THYROID DISORDERS

Your thyroid gland is one of the endocrine glands that makes hormones to regulate physiological functions in your body, like metabolism. Other endocrine glands are the pancreas, the pituitary, the adrenal glands, and the parathyroid glands.

The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and wraps around the front half of the trachea (windpipe). It is shaped like a bow tie, just above the collarbones, having two halves (lobes) which are joined by a small tissue bar (isthmus.). You can't always feel a normal thyroid gland.

What is a thyroid disorder?

Diseases of the thyroid gland are very common, affecting millions of Americans. The most common thyroid problems are:

an overactive gland, called hyperthyroidism (e.g., Graves' disease, toxic adenoma or toxic nodular goiter)
an underactive gland, called hypothyroidism (e.g., Hashimoto's thyroiditis)
thyroid enlargement due to overactivity (as in Graves' disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a "goiter".

Patients with a family history or who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy.

If you develop significant swelling in your neck or difficulty breathing or swallowing, you should call your surgeon or be seen in the emergency room.

What treatment may be recommended?

Depending on the nature of your condition, treatment may include the following:

Hypothyroidism treatment:

thyroid hormone replacement pills

Hyperthyroidism treatment:

medication to block the effects of excessive production of thyroid hormone
radioactive iodine to destroy the thyroid gland
surgical removal of the thyroid gland

Goiters (lumps):

If you experience this condition, your doctor will propose a treatment plan based on the examination and your test results. He may recommend:

a fine needle aspiration biopsy - a safe, relatively painless procedure. With this procedure, a hypodermic needle is passed into the lump, often after administration of local anesthesia into the skin, and tissue fluid samples containing cells are taken. Often several passes with the needle are required. Sometimes ultrasound may be used to guide the needle into the nodule. There is little pain afterward and very few complications from the procedure occur. This test gives the doctor more information on the nature of the lump in your thyroid gland and specifically may help to differentiate a benign from a malignant thyroid mass.
thyroid surgery - may be required when:

the fine needle aspiration is reported as suspicious for or suggestive of cancer
the trachea (windpipe) or esophagus are compressed because both lobes are very large

Historically, some malignant thyroid nodules have shown a reduction in size with the administration of thyroid hormone. However, this treatment, known as medical "suppression" therapy, has proven to be an unreliable treatment method.

How is a diagnosis made?

The diagnosis of a thyroid function abnormality or a thyroid mass is made by taking a medical history and a physical examination. Specifically, your doctor will examine your neck and ask you to lift up your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps to feel the thyroid and any mass in it. Other tests your doctor may order include:

evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope
an ultrasound examination of your neck and thyroid
blood tests of thyroid function
a radioactive thyroid scan
a fine needle aspiration biopsy
a chest X-ray
a CT or MRI scan