What is Thyroid ? Types, Causes, Symptoms and Treatment

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Overview

Millions of people worldwide suffer from thyroid diseases, such as goiter (goiter), non-cancerous or cancerous thyroid nodules, or hyperthyroidism. Some thyroid diseases can be treated with drugs, but other conditions are best treated with surgery.

What is Thyroid ?

The thyroid is located in front of the neck and in front of the trachea. It is shaped like a butterfly, with a “leaf” on each side, connected by a thin piece of tissue. The nerves that control the vocal cords are just behind the thyroid.

You usually do not see or feel the thyroid gland. But if it gets bigger, it will cause swelling of the neck, called goiter. Other thyroid diseases may not cause obvious goiter.

The thyroid gland produces important hormones called thyroxine and T3. These hormones control your metabolism-in other words, the way your body gets energy from the food you eat. If your thyroid function is not good, your body will consume energy faster or slower than normal.

If your thyroid function is not active enough, it is called hypothyroidism. Hypothyroidism can cause you to gain weight, feel tired, and make it difficult for you to tolerate cold temperatures. If your thyroid function is too active (hyperthyroidism), your thyroid hormones will exceed what your body needs. Hyperthyroidism can cause you to lose weight, increase your heart rate, and make you very sensitive to heat.

What is the reason of Thyroid ?

Goiter can be caused by several conditions. These include:

  • Graves disease-the thyroid gland swells and produces too much thyroxine
  • Thyroiditis (inflammation of the thyroid gland)-there may be multiple causes such as viral infection
  • Iodine deficiency-The thyroid needs iodine to produce hormones. If you lack iodine in your diet, your thyroid will swell in an attempt to produce enough hormones
  • Medications-Certain medications, such as amiodarone, interferon-α, and lithium, can cause goiter
  • Genetic factors-some people have a tendency to have a larger thyroid due to genetic reasons

Thyroid nodules (small bumps in the thyroid) can be caused by:

  • Cyst-a benign (non-cancerous) tumor filled with fluid
  • Adenoma-a solid benign tumor
  • Cancerous tumor (rare)

An overactive thyroid (hyperthyroidism) may be caused by Grave’s disease or thyroid nodules.

The two main causes of hypothyroidism (hypothyroidism) are autoimmunity (white blood cells attack the thyroid and destroy thyroid cells) and the side effects of treating thyroid diseases. Other rare causes include hereditary thyroid deficiency, complications from viral infections, or side effects of certain medications.

Thyroid

What is the symptom of Thyroid ?

If your thyroid produces too many hormones, you may experience some or all of the symptoms of hyperthyroidism (also called thyrotoxicosis):

  • Restlessness, nervousness, emotional agitation, restlessness, poor sleep, and “always on the go”
  • Shaking hands
  • Despite increased appetite, weight loss
  • Palpitations
  • Sweating, don’t like heat, often thirsty
  • Diarrhea or going to the toilet more often than normal
  • Shortness of breath
  • Skin problems such as thinning hair and itching
  • Menstrual changes-usually shorter or longer periods
  • Tiredness and muscle weakness
  • Swelling of the thyroid gland in the neck (goiter)

Risk factors

There are certain factors that increase the risk of thyroid disease. These include:

  • Gender-women are more likely to develop thyroid disease than men
  • Age-middle-aged and elderly people are at increased risk of thyroid disease
  • You or a family member has a history of thyroid disease-for example, if you have thyroid problems during or after pregnancy, or if one of your close relatives has thyroid disease, your risk of developing thyroid disease will increase
  • Smoking-if you are or have been a smoker, your risk of autoimmune thyroid disease is increased
  • Iodine intake-if you do not have enough iodine in your diet, or conversely, if you take iodine or herbal supplements, your risk of thyroid problems increases
  • Certain medications increase the risk of thyroid disease
  • Major stress-Major life events, such as death or divorce, or major physical stress, such as car accidents, may trigger autoimmune thyroid disease

How to diagnosis to thyroid ?

To diagnose thyroid problems, your doctor will need to examine you. The doctor will pay special attention to your thyroid and other areas of the body that may reflect thyroid problems, such as skin, nails, hair, heart, weight, and body temperature. In addition, blood tests will be performed to determine the level of thyroid hormones. You may also need a thyroid imaging test so that the doctor can “see” your thyroid. Finally, if you have a lump on your thyroid, you need to insert a thin needle directly into the lump to remove some cells to check for cancer.

 

What is the treatment options of Thyroid ?

Overview

Many thyroid problems can be treated without surgery. The treatment the doctor chooses depends on your condition. The most common medical treatments and surgeries are described here.

Medical treatement

An overactive thyroid (hyperthyroidism) can be treated with drugs that slow down the production of thyroid hormones. Radioactive iodine or antithyroid drugs can be used to reduce thyroid hormone production. However, both of these treatments can cause hypothyroidism, which also requires treatment.

