THYROID CONDITIONS
Understanding the Thyroid Gland
The thyroid is a butterfly-shaped gland located at the base of your neck. It plays a crucial role in regulating your body’s metabolism, energy levels, heart rate, and temperature through the production of thyroid hormones (T3 and T4). Thyroid conditions are common and can affect people of all ages. While many thyroid problems can be managed medically, some conditions require surgery, either due to the size of the thyroid, abnormal function, or concern for cancer.
Common Thyroid Conditions
Thyroid Nodules:
These are lumps or growths in the thyroid. Most are benign, but some can be cancerous or cause compressive symptoms like difficulty swallowing or a visible lump in the neck.
Multinodular Goitre:
When multiple nodules cause the thyroid to enlarge, it can result in cosmetic concerns, difficulty breathing or swallowing, or abnormal thyroid hormone levels.
Hyperthyroidism:
An overactive thyroid, commonly caused by Graves’ disease or toxic nodules, may require surgery if medications or radioactive iodine are not effective or suitable.
Thyroid Cancer:
Most thyroid cancers are highly treatable when detected early. Surgical removal is often the first and most important step in treatment, followed by tailored post-operative care.
When is Thyroid Surgery Recommended?
Surgery may be advised in the following situations:
Suspicion or confirmation of thyroid cancer
Large goitre causing compressive symptoms
Cosmetic concerns due to neck swelling
Persistent hyperthyroidism not controlled with medications
Indeterminate or suspicious biopsy results
Types of Thyroid Surgery
Surgical management is tailored to your specific condition, whether it’s benign nodular disease, hyperthyroidism, or thyroid cancer. The goal is always to achieve optimal disease control while preserving important surrounding structures, such as the nerves and parathyroid glands.
Hemithyroidectomy (Lobectomy)
This involves removing one lobe (half) of the thyroid gland. It is commonly performed when:
There is a solitary nodule with indeterminate biopsy results
The nodule is large or symptomatic but confined to one lobe
Low-risk thyroid cancer is confined to one side
Majority of the patients retain normal thyroid function with the remaining lobe and do not require long-term hormone replacement.
Total Thyroidectomy
Removal of the entire thyroid gland. This is indicated when:
Thyroid cancer is confirmed or strongly suspected
Multinodular goitre involves both lobes
Graves’ disease is not controlled with medical therapy
The patient prefers definitive treatment to avoid future procedures
Patients undergoing total thyroidectomy will need lifelong thyroid hormone replacement therapy.
Completion Thyroidectomy
This is performed when a hemithyroidectomy has already been done and a diagnosis of cancer is later confirmed on pathology. The remaining lobe is removed to reduce recurrence risk and facilitate radioactive iodine therapy and long-term monitoring using thyroglobulin.
Isthmusectomy
This is a more limited procedure involving removal of the isthmus — the thin bridge of thyroid tissue connecting the two lobes. It is only suitable when a small nodule is confined to the isthmus without any suspicious features elsewhere.
Note: We do not perform “nodulectomy” (removal of just the nodule) in other locations of the thyroid, as this does not allow adequate assessment of surrounding tissue or margins, and carries a higher risk of incomplete treatment or recurrence. Proper surgical evaluation requires removal of at least one thyroid lobe.
Nipple Discharge
Nipple discharge is a very common breast symptom, mostly physiological, occasionally pathological, and only rarely associated with underlying cancer specially in women < 40 years of age.
Physiological nipple discharge or galactorrhea could be unilateral or bilateral (both breasts) and most-commonly caused by nipple stimulation or medications (antipsychotics and antidepressants). Occasionally it may be caused by a benign pituitary tumour producing prolactin hormone (the milk hormone normally secreted during breastfeeding).
The two most common causes of pathological nipple discharge are intraductal papilloma and duct ectasia. The former is a benign growth within a milk duct associated with unilateral clear or bloody nipple discharge, while the latter is referred to dilated subareolar milk ducts associated with often bilateral greenish or cheesy discharge.