Thyroid Gland Nodules

The thyroid gland is a small bow-tie shaped gland that is located between the adam's apple and the top of the breast bone.

This small gland secretes a hormone that greatly affects your bod'y energy level. Abnormalities of this gland are common, usually seen in middle-aged women.

Thyroid disease is frequently overlooked so a high level of awareness and close follow-up with your primary care physician is necessary to diagnose a thyroid problem.

Thyroid problems fall generally in four categories:

Underactive thyroid (hypothyroidism) - symptoms may include feel sluggish and tired, gain weight easily, get cold easily, dry and brittle skin hair & nails, depressed mood, slower thinking, muscle pain, constipation, muscle aches, heavier or longer menstrual periods
Overactive thryroid (hyperthyroidism) - fell jittery, lose weight unintentionally, get hot easily, rapid heart beat, muscle weakness, frequent bowel movements, hair loss, shorter or ligther menstrual periods
Thyroid Nodules - one or more lumps in the thyroid gland. These are usually benign but may be cancerous so they need to be evaluated by a physician. A history of radiation or family history of thyroid disease may be present.
Thyroid Enlargement (goiter) - See or feel a swelling in the neck, tighter collars or necklaces, trouble swallowing or even trouble breathing

Evaluation for Thyroid Disease

Office examination will include a detailed medical history, physical examination and blood test. Dr. Sinha may order additional testing such as a radioiodine uptake test to measure thyroid function and a thyroid scan to take pictures of thyroid gland. In addition, an ultrasound exam, may also be performed to better delineate nodules or cysts in the thyroid gland.

Biopsy of the Thyroid Mass

If Dr. Sinha suspects that a nodule may be cancerous, a fine needle biopsy may be performed in the office or during the ultrasound examination to sample cells from the nodule (see diagram to the right).

Sometimes, if the fine needle biopsy is not diagnostic and the suspicion of cancer still exists, an operative thyroid lobectomy (removal of a portion of the thyroid gland) may be necessary to diagnose the mass and also, in many cases, serve as the definitive therapy as well.

Treatment for Thyroid Disease

An underactive thyroid, with low suspicion of cancer, is treated by supplemented thyroid hormone. Since thyroid surgery is usually not indicated in these cases, Dr. Sinha usually refers patients to medical specialist who can manage and adjust the thyroid medication.

For an overactive thyroid, there are several options depending on the findings during the evaluation process. Thyroid medication may be used to slow the excessive production of thyroid hormone. Radioactive iodine given in a pill or liquid form may be used to destroy the overactive thyroid cells. Sometimes, Dr. Sinha will need to remove the thyroid gland surgically (thyroidectomy).

For thryoid nodules and goiter, thyroid hormone pills may be used to shrink the nodules or the goiterous gland. If the nodule is large, cancer is suspected or if there is difficulty with breathing an swallowing, a thyroidectomy may be performed. For cancer, often radioactive iodine is given after surgery to destroy any residual cancerous cells. Thyroid hormone replacement pills may be necessary after surgery to maintain the body's level of thyroid hormone.

Surgical Removal of the Thyroid Gland (Thyroidectomy)

The surgery is performed under general anesthesia. A small, horizontal "collar" incision is made in the front of the neck, hidden in a natural skin fold to hide any scar. A portion, or all of the gland may be removed. After the procedure, patients stay in hospital for about one day. A small plastic drain may be left in place during this time to remove any fluid that may build up under the skin.

As with any surgery there is a potential for complications including bleeding, infection, damage to the nerve controlling the vocal cords or damage to a nearby set of parathyroid gland causing serious, permanent problems with calcium metabolism. Although the likelihood of any of these or other complications are fairly low, a detailed discussion on risks versus benefits of surgery is undertaken before any procedure is planned.

Thyroid disease is common and complicated issue. Dr. Sinha works in concert with other specialists to help determine which course of treatment is best for you. You may call our office at 404-257-1589 to schedule a consultation for further information.