Thyroid surgery

Changes in the thyroid gland are common and can occur at any age. Around one in three adults develop a thyroid disorder in their lifetime. These can be both hormonal changes, in the sense of an over- or underactive thyroid, as well as structural changes, such as thyroid nodules or the general change in size of the thyroid. Often it’s a mixed form whereby the structural changes in the thyroid gland can also lead to hormonal changes. If a thyroid disorder is suspected, the endocrinologist will usually use a blood sample and ultrasound to determine whether there is a hormonal and/or structural change. Some changes in the thyroid are also further clarified using scintigraphy, a special nuclear medicine imaging process. If there is a pronounced hyperthyroidism, for example in the context of Graves’ disease or thyroid autonomy, and if the hyperfunction persists despite drug or nuclear medicine therapy, surgical therapy is usually necessary. We perform all thyroid surgeries using the smallest possible incision above the cervical fossa. If possible, we also let it disappear in a pre-existing crease in the neck in order to achieve a perfect cosmetic result. By using special, very small instruments, we operate in a particularly tissue-sparing manner.

 

Structural thyroid changes 

The structural changes include thyroid nodules and changes in the size of the thyroid gland. A general increase in the size of the thyroid gland (diffuse goiter) is caused in particular by an iodine deficiency. Nowadays, very pronounced goiters are rarely seen, as iodine is added to food, for example in the form of iodized salt. However, if a pronounced goiter persists despite drug or nuclear medicine therapy, there is usually an indication for surgical therapy.

We diagnose nodular changes, the so-called nodulous goiter, by means of ultrasound examinations. If there is an increase in the number or size of the nodes or if the hormonal activity of the nodes is conspicuous, a further endocrinological or nuclear medicine scan is done first. A surgery may also be necessary here.

During thyroid surgery, part of the thyroid gland or, depending on the findings, the entire thyroid gland is removed through a small access above the cervical fossa. If possible, we also “hide” the access in a pre-existing crease in the neck in order to achieve a cosmetic result to your satisfaction. The use of special, very small instruments enables us to perform particularly tissue-sparing surgeries.

 

Hormonal changes in the thyroid 

Hormonal changes in the thyroid can lead to an overactive thyroid, known as hyperthyroidism, or to underactive thyroid, known as hypothyroidism.

 

Underactive thyroid (hypothyroidism) 

A feeling of physical exhaustion, weight gain and hair loss are typical of an underactive thyroid. The hypofunction can be caused, for example, by an autoimmune disease such as Hashimoto’s thyroiditis. The diagnostic focus here is on endocrinological blood tests and ultrasound examinations. In the case of persistent or relevant hypofunction, drug therapy is required at least temporarily. Surgical therapy is usually not necessary.

 

Overactive thyroid gland (hyperthyroidism) 

If the thyroid is overactive, symptoms such as palpitations, weight loss and restlessness are common. Here, too, there can be symptoms such as hypothyroidism. The hyperfunction is also diagnosed by means of endocrinological blood sampling, sonography and, as a rule, special nuclear medicine imaging, the scintigram. Surgical therapy can be indicated if the symptoms persist despite drug or nuclear medicine therapy. 

 

Operative spectrum in thyroid diseases

  • Complete removal of the thyroid gland (thyroidectomy)
  • Removal of half the thyroid gland (hemithyroidectomy)
  • Removal of an individual or localized change in the thyroid gland (enucleation)
  • Removal of lymph nodes at thyroid cancer
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Dr. med. Nina Picker

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