The thyroid gland is a very small but all the more important organ. Thyroid function disorders lead to many secondary diseases and should be treated in any case. You can read about how different thyroid diseases manifest themselves and how they can be treated in the detailed article, watch the video or follow along with the PowerPoint presentation. Click here to go directly to the topic.
Recognise and treat thyroid diseases
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Overall, thyroid disease affects about six percent of the total population. Hypothyroidism, hyperthyroidism, a benign or malignant growth of the thyroid gland are forms of thyroid disease that can all be treated well. As the thyroid gland is a small but very important organ, professional advice and help should always be sought if thyroid disease is suspected. In a detailed article, Swiss1Chirurgie shows how thyroid diseases are to be assessed and how they can be treated. Read the detailed technical article on thyroid diseases and treatment options here.
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The thyroid gland – a small organ with a big impact
The thyroid gland is a relatively small organ located below the larynx in the throat. Despite its small size, the organ and its thyroid hormones have a very far-reaching effect on almost all organs in our body. If the thyroid gland functions normally, we don’t notice anything about it in principle. Only when disorders of the thyroid gland are present do we become aware of their importance. Known forms of thyroid disease are, for example, hypothyroidism and hyperthyroidism.
Anita Scheiwiller, MD, deals with the function and disorders of the thyroid gland. Among other things, it shows in interesting series of lectures how to evaluate the normal function of the thyroid gland, which disorders and diseases can occur and how they can be treated.
Anita Scheiwiller, MD, is a practising visceral surgeon in the Swiss1Chirurgie clinic in Bern, where she is very committed to working in the specialist areas of intestinal and rectal disorders, obesity surgery and thyroid disorders. With 20 years of professional experience as a surgeon, Anita Scheiwiller, MD, advises and treats her patients with great empathy, experience and professional competence.
The thyroid gland – position and shape
The thyroid gland is a very small organ that is not normally visible from the outside. Embedded in structures of the neck, the thyroid gland lies directly on the trachea below the larynx. The spatial proximity to the vocal cord nerve and the carotid artery as well as to the parathyroid glands is also interesting here. This circumstance is also particularly important when surgical interventions in the area of the thyroid gland become necessary. Here it is important to work very precisely, accurately and carefully to avoid injury, especially to the vocal cord nerve or the parathyroid glands. Because of its shape, the thyroid gland is often called the butterfly organ.
The function of the thyroid gland
As the title of this article suggests, the thyroid gland is a very small organ that nevertheless has a big impact. The thyroid gland continuously produces hormones that are referred to in medical parlance as T3 (triiodothyronine) and T4 (tetraiodothyronine). In order for this hormone release to function, the thyroid gland is stimulated by a precursor hormone from the pituitary gland. This results in a control loop from the pituitary gland to the thyroid gland. This means that disorders in the function of the pituitary gland can also lead to disorders in the function of the thyroid gland.
It is important to know that iodine, among other things, is necessary for the production of thyroid hormones. Without an adequate supply of iodine, thyroid function will also be disturbed.
What effects do thyroid hormones have on the organism?
The thyroid hormones have clear effects on almost all organs of the human body. Colloquially, we rate the thyroid hormones as the “accelerator pedal of the body”, which make essential functions of other organs possible in the first place. For example, the metabolism as a whole can be accelerated but also slowed down. Thyroid hormones also have a significant effect on the activity of the heart. In addition, these hormones affect blood pressure, energy and fat metabolism and thus also body weight, bone metabolism and even brain function. The effects of the thyroid hormones extend to the function of the muscles. These facts alone show how important the well-functioning thyroid gland is for human health.
Thyroid hormone production disorders
If too few hormones are produced and secreted by the thyroid gland, then we are talking about an underactive thyroid gland. An underactive thyroid gland has a wide range of effects on well-being and health. The most common symptoms are tiredness, fatigue and weight gain. More rarely, enlargement of the thyroid gland is observed, which can occur in connection with hypothyroidism.
We observe hypothyroidism as a very common condition. After all, about five percent of the total population suffer from hypothyroidism. That is a lot, especially since many of those affected do not notice anything directly at first. Even the patients who show corresponding symptoms cannot classify them correctly in the first step. Accordingly, many affected people do not even think that a disturbed function of the thyroid gland could be the cause of the individual complaints and symptoms.
The causes of hypothyroidism are often infections of the thyroid gland or the consequences of surgical procedures, such as thyroidectomy. Hypothyroidism can also be observed as a result of certain therapies or in connection with taking various medications.
What very often played a role in earlier times, but only marginally today, is iodine deficiency. Images of huge goiters, medically known as goiters, are well known. This was very common in iodine deficient areas, often in mountain valleys. Due to the enrichment of various foodstuffs with iodine, this problem is hardly seen today. Just think of the well-known iodised salt.
For the treatment of hypothyroidism, the focus is on relatively easy-to-use options. Thus, missing or insufficiently produced thyroid hormones can simply be replaced by corresponding preparations in tablet form. These medicines are quite easy to adjust and well tolerated. Checking the correct setting can be done at the GP.
