As the gland swells it may cause pressure effects such as:
Pressure on the windpipe causing shortness of breath
Pressure on the gullet causing difficulty swallowing
Pressure on the nerves to the vocal cords causing a hoarseness of the voice
It may also cause an ugly swelling in the front of your neck.
The aims are to stop the pressure effects of the gland, to remove any tumour, to prevent any tumour in the neck from coming back and to remove overactive thyroid tissue. At the same time, we aim to avoid any damage to the nerves and parathyroid glands. If possible we leave enough thyroid tissue for your needs.
This means removing part or all of the thyroid gland. You will have a general anaesthetic and be completely asleep while it this is done.
You will lose the pressure effects. The thyroid will be back to a normal size. Any removed tumour will be examined to see if further treatment is needed. The operation should prevent further problems from cysts.
The effects of an overactive thyroid should disappear, although eye problems may continue and need extra treatment.
Are there any alternatives?
If there are pressure effects due to inflammation of the thyroid, removal of only the central part of the thyroid in front of the windpipe is worth considering.
If bleeding into a cyst is settling down, and it is unlikely to be a tumour, it is reasonable to wait and see if it happens again.
If the thyroid is overactive and has not settled down after a course of drug treatment, then treatment with radioactive iodine is often better than an operation. An operation is usually better for a younger patient than radioactive iodine. The same applies if the over-activity comes from just one part of the thyroid gland, called a hot nodule.
X-ray treatment is better than an operation for only one rare type of tumour, an anaplastic tumour. The other types are better treated with surgery.
What if you do nothing?
There is often some uncertainty about the cause for a thyroid swelling. Scans, tissue sampling by needle and blood tests may not give a clear answer. If you do nothing and the cause remains unclear, you could be missing out on important treatment.
If the thyroid is already pressing on your windpipe, it may get rapidly worse if you leave it. It may block your windpipe and stop your breathing completely.
Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.
© Dumas Ltd 2006