- Thyroid is a butterfly shaped gland in neck which produces thyroid hormone , essential for our body metabolism.
- Thyroid gland has two lobes on either side and connected in centre.
- It is quite common to have lumps in thyroid gland which may be completely benign or cancerous.
- Many patients start noticing swelling in anterior neck with no pain or discomfort.
- These may gradually increase in size and become large lumps overtime.
- Many a times these lumps are multiple and present on both lobes , which can progress to form a large swelling.
- Most of these are non -cancerous and would require surgery for cosmetic reasons or as the size of lumps may cause pressure on surrounding structures like air pipe and food pipe.
Most of the times thyroid cancer also present as pain less lump in thyroid which slowly progress in size. So its difficult to differentiate from non cancerous ones. However few cases present with
- rapidly increasing lump in thyroid
- Enlarged neck nodes due to cancer spread
- Change in voice
- Difficulty in breathing
Investigations For Thyroid Lump
Ultrasound scan of thyroid gland
Based on features of lump we can segregate them into highly suspicious for cancer, borderline or non cancerous lumps.
Cytology is quick and easy test done after USG . This can pick up cancer in lump or at least guide us with risk of cancer in the sampled lump(BETHESDA CLASSIFICATION)
MRI / CT scan are rarely done in patients with large lumps or with ominous symptoms of advanced thyroid cancer.
Removal of one half of thyroid gland is called hemi thyroidectomy . This is generally done for
- Benign lumps in one thyroid lobe
- Early stage thyroid cancer
- Diagnostic for follicular adenoma
Removal of complete thyroid gland is called total thyroidectomy. Most common indications are
- Benign nodules in both lobes.
- Thyroid cancer.
Thyroid cancer patients presenting with spread of cancer to neck nodes , requires appropriate neck dissection along with thyroidectomy to completely clear disease.
How Safe Is Thyroid Surgery
In experienced hands thyroidectomy is a completely safe surgery.
Three structures of concern during surgery are
- Recurrent laryngeal nerve which supplies muscles of vocal cords.
- External branch of superior laryngeal nerve which also supply to muscle of vocal cord.
- PARA THYROID glands which maintain calcium levels in blood.