If enlargement of the thyroid is diagnosed at the same time as hypothyroidism, surgery is advisable. This usually involves removing the entire thyroid gland. For the operation itself, read the special section.
The opposite of hypothyroidism is known as hyperthyroidism. In this case, the thyroid gland produces excessive amounts of hormones. This also has a noticeable impact on the entire body, as these hormones affect so many functions.
The symptoms are opposite to those of hypothyroidism. Weight loss, abnormal nervousness, sweating, undifferentiated trembling, rapid heartbeat and other unpleasant symptoms can be observed. Often the so-called “googly eyes” can be seen, which are typical for a special form of hyperthyroidism.
Hyperthyroidism is also often accompanied by enlargement of the thyroid gland. Overall, we observe hyperthyroidism somewhat less frequently than hypothyroidism. Nevertheless, over one percent of the total population is affected by hyperthyroidism. We often see younger patients in the process. Women are affected five times more often.
The treatment of hyperthyroidism proves to be somewhat more difficult than that of hypothyroidism. There are medicines that can suppress excessive hormone production. However, these drugs are not so well suited for long-term therapy. Both side effects and the diminishing effect of the medication must be taken into account.
Another solution, which is often used, is surgery to remove the entire thyroid gland. Destruction of the thyroid gland from within can also be used. Radioactive iodine is used, which is stored in the thyroid gland and destroys the cells there.
Other thyroid diseases
In addition to hypothyroidism and hyperthyroidism, we also know other diseases of the thyroid gland. This includes, for example, an enlarged thyroid gland that nevertheless shows normal hormone production. Iodine deficiency may be the cause of benign enlargement of the thyroid gland (goiter). Other underlying diseases or side effects of certain medicines are also possible.
If there is no danger of cancer, for example, in the case of an enlarged thyroid gland, it is possible to wait and observe at first. If the thyroid gland continues to grow, surgery should be performed. In some cases, the growth is only unilateral, so that only one side needs to be operated on. If both sides are affected, the entire organ is removed. It is also possible to destroy the thyroid gland from the inside. However, this radioiodine therapy is only used relatively rarely for benign enlargements.
When the thyroid gland reaches a certain size, it can also cause mechanical damage to the affected area. Often the oesophagus or trachea are then pushed to the side and compressed, leading to corresponding symptoms such as shortness of breath, difficulty swallowing. voice changes and sleep apnoea. Often there is both a visual and functional disturbance, which is distressing for the patient. Surgery is always the treatment of choice for mechanical impairments.
Surgery is always indicated for malignant thyroid enlargements associated with the rather rare thyroid cancer. Overall, thyroid cancer has a much better prognosis compared to other cancers.
Examinations of the thyroid gland
One method of examining the function of the thyroid gland is the laboratory chemical assessment of hormone production. In imaging diagnostics, ultrasound examination has proven its worth. In the simple, painless examination without radiation exposure, pathological processes in the area of the thyroid gland can be easily detected.
Further examinations are possible depending on the clinical picture. Scintigraphy can be used in cases of hypothyroidism or hyperthyroidism. The function of the thyroid gland is assessed and proven. Sometimes tissue examinations are also necessary to classify whether the process is benign or malignant. This involves puncturing the organ with a fine needle and removing a small amount of thyroid tissue. This can then be examined more closely under the microscope.
Molecular and genetic tests are also used today, although rarely, to confirm or classify a finding.
The operation of the thyroid gland
The first step in thyroid surgery is always a four to five centimetre incision in the lower neck, made transversely. Through the resulting opening, the neck muscles can first be pushed to the side. This clears the way directly to the thyroid gland. Depending on whether the operation is unilateral or bilateral, the surgical procedure takes two to three hours.
After the procedure, patients stay in hospital for about two to three days. The healing and recovery process is generally very fast.
As with any operation, complications are possible but very rare. The vocal cord nerve, for example, which is located in the direct vicinity of the thyroid gland, is at risk. The consequences of an injury to the vocal cord nerve would be hoarseness, voice changes or shortness of breath. Secondary bleeding is also possible. Monitoring in the recovery room during the first hours is therefore necessary. It is also important to protect the parathyroid glands, which are located next to the thyroid gland. These also produce hormones and should not be injured or removed.
What remains visible after the operation is a fine scar on the neck, but this usually heals very well and is hardly noticeable after some time.
If the thyroid gland is completely removed, the missing hormone production must be replaced. Thyroid hormones are administered as medication for this. In most cases, patients go home well adjusted and only need to have their hormones checked by their family doctor or metabolic specialist every few months.
Overall, we observe thyroid diseases quite frequently, even if they are not always recognised immediately. Here, it is important to have a good diagnosis by the general practitioners, who should always refer possibly affected patients to a specialist for thyroid diseases. Hypothyroidism, hyperthyroidism or a benign or malignant thyroid growth can then be diagnosed.
If the thyroid gland has to be removed, hormone replacement is very simple. In this way, full organic and physical performance can be restored. The surgical procedure can be assessed as safe and with few complications.
You can experience the whole article here as a video recording of a lecture by Dr. med. Anita Scheiwiller or watch a supporting presentation.