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Thyroid

 

Function

The thyroid is responsible for the production, storage, and the release of thyroid hormones. Its activities are directed by the interbrain and pituitary gland. When the level of thyroid hormones in the blood is too low, the thyroid is stimulated by hormonal signals to release more thyroid hormones into the blood. Thyroid cells produce two different types of hormones: triiodinethyronine (T3) and tetraiodinethyronine (T4), which are responsible for the regulation of many cells in the human body. An absence of these two hormones is incompatible with life. An undersupply of thyroid hormones causes a slow down of energy levels and metabolism. An oversupply of thyroid hormones in the blood causes hyperthyroidism.

 

Location

The thyroid is located under the larynx and has the shape of a butterfly. Its lobes wrap around the front of the trachea. A woman's thyroid weighs about 18 grams and that of a man about 25 grams.

 

The thyroid consists of specialized thyroid cells which lie together in the form of many very tiny bubbles (follicles). The recurrent laryngeal nerves which innervate the internal larynx muscles and are responsible for voice function, run on both sides behind the thyroid lobes. These nerves must not be injured during thyroid operations. The four parathyroid glands are found behind the thyroid and are responsible for the calcium metabolism.

 

Diseases of the thyroid

Surgery should be considered in the following diseases of the thyroid:

  • A distinct enlargement of the thyroid including nodules
  • Thyroid hyperactivity
  • Thyroid tumors

 

When is an operation indicated?

The following thyroid functional disorders and diseases should be treated surgically:

  • A distinct enlargement of the thyroid with nodules, which cannot be sufficiently treated with medications.
  • Hyperactivity of the thyroid which cannot be sufficiently suppressed with medications or which reoccurs after discontinuation of medications (recommended length of therapy with medications is 12 months).
  • Changes in the thyroid with formation of nudules, which are suspected to be malignant tumors (thyroid carcinoma).

 

Surgery

Thyroid surgery is always done under a general anaesthetic. Access to the thyroid is achieved through a 6-8 cm horizontal incision 2 cm above the collar bone. There is a very low rate of complications at centres specialized in thyroid surgery. Our hospital uses a so called neuromonitoring, which permits routine images of the vocal cord nerves and their functions.

 

The degree of the operation depends on the disease being treated. If both sides of the thyroid are affected with lumps, the lobe most affected is usually removed. (hemithyroidectomy) and the other lobe is reduced to 1-2 cm3 (subtotal resection).
If the changes in the thyroid are very extensive, or if a malignant tumour has been diagnosed, the entire thyroid is removed. In order to rule a malignant tumor out, a pathologist performs a quick examination of tissue and gets the first test results to the surgeon during the operation. If these results show that it is a malignant tumor, the surrounding lymph vessels and nodes are also removed as well as the entire thyroid.

 

You will normally be admitted on the day before surgery. On the same day of surgery you may eat and drink. You will generally be release 2-3 days following surgery.

 

Complications

Even in specialized centers with very precise surgical techniques, there are rare cases which suffer complications following thyroid surgery.

 

  • Paresis of the recurrent laryngeal nerves

Damage to just one side of the recurrent laryngeal nerves results in hoarseness. Damage to both sides results in toneless voice and difficulties with swallowing. The reason for the loss of function of the recurrent laryngeal nerves is rarely, due to a cutting of the nerves but due to a functional disorder from pressure or stretching.

 

  • Functional disorders of the parathyroid glands

The parathyroid glands are four 2-3 mm organs located in the area of the back of the thyroid capsule. They produce parathyroid hormone (PTH) which regulates calcium levels. In operations where the entire thyroid has been removed ( = total thyroidectomy) too low calcium levels in the blood may result from resection or damage to the parathyroid glands. The resulting muscle cramps (caused by a lack of calcium) are treated with calcium pills.

 

  • Postoperative Bleeding

The thyroid gland has an excellent blood supply. Today, thanks to the very precise surgical techniques including imaging and control of even the smallest vessels, postoperative bleeding is a very rare occurrence.

 

Aftercare

For the first few hours after surgery, your cardiovascular parameters will be monitored, bandages and drainage tube are checked. On the day after surgery, the drainage tube is removed, on the second day after surgery an ear-nose-throat examination is done to check the recurrent laryngeal nerves, and on the third or fourth day after surgery the stitches will be removed.

Before being released you will have a final appointment with the doctor to discuss the results of the pathological examination in order to plan future treatment. Any further care is done by your family doctor or Endocrinologist. To avoid future nodules in the remaining part of the thyroid, thyroid hormone must be taken daily. Whether iodine supplementation will be recommended depends on the size of the remaining part of the thyroid.

 

Important research projects concerning endocrine surgery

  • Detection of disseminated tumour cells in the blood of patients with papillary, follicular, and medullary thyroid carcinoma with RT-PCR systems.
  • Detection of disseminated tumour cells in patients with medullary thyroid carcinoma by semiquantitative PCR systems.
  • Examination of disseminated tumor cells in bone marrow samples from patients with differentiated, anaplastic, and medullary thyroid carcinomas by immunohistochemistry.
  • Clinical evaluation of results of surgical therapies in differentiated and medullary thyroid carcinomas.
  • Participation in multicenter studies concerning the genotype-phenotype-correlation in hereditary medullary thyroid carcinomas

 

Consultation

Consultation for endocrine surgery is once a week on Wednesdays at the Department of Surgery, University of Heidelberg from 13:00-15:30. The consultations are done in cooperation with an endocrine surgeon and an endocrinologist.

 

To make an appointment, please call in advance. Contact person is Mrs. Carolin Galm (Tel: 06221-56-36217)

 

Should you have further questions or prefer e-mail contact it would be our pleasure to answer these: (carolin.galm@med.uni-heidelberg.de).