A goiter is an abnormally enlarged thyroid gland. The treatment of goiter depends on what causes it, what size it is and what other symptoms the patient might have.
Usually, goiters are found during the physical examination. Blood test and ultrasound thyroid scan may be prescribed by your doctor to form a diagnosis. A thyroid ultrasound scan can help determine the size and nature of the goiter.
Next, based on the scan result and prior study of the thyroid function, a Fine Needle Aspiration (FNA) biopsy is performed on the patient, if necessary. An FNA biopsy is especially needed for large sized goiter or suspicious looking goiter to rule out cancer.
The way FNA biopsy is done:
- Generally you will be lying down for this procedure, then the neck area where the goiter is located will be cleaned with antiseptic solution
- Local anesthetic may or may not be injected under the skin to numb the area
- With assistance of ultrasound images to locate the correct site, a very thin needle will be inserted into the goiter (you might feel a sting)
- Substance inside of the goiter will be sucked out, to later be observed and examined. This procedure is usually repeated two or three times until enough sample is obtained
- The needle puncture wound will be compressed and the procedure is over.
FNA biopsy does not require any special preparation, and the patient can return to doing regular activities on the same day. In some cases, a patient is told to come back at a scheduled time to have the thyroid gland checked again in order to make sure there is no regrowth of the goiter. It is actually advised to have your thyroid gland regularly checked when you are over 35 years old, sometimes even earlier if you have a family history or if you experience symptoms of hypothyroidism or hyperthyroidism.
Thyroidectomy is the name of the surgical procedure used to remove all or just part of the thyroid gland. This procedure was once highly frowned upon and even banned by the French medical society, due to its high mortality rates. Thankfully, the ever advancing medical technology makes it no longer the case.
There are various indications but one of the major indications is a diagnosis of thyroid cancer proven by the fine needle aspiration biopsy.
A thyroidectomy is also a viable option for patients with:
- Symptomatic goiters. Patients who have symptoms such as breathing difficulty, swallowing difficulty, shortness of breath, and/or hoarseness
- Very larger goiter
- Rapid enlargement of goiter
- Aesthetic concern
- Refractory Graves’ disease. Graves’ disease is a type of autoimmune thyroid disorder causing the condition of hyperthyroidism.
- If hyperthyroidism is the case, the contraindication is relative due to concerns for during or after surgery thyroid storm which is a rapid rise of thyroid hormone level
- Pregnancy. Although thyroidectomy can be performed during pregnancy for malignancy, it is recommended to postpone the procedure until after the patient gives birth, if possible, to avoid risking the fetus to the anesthesia.
Types of thyroid cancer
- Papillary thyroid cancer (PTC) is the most common type of thyroid cancer, making up to 70-80% of all thyroid cancer cases
- Follicular and Hürthle cell. Follicular or Hürthle cell cancers are more difficult to diagnose on fine needle aspiration (FNA) biopsy compared to PTC and are more likely to spread to the lungs or bones
- Medullary thyroid cancer (MTC) accounts for 3 to 10% of all thyroid cancers and grows from specialized thyroid cells called parafollicular or C-cells that make a hormone called calcitonin.
Treatment for thyroid cancer
A total thyroidectomy which removes the entire thyroid gland is almost always recommended to treat the three types of thyroid cancer above.
Risk factors for thyroid cancer
- Age (between 25 – 65 years old)
- Gender (female)
- Radiation exposure to the head and neck as a child. Cancer may occur as soon as 5 years after exposure.
- Have a history of goiter
- Have a family history of thyroid disease or thyroid cancer, such as familial medullary thyroid cancer (FMTC)
- Certain genetic conditions.
Having a risk factor does not always mean that you will get cancer and not having risk factors does not mean that you will not get cancer. Visit and consult with your doctor if you think you may be at risk.
Depending on the reason why thyroidectomy is performed, the type of thyroidectomy you have will either be:
- Total thyroidectomy, which removes the entire thyroid gland
- Partial thyroidectomy, which removes part of the thyroid gland
Preparation of thyroidectomy
Weeks before surgery, you may already have had the ultrasound thyroid scan and the fine needle aspiration biopsy. For patients with diagnosed thyroid cancer, an ultrasound of the lateral neck compartments must be performed to be evaluated for metastatic disease. Computed tomography (CT scan) of the neck is helpful in patients with significant goiters.
Days before surgery, you may be asked to stop taking certain medicines. On the day of the surgery, you should stop eating and drinking for the instructed time. All patients undergoing thyroidectomy should have their vocal function evaluated and documented prior to the surgery.
Before you undergo the surgery, you will be given general anesthesia to get you unconscious so you won’t be able to feel anything. During surgery, a surgeon will make an incision (cut) in the middle front of your neck so they can see the thyroid gland. The surgeon will then attempt to remove enough gland in order to relieve the symptoms while leaving enough of it to keep on producing thyroid hormone. If this isn’t possible, later you may require hormone therapy after the surgery. Finally, the incision cut in your neck will be closed with sutures/stitches.
A total thyroidectomy may take up to 5 hours and partial thyroidectomy may take up less time than that.
After the surgery, you will be left with a scar and usually with only very little pain.
Make sure you get a proper patient education before discharge. Patient education is important, it will include instructions on how to properly care for the incision wound, as well as information on signs of hypocalcemia (numbness, tingling around the mouth). For incision care, hydrogen peroxide and petroleum jelly are commonly used for applying onto the wound. Should patients develop neck swelling or difficulty breathing, they should go immediately to the nearest emergency room.
- Infection. The rates of infection after thyroidectomy have significantly decreased with improvements in technology and aseptic technique, and are currently estimated between 1-2%
- Nerve damage. The thyroid gland is located very close to laryngeal nerves which control vocal cords and if accidentally damaged during surgery, it will affect your voice and your breathing
- Parathyroid gland damage. Parathyroid gland helps regulate calcium levels in the body. If accidentally damaged, this will cause temporary hypocalcemia which is low-level calcium in your body, resulting in tingling, cramps, numbness (usually around mouth/fingertips) and you will probably need to take calcium and/or vitamin D supplement. Patients who are at increased risk for this complication are those with Graves’ disease or malignancy or those undergoing total thyroidectomy, or total thyroidectomy with central compartment neck dissection
- Neck hematoma. This complication is rare but dangerous. It could lead to asphyxiation and airway compromise
- Thyroid storm. A surge in thyroid hormone level. This can happen during or after the thyroidectomy. Manifestations include rapid heart rate, hyperthermia, irregular heartbeat. If it happens during surgery, the process will be paused and actions will be immediately taken to fix it. It happens after the surgery, patients will be given medications.
- If the goiter is small and doesn’t cause any problems, and the thyroid gland is functioning well, there is no treatment needed. Your doctor may suggest a wait and see approach
- If the goiter is due to Hashimoto’s thyroiditis, a condition where the thyroid gland is attacked by the body immune system, resulting in hypothyroidism, the patient will be given thyroid hormone supplement. This will restore the hormone balance, but it does not usually make the goiter disappear completely. The goiter may get smaller because the thyroid gland can again produce a normal amount of hormone. Levothyroxine is a medication commonly used to treat hypothyroidism.
- If the goiter is due to hyperthyroidism, the treatment will depend on the cause of it. For example, treatment of Graves’ disease with radioactive iodine usually leads to the goiter getting smaller in size or even disappear completely. Radioactive iodine is mainly used to treat goiter caused by the overactive thyroid gland. Radioactive iodine is taken orally, it reaches your thyroid gland through your bloodstream and destroying thyroid cells
- Multinodular goiter. A patient can suffer from multinodular goiter even when they have normal levels of thyroid hormones in the body. If this is the case, then it doesn’t require specific treatment. But when the multinodular goiter gets so large in size that it causes other symptoms such as breathing and/or swallowing difficulty, then it will need to be treated. Radioactive iodine can shrink nodules in the gland that cause problems with breathing or swallowing, but the nodules may come back after treatment. Surgery is the recommended option to go.
- Consume enough iodine rich foods. But bear in mind that it can get tricky with iodine consumption, so please be careful and not consume too much of iodine rich foods
- Eat vitamin B rich foods
- Eat lots of vegetables and fruits
- Eat zinc-rich foods
- Avoid alcohol consumption
- Avoid smoking
- Eat almonds
- Eat selenium rich foods (brazil nuts, sunflower seeds). those are good if the case you suffer from is hypothyroidism
- Consume ginseng
- Eat enough kelp and/or seaweed
- Drink green tea
- Apply flaxseed paste onto the goiter. Simply grind the seeds and mix with water to make a paste
- If you can, just go for gluten free diet
- Rest / sleep enough
- Try and not stress yourself out. Stress plays a disruptive role in hormones producing in the body, and
- In general, try and change for the better lifestyle. Not only the physical state of your body but just as important, the mental state, too.
When it comes to illnesses, sometimes people can get overly distressed before launching right into panic mode as reactions to often inadequately done self-diagnose. Concerning thyroid gland related issues and them causing goiter and/or multinodular goiter, there is a chance of him(self)diagnose. Symptoms such as excessive sweating, fatigue, and weight gain, they are not always pointing to thyroid disease (hypothyroidism or hyperthyroidism).
Sometimes those symptoms occur because we are stressed, not eating properly, not resting enough, or even it could be because we do rigorous exercise with no support of balanced diet. It is best to seek help from professional health care provider to determine whether you indeed are suffering from goiter or another thyroid disease, or not.
We now know that goiter can be treated in many ways, with and without surgery. However, a preventative measure is always wise considering the many complications of the surgical procedure. The case of goiter ends up being a cancer is not very common, but you are encouraged to get it checked especially when the goiter is huge, rapidly growing, and causing other troubling symptoms.