Introduction
- The thyroid gland is a butterfly shaped organ located in the neck in front of the windpipe
- Certain diseases and swelling of the thyroid gland require its surgical removal. This often leaves a long visible scar in the neck.
- Endoscopic neck surgery has evolved to add an aesthetic component to thyroid and parathyroid surgeries
- The cut for the surgery is made below the neckline so there is no visible scar on the neck
Signs and symptoms
- Enlarging swelling in the neck which moves up and down with swallowing
- Multiple nodules may be present
- The thyroid swelling may be secondary to low functioning (Hypothyroidism) of the gland or increased functioning (Hyperthyroidism)
- Iodine deficiency also results in enlargement of the thyroid gland, a condition known as Goitre
- Pain in the swelling is indicative of inflammation and may be due to thyroiditis. During active thyroiditis patient may be hyperthyroid. Once the inflammation settles the patient may become hypothyroid.
- Hypothyroidism
- Tiredness
- Cold extremities
- Weight gain
- Facial puffiness
- Dry skin
- Constipation
- Hyperthyroidism
- Nervousness
- Tremors
- Unintended weight loss
- Intolerance to heat
- Increased heartbeats
- More than 90% of thyroid swellings are benign
- Rarely a thyroid swelling maybe cancerous.
Diagnosis
- Swelling of the thyroid gland is visible and can be confirmed by physical examination
- Thyroid function tests indicate the functioning of the gland – normal, hypo or hyper and include blood levels of active forms of thyroid hormones T3, T4 as well as TSH (thyroid stimulating hormone – regulates secretions of thyroid gland)
- Ultrasound of the gland tells the exact size, number and character of the swelling. Whether it is solid or filled with fluid
- A biopsy from the gland will determine the type of swelling and whether it is benign or cancerous
- A thyroid scan tells us whether the swelling is functional or not (ie. if it is producing thyroid hormone or not)
Complications
- Large and rapidly increasing swelling may compress the trachea and cause difficulty in breathing , especially on lying down
- Untreated hypothyroidism can cause cardiac failure, coma and even death.
- Untreated hyperthyroidism can result in cardiac problems like arrhythmias, cardiomyopathy and cardiac failure, thyroid storm (a life threatening condition seen especially in patients’ of Grave’s disease), stroke and death
- Rarely cancer may occur in the thyroid gland
Treatment
- Endoscopic surgery for thyroid swellings is indicated primarily for cosmetic reasons for unsightly neck swellings. These are secondary to goitrous enlargement of the gland. Patients with thyroid cancer are not candidates for this approach. The surgical ports can be placed on the chest, in the axilla, behind the ear and through the mouth.
- There are criteria to define which patient can safely undergo endoscopic thyroidectomy
- Swelling size < 5 cm,
- Non cancerous
- No previous neck surgery
- Patient fit for general anaesthesia
- To reach the surgical site a tunnel is created up to the neck and then the affected part of thyroid gland dissected out and removed.
- A tube is sometimes left inside for a few days till the walls of the cavity stick together.
Recovery
- The patient recovery is rapid and hospital stay is only for a day or two.