Thyroid/Parathyroid
Doctor, tell me more
about my Thyroid Gland...
Fine Needle Aspiration
Doctor, tell me more about my Thyroid Gland...
Information about thyroid disorders
What is Your Thyroid Gland?
Your thyroid gland is one of the endocrine glands,
which make hormones to 
regulate
physiological functions in your body. The thyroid gland manufactures
thyroid hormone, which regulates the rate at which your body
carries on its necessary functions. Other endocrine glands are
the pancreas, the pituitary, the adrenal glands, the parathyroid
glands, the testes, and the ovaries.
The thyroid gland is located in the middle of
the lower neck, below the larynx (voice box) and just above
your clavicles (collarbones). It is shaped like a "bow
tie," having two halves (lobes): a right lobe and a left
lobe joined by an "isthmus". You can't always feel
a normal thyroid gland.
When Is a Thyroid Gland Abnormal?
Diseases of the thyroid gland are very common,
affecting millions of Americans. The most common diseases are
an over- or under-active gland. These conditions are called
hyperthyroidism (e.g., Grave's disease) and hypothyroidism.
Sometimes the thyroid gland can become enlarged from over-activity
(as in Grave's disease) or from under-activity (as in hypothyroidism).
An enlarged thyroid gland is often called a "goiter."
Sometimes an inflammation of the thyroid gland (Hashimoto's
disease) will cause enlargement of the gland.
Patients may develop "lumps" or "masses"
in their thyroid glands. They may appear gradually or very rapidly.
Patients who had radiation therapy to the head or neck as children
for acne, adenoids, or other reasons are more prone to develop
thyroid malignancy. A doctor should evaluate all thyroid "lumps"
(nodules).
How Does Your Doctor Make the Diagnosis?
The diagnosis of a thyroid abnormality in function
or a thyroid mass is made by taking a medical history and a
physical examination. Specifically, your doctor will examine
your neck and ask you to lift up your chin to make your thyroid
gland more prominent. You may be asked to swallow during the
examination, which helps to feel the thyroid and any mass in
it. Other tests your doctor may order include:
An ultrasound examination of your neck and thyroid
Blood tests
of thyroid function
A radioactive
thyroid scan
A fine needle
aspiration biopsy
A chest X-ray
A CT or MRI
scan
Fine Needle
Aspiration
If a lump in your thyroid is diagnosed, your
doctor may recommend a fine needle aspiration biopsy. This is
a safe, relatively painless procedure. A hypodermic needle is
passed into the lump, and samples of tissues are taken. Often
several passes with the needle are required. There is little
pain afterward and very few complications from the procedure
occur. This test gives the doctor more information on the nature
of the lump in your thyroid gland and specifically will help
to differentiate a benign from a malignant thyroid mass.
Treatment of Thyroid Disease
Abnormalities of thyroid function (hyper or
hypothyroidism) are usually treated medically. If there is insufficient
production of thyroid hormone, this may be given in a form of
a thyroid hormone pill taken daily. Hyperthyroidism is treated
mostly by medical means, but occasionally it may require the
surgical removal of the thyroid gland.
If there is a lump of the thyroid or a diffused
enlargement (goiter), your doctor will propose a treatment plan
based on the examination and your test results. Most thyroid
"lumps" are benign. Often they may be treated with
thyroid hormone, and this is called "suppression"
therapy. The object of this treatment is to attempt shrinkage
of the mass over time, usually three-six months. If the lump
continues to grow during treatment when you are taking the medication,
most doctors will recommend removal of the affected lump.
If the fine needle aspiration is reported as
suspicious for or suggestive of cancer, then thyroid surgery
is required.
What Is Thyroid Surgery?
Thyroid surgery is an operation to remove part
or all of the thyroid gland. It is performed in the hospital,
and general anesthesia is usually required. Usually the operation
removes the lobe of the thyroid gland containing the lump and
possibly the isthmus. A frozen section (an immediate microscopic
reading) may or may not be used to determine if the rest of
the thyroid gland should be removed. Sometimes, based on the
result of the frozen section, the surgeon may decide to stop
and remove no more thyroid tissue, or proceed to remove the
entire thyroid gland, and/or other tissue in the neck. This
is a decision usually made in the operating room by the surgeon,
based on findings at the time of surgery. Your surgeon will
discuss these options with you preoperatively.
After surgery, you may have a drain (a tiny
piece of plastic tubing), which prevents fluid from building
up in the wound. This is removed after the fluid accumulation
is minimal. Most patients are discharged one to three days after
surgery. Complications after thyroid surgery are rare. They
include bleeding, a hoarse voice, difficulty swallowing, numbness
of the skin on the neck, and low blood calcium. Most complications
go away after a few weeks. Patients who have all of their thyroid
gland removed have a higher risk of low blood calcium post-operatively.
Patients who have thyroid surgery may be required
to take thyroid medication to replace thyroid hormones after
surgery. Some patients may need to take calcium replacement
if their blood calcium is low. This will depend on how much
thyroid gland remains, and what was found during surgery. If
you have any questions about thyroid surgery, ask your doctor
and he or she will answer them in detail.
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What Is FNA?
Fine needle aspiration (FNA) is a technique
that allows a biopsy of various bumps and lumps. It allows your
otolaryngologist to retrieve enough tissue for microscopic analysis
and thus make an accurate diagnosis of a number of problems,
such as inflammation or even cancer.
FNA Is Used for Diagnosis In:
Neck lymph nodes
Neck cysts
Parotid gland
Thyroid gland
Inside the mouth
Any lump that
can be felt
Why Is It Important?
A mass or lump sometimes indicates a serious
problem, such as a growth or cancer*. While this is not always
the case, the presence of a mass may require FNA for diagnosis.
Your age, sex, and habits, such as smoking and drinking, are
also important factors that help diagnosis of a mass. Symptoms
of ear pain, increased difficulty swallowing, weight loss, or
a history of familial thyroid disorder or of previous skin cancer
(squamous cell carcinoma) may be important as well.
* When found early, most cancers in the head
and neck can be cured with relatively little difficulty. Cure
rates for these cancers are greatly improved if people seek
medical advice as soon as possible. So play it safe. If you
have a lump in your head and neck area, see your otolaryngologist
right away.
What Are Some Areas that Can be Biopsied
In This Fashion?
FNA is generally used for diagnosis in areas
such as the neck lymph nodes or for cysts in the neck. The parotid
gland (the mumps gland), thyroid gland, and other areas inside
the mouth or throat can be aspirated as well. Virtually any
lump or bump that can be felt (palpated) can be biopsied using
the FNA technique.
How Is It Done?
Your doctor will insert a small needle into
the mass. Negative pressure is created in the syringe, and as
a result of this pressure difference between the syringe and
the mass, cellular material can be drawn into the syringe. The
needle is moved in a to and fro fashion, obtaining enough material
to make a diagnosis. This procedure is generally accurate and
frequently prevents the patient from having an open, surgical
biopsy, which is more painful and costly. The procedure generally
does not require anesthesia. It is about as painful as drawing
blood from the arm for laboratory testing (venipuncture). In
fact, the needle used for FNA is smaller than that used for
venipuncture. Although not painless, any discomfort associated
with FNA is usually minimal.
What Are the Complications of This Procedure?
No medical procedure is without risks. Due to
the small size of the needle, the chance of spreading a cancer
or finding cancer in the needle path is very small. Other complications
are rare; the most common is bleeding. If bleeding occurs at
all, it is generally seen as a small bruise. Patients who take
aspirin, Advil®, or blood thinners, such as Coumadin®, are more
at risk to bleed. However, the risk is minimal. Infection is
rarely seen.
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