Thyroid anatomy and functions
The thyroid gland