Hypothyroidism (hypothyroidism) can be treated by supplementing not producing enough hormones. This drug can also be used to treat thyroid cancer or other thyroid diseases.

surgery

In some cases, surgery may be necessary to remove part or all of the thyroid gland. E.g:

  • If a goiter or nodule (growth on the thyroid) is large and compresses your windpipe, or its size causes other symptoms
  • If you cannot tolerate thyroid medications (ie you have serious side effects)
  • If you cannot/do not want to receive radioactive iodine treatment
  • If your thyroid nodule is cancerous, if cancer cannot be ruled out, or despite medication, the nodule continues to grow

There are several different types of thyroid surgery, such as:

  • Biopsy or lumpectomy-remove only a small part of the thyroid
  • Lobectomy-only half of the thyroid gland is removed
  • Subtotal thyroidectomy-only a small amount of thyroid tissue is left on both sides
  • Near total thyroidectomy-only about one gram of thyroid tissue is left on one side after surgery
  • Total thyroidectomy-removal of all thyroid tissue

Undergoing thyroid surgery

Traditional surgery

Overview

Traditional thyroid surgery is a relatively fast operation, requiring only one or two nights of hospitalization. Your medical team (surgeons, anesthesiologists and nurses) will explain to you what to expect.

Thyroid surgery is usually performed through a 2-8 cm incision (incision) in the skin below the neck. The operation is performed under general anesthesia, and the surgeon removes all or part of the thyroid gland. The incision is usually designed in the folds of the neck skin to make it less obvious.

Preoperative

If you have hyperthyroidism (an overactive thyroid), you may need to take (or continue to take) medications to control hormone levels a few weeks before surgery. If your thyroid hormone levels are normal at the time of surgery, surgery is the safest.

Some time before the operation, you may have blood tests, chest X-rays and electrocardiogram (ECG) to make sure you are suitable for the operation. In some hospitals, you may undergo a vocal cord examination before surgery to determine whether its function is normal, and to assess whether it will increase the risk of vocal cord damage during the operation.

If it is determined that you need surgery, you will go to the surgeon and he will explain to you how to perform the surgery. You may only need to remove one lobe of the thyroid (lobectomy), remove almost all of the thyroid (subtotal thyroidectomy/subtotal thyroidectomy), or remove the entire thyroid (total thyroidectomy).

When preparing for the operation, you will be asked not to eat anything after dinner the day before the operation.

If the doctor thinks you may have thyroid cancer and performs surgery, the surgeon may also remove some lymph nodes near the thyroid. The scope of surgery in this case will not be known. The surgeon will need to examine your thyroid and lymph nodes during the operation to determine how much to remove.

The anesthesiologist will also explain to you how to perform anesthesia. In traditional thyroid surgery, you will receive general anesthesia and sleep during the operation.

Postoperative

When you wake up from anesthesia, you may enter a special rehabilitation area where the nurse will monitor closely until you are fully awake. Before you drink again, a small tube inserted into your body will temporarily replenish you with fluid and drain excess fluid from the incision area. These lines will be removed on the same day or the next day of the operation, depending on the scope of the operation and the speed of recovery.

There will be stitches in the incision area of ​​your neck. These will disappear in a few weeks. In the next few days, your neck and throat will feel pain and stiffness. Pain medications will be given during your hospital stay and when you are discharged. The pain will ease and disappear within a few days.

You may notice some changes in your voice, which may occur if there is any damage to the nerves that innervate the sound box (larynx) during the operation. These changes should only last a few days. You can also perform a laryngoscopy on the vocal cords to make sure they are functioning properly.

Your medical team will ask you to get out of bed soon after the operation-possibly the day after the operation. You will receive exercises to help relieve neck stiffness. You will also receive some leg and breathing exercises to ensure normal blood circulation and lung function, and to help prevent any infections or blood clots after surgery.

You can leave the hospital and go home one or two days after the operation.

Minimally invasive surgery

Overview

Minimally invasive thyroid surgery is a relatively quick procedure, and may or may not require a night of hospitalization. Your medical team (surgeons, anesthesiologists and nurses) will explain to you what will happen before, during and after the operation.

For some thyroid diseases, there are new surgical methods that can replace traditional surgery. With minimally invasive surgery, the surgeon can perform the operation through one or two very small incisions. Unlike the above-mentioned traditional surgery, the minimally invasive method only leaves tiny scars.

Preoperative

If you have hyperthyroidism (an overactive thyroid), you may need to take (or continue to take) medications to control hormone levels a few weeks before surgery. If your thyroid hormone levels are normal at the time of surgery, surgery is the safest.

Some time before the operation, you may have blood tests, chest X-rays and electrocardiogram (ECG) to make sure you are suitable for the operation. In some hospitals, you may undergo a vocal cord examination before surgery to determine whether its function is normal, and to assess whether it will increase the risk of vocal cord damage during the operation.

