequency ablation is a technology to introduce heat into cells thereby killing them without injuring the surrounding area. This is a non-surgical option to treat thyroid nodules. Using an ultrasound machine, a small needle is introduced into a thyroid nodule and heat is targeted into just this area. The procedure takes 20 minutes, there is no anesthesia needed, only local numbing medication. Patients can return to activities without restrictions the next day. It can take up to 9 months for a nodule to fully change in size, but decreases in size of up to 90% can often be seen.