Broadly Thyroid diseases can be divided as
- Endocrine abnormality hyper or hypo
- Nodules in thyroid- benign or malignant
- Infection or inflammation
How to test for thyroid disease
- for endocrine abnormality – blood test of thyroid function is enough
- For knowing about nodules Ultrasound scan along with FNAC needed
- for thyroiditis – both blood tests and scan important
What are the warnings in thyroid disease
- Hypothyroidism – Tiredness, slow heart rate, Weight gain, Irregular periods, Increase sensitivity to cold, Dry skin, Puffy face
- Hyperthyroidism – Anxiety, Fine tremor, Weight loss, Protruding eyes, palpitation, irregular heart rate
- Thyroid nodule – feeling of nodule in neck detected accidentally as it was seen outside. Change in voice is a bad sign
- Thyroiditis – features of hypo of Hyperthyroidism, may have pain in neck.
Does all thyroid diseases need surgery?
Thyroidectomy is done when there is high suspicion of cancer or when its large enough to compress on air passage and food passage. In Hyperthyroidism, subtotal thyroidectomy removes need of medicines
Types of thyroid surgery
- total thyroidectomy- complete removal high suspicion of cancer
- subtotal thyroidectomy- in Hyperthyroidism to reduce the hormone production
- Hemithyroidectomy- removal of half of thyroid -nodule only in 1 lobe and is suspicious. Hemithyroidectomy can be done as daycare surgery
Is there an option for keyhole thyroid surgery?
Endoscopic Thyroidectomy can be done via armpit or through mouth. Large size and confirmed cancer are not good candite. Robotic Thyroidectomy via intra oral approach and trans axillary are being done.
Advice to patients on Thyroid replacement medicines
Take it daily or regularly take it in empty stomach min half hour before coffee or tea. If missed a dose take it on next day as twice the dose, if there is a dose change and you are keeping with dose change check TSH at 6 weeks and review. If you stopped medicine by self or on advice check TSH after 6 weeks. All women in child bearing age need to have TSH between o.5 and 3mIU/L