If it is determined that you need surgery, you will see a surgeon who will explain how to perform minimally invasive surgery, including the location of the incision. You may only need to remove one lobe of the thyroid (lobectomy), remove almost all of the thyroid (subtotal thyroidectomy/subtotal thyroidectomy), or remove the entire thyroid (total thyroidectomy).

When preparing for the operation, you will be asked not to eat anything after dinner the day before the operation.

The anesthesiologist will explain to you how to perform anesthesia. You may only need local anesthesia, which means that only the neck area will lose sensation. In this case, you will also receive mild tranquilizers to reduce anxiety. When receiving this type of anesthesia, you will be able to communicate with the surgeon during the operation. If you receive general anesthesia, you will be asleep during the operation.

Postoperative

When you wake up from anesthesia, you may enter a special rehabilitation area where the nurse will monitor closely until you are fully awake. Before you drink again, a small tube inserted into your body will temporarily replenish you with fluid and drain excess fluid from the incision area. These lines will be removed on the same day or the next day of the operation, depending on the scope of the operation and the speed of recovery.

There will be some stitches at your incision. These will disappear in a few weeks. In the next few days, your neck and throat will feel pain and stiffness. Pain medications will be given during your hospital stay and when you are discharged. The pain will ease and disappear within a few days.

You may notice some changes in your voice, which may occur if there is any damage to the nerves that innervate the sound box (larynx) during the operation. You can also perform a laryngoscopy on the vocal cords to make sure they are functioning properly.

Your medical team will ask you to get out of bed soon after the operation-possibly the day after the operation. You will receive exercises to help relieve neck stiffness. You will also receive some leg and breathing exercises to ensure normal blood circulation and lung function, and to help prevent any infections or blood clots after surgery.

You can leave the hospital and go home one or two days after the operation.

Postoperative life

Overview

After thyroid surgery, you need to take some time to recover. However, you should be able to resume normal activities soon. Your medical team will let you exercise and give you some tips to speed up your recovery.

Postoperative recovery

Your recovery will depend on the scope and type of surgery you have received. Traditional open surgery requires longer recovery time than minimally invasive surgery.

After the operation, you may experience:

  • Voice changes, such as hoarseness, difficulty speaking loudly, vocal fatigue, and changes in pitch. These changes are due to damage to the laryngeal nerves that innervate your sound box (larynx) during the operation. This may last a few days or weeks, but it is rarely permanent.
  • Due to parathyroid damage during surgery, you may experience a decrease in blood calcium levels. This is usually only a temporary problem and can be treated with calcium supplements for a few days. The manifestations of your low calcium are numbness and tingling on the lips, hands and soles, itchy skin, muscle twitches and cramps, headache, anxiety and depression.

You will need to take care of the incision area for a few days after surgery. Depending on the type of dressing (covering) on ​​your wound, your doctor may or may not allow you to bathe, shower, or swim until the healing is complete. You may notice bruising or slight swelling around the scar. this is normal. However, if you notice any obvious swelling, you should contact your surgeon immediately, as this may be a sign of infection. The scar may gradually turn pink and harden. It is usually the hardest about three weeks after the operation, and then gradually softens over the next two to three months. You can rub a small amount of non-scented moisturizer around the wound, as this will help soften the skin and prevent dry skin as the wound heals.

Before you return to work and resume other daily activities, you need to rest for at least one to two weeks to recover. No heavy objects should be lifted for about 2 weeks after the operation to avoid any strain on the neck.

After the operation, your neck may swell, feel stiff and numb. This is normal and will gradually relieve as the wound heals. As long as you have no pain or difficulty when turning your head (within about a week), you should be able to resume driving and other daily activities, including non-contact sports. The hospital physiotherapist may recommend some gentle neck and shoulder exercises after the operation. These will help prevent any permanent stiffness. Be sure to follow the instructions of the physical therapist. If you still have pain or stiffness, please contact your doctor.

When your neck feels stiff and painful, you may need to eat soft and easy-to-swallow foods. Make sure to eat slowly, and drink plenty of water during and after eating to soften your food and prevent blockages. Using a blender to handle solid food may help.

After the operation, you will need to visit a doctor or surgeon several times to check hormone levels and wound healing. At the visit, you will be given advice on how long you can return to daily activities.

Daily life

Patients undergoing total thyroidectomy and most patients undergoing subtotal thyroidectomy will need to take thyroid replacement drugs (thyroxine) later in life. If you do not accept this thyroid hormone replacement, people will feel tired, depression, inattention, memory loss, unexplained or excessive weight gain, dry skin, rough skin and/or itching, dry hair, hair loss, feeling Cold (especially feet and hands), constipation, muscle cramps, joint pain, increased menstrual flow, decreased libido, and more frequent menstrual periods. Hormone replacement pills are small and easy to take orally. The doctor will check your hormone levels regularly and adjust the dose of thyroxine to a level suitable for you.

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