Minimally Invasive Thyroid Surgery

Goiter

A Goiter is an enlarged Thyroid Gland, and usually causes no pain. As the gland enlarges, it may cause a visible growth under the skin in the neck, and may also result in a sensation of swelling in the neck. As the size increases, the gland may place pressure on the windpipe and esophagus, making breathing and swallowing uncomfortable. 

A low level of iodine in the diet is the most common cause of Goiters internationally. However, in the United States where dietary iodine is plentiful, Goiters more often develop as a result of thyroid hormones imbalances, nodules within the thyroid and certain auto-immune diseases.

Treatment of Goiters depends on the size of the Goiter, symptoms and the underlying cause. Smaller Goiters with no symptoms do not require treatment. Surgical excision of all or part of the Thyroid Gland should be considered for Nodular Goiters causing Hyperthyroidism or Goiters compressing other structures in the neck which result in difficulty breathing or swallowing.

Hypothyroidism and Hyperthyroidism

Hypothyroidism and Hypothyroidism are conditions characterized by abnormal thyroid hormone production. Various diseases and conditions can result in Hypothyroidism or Hyperthyroidism. These conditions are commonly treated with medications and are best managed by internists and endocrinologists.

• Hypothyroidism
  Hypothyroidism is a condition in which the Thyroid Gland does not produce an adequate amount of hormones and is thus under-active.  
  Common symptoms include low energy, fatigue, depression, feeling cold, muscle pain, slowed thinking, constipation, weight gain and dry and brittle skin, hair and nails.
• Hyperthyroidism
  Hyperthyroidism is a condition in which the Thyroid Gland produces excessive amounts of hormones. Common symptoms include shaking, nervousness, irritability, feeling hot, rapid and irregular heartbeat, muscle weakness, fatigue, frequent bowel movements, weight loss and hair loss.

Nodule

A Thyroid Nodule is an abnormal growth (lump) of thyroid cells within the Thyroid Gland. Nodules can be solid or fluid filled. The majority of Thyroid Nodules are asymptomatic, do not alter thyroid hormone levels and are non-cancerous (benign).

Thyroid Nodules are quite common, occurring in up to 50% of the adult population. Since the majority of these nodules are very small and not symptomatic, they are not identified. Approximately 300,000 new Thyroid Nodules are found every year in the United States. Less than 5% of all Thyroid Nodules are cancerous. Since it is often not possible to distinguish between a non-cancerous nodule and a cancerous nodule, further testing is usually indicated to find the nature of the nodule.

Nodules are often too small for the patient to sense. They are usually discovered by a physician during routine examination of the thyroid or incidentally noted during imaging of the neck for other medical problems. Occasionally, the Thyroid Nodule may become large enough so that it is visible through the skin or may press on the windpipe or esophagus, making it uncomfortable or difficult to breathe or swallow.

Treatment options depend on the type of Thyroid Nodule present in the Thyroid Gland. Benign and asymptomatic nodules are commonly observed and followed with serial examinations. Surgery is usually recommended if the nodule is cancerous or if the nature of the nodule cannot be determined with testing.

Causes:

Although the causes of Thyroid Cancer are not clear, certain risk factors have been associated with increased chance of developing Thyroid Cancer. These risk factors include:

• Radiation exposure - Sources of such radiation include medical treatments and radiation fallout from power plant accidents or nuclear weapons.
• Family history - Several inherited conditions have been linked to various types of Thyroid Cancer.
• Gender – Women are approximately three times as likely as men to develop Thyroid Cancer.
• Age - Thyroid Cancers can occur in people of all ages; however, most cases are found in people between the ages of 20 and 60 years.
• Diet low in iodine - In the United States, dietary iodine is plentiful since iodine is added to table salt and other foods.

Types of Thyroid Cancer:

The type of Thyroid Cancer determines the treatment and prognosis. Types of Thyroid Cancer include:

• Papillary Thyroid Cancer
  Papillary Thyroid Cancer is the most common, accounting for about 80 percent of all Thyroid Cancers.  Papillary Thyroid Cancer can develop at any age, but is most commonly diagnosed in women ages 30 to 50. It spreads slowly and is the least dangerous type of Thyroid Cancer. In general, when diagnosed early, Papillary Thyroid Cancer has a high cure rate.

• Follicular Thyroid Cancer
  Follicular Thyroid Cancer accounts for about 20 percent of all Thyroid Cancers. Hurthle cell cancers are considered to be a variant of this type of Thyroid Cancer. Follicular Thyroid Cancer typically occurs in people older than 50.

• Medullary Thyroid Cancer
  Medullary Thyroid Cancer accounts for about 5-10 percent of Thyroid Cancers. It is a cancer of non-thyroid cells that are normally present in the Thyroid Gland. Medullary Thyroid Cancer may be associated with inherited genetic syndromes that include tumors in other glands. Once diagnosed, genetic testing is recommended in order to identify whether the patient has the familial form. If they do, their family members must also be tested to see if they carry the gene. Most Medullary Thyroid Cancers are not associated with inherited genetic syndromes.

• Anaplastic Thyroid Cancer
  Anaplastic Thyroid Cancer is the most dangerous form of Thyroid Cancer. It is rare and spreads quickly to invade nearby structures such as the windpipe (trachea). It is associated with a poor prognosis. Anaplastic Thyroid Cancer typically occurs in people that are 60 years of age or older.

• Thyroid Lymphoma
  Thyroid Lymphoma develops in the immune system cells in the Thyroid Gland. Thyroid Lymphomas constitute approximately 5% of all thyroid neoplasms. Thyroid Lymphoma is a highly curable malignancy if diagnosed promptly and managed correctly. They are more common in women and usually affect patients with a median age of 60 years.

Symptoms

In general, Thyroid Cancer does not present any signs or symptoms early in the disease. As the cancer grows, it may begin to cause symptoms. Symptoms may vary depending on the type of Thyroid Cancer. They include:

• A mass in the thyroid that can be felt through the skin (nodule)
• Difficulty swallowing
• Enlargement of the Thyroid Gland
• Hoarse voice or a change in the voice
• Neck or throat pain
• Swollen lymph nodes in the neck

Treatment:

Surgical removal of part or all of the Thyroid Gland is usually the treatment of choice for Thyroid Cancer. Depending on the type of cancer, the surgery may also include removal of surrounding lymph nodes and may be followed by radioactive iodine treatment.

• Thyroid cancer
• Large Goiters that are causing difficulty breathing or swallowing
• Thyroid cysts that return after repeat drainage
• Hyperthyroidism that does not respond to medications