The thyroid gland is a bow tie shaped gland that wraps around the windpipe. It produces the hormone thyroxine, which is essential for metabolism and crucial to many of the body’s functions.
Thyroid nodules are much more common in women. Don’t worry too much please if you discover one, as most of these lumps end up being benign and, on the whole, don’t require any further treatment.
I will perform a comprehensive head and neck clinical examination. This includes passing a small endoscope with a high definition camera through your nose to examine your voice box. This is to ensure the vocal cords are working and importantly remain in working order after any thyroid surgery.
I am likely to arrange some blood tests; these will include thyroid function, bone (including calcium) and vitamin D profiles as well as thyroid autoantibodies. Special cancer-specific blood tests may also be requested if there is a strong family history or suspicion of a familial type of thyroid cancer.
An ultrasound scan of the neck is the key to diagnosis. This can often be performed at the same clinic visit, to provide a “one stop” diagnosis. For example, if you visit me at One Welbeck on a Thursday afternoon; an experienced head and neck radiologist is usually present in the room across the corridor performing a neck ultrasound list. If the radiologist is suspicious about cancer, a biopsy specimen using an ultrasound guided needle will be taken.
If I’m worried about a cancer in your thyroid gland, I may arrange a CT scan of the neck and chest which will provide additional information about cancer entry into the voice box or windpipe, demonstrate metastatic lymph nodes or demonstrate if a thyroid gland has enlarged so much that it has dived behind the breastbone (retrosternal goitre).
Sometimes we need to look at whether any nodules are over or under producing thyroid hormone and a radioactive iodine labelled scan will be helpful to determine this.
If the thyroid gland is either over producing or under producing thyroid hormone then specialist medical treatment may be required to reset the balance. This will usually be supervised by an endocrinologist. Occasionally, surgery may be required for resistant cases of an overactive thyroid.
I am likely to recommend surgery for a benign thyroid gland enlargement or large nodules that cause “compressive” symptoms such as restricted breathing, particularly when lying down or swallowing difficulties. You may require half or the whole of your thyroid gland to be removed, depending on the location of the enlargement.
Occasionally for smaller nodules, a less invasive radiofrequency ablation technique can vaporise them. This can be performed without general anaesthesia in the clinic by one of my radiology colleagues.
If the ultrasound scan and needle biopsy are not conclusive and there remains doubt about whether a nodule is benign or malignant, I may recommend performing a diagnostic hemithyroidectomy (removal of half of the thyroid gland).
Less than 5% of thyroid nodules turn out to be cancerous. Most cancers are histologically “papillary” thyroid cancer.
Most cases of papillary thyroid cancer are reassuringly slow growing and have an excellent prognosis if treated early.
Some very small solitary cancers can even be left alone and closely followed up with interval ultrasound. Larger ones, or if there appears to be more than one cancer nodule in the thyroid gland, usually need either a hemithyroidectomy or a total thyroidectomy.
Your cancer will be discussed in a thyroid cancer multidisciplinary team meeting and treatment will be individualized to your particular needs.
For larger, advanced or aggressive cancers you are likely to require additional radioactive iodine or external beam radiotherapy to complete the treatment.
I have a high volume thyroid surgical practice and am experienced in the surgical management of advanced thyroid cancers and large retrosternal goitres. When it is deemed necessary, because I regularly perform other types of advanced head and neck cancer surgery, I am also highly trained and skilled in performing lymph node clearances with preservation of important nerves and major vessels in the neck.
I routinely use a nerve monitor and loupe magnification during all my operations. I aim to identify and preserve all the nerves to your voice box (the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve on each side). It is also vitally important to preserve the small parathyroid glands that are intimately related to the under surface of the thyroid gland; these help to regulate the calcium levels in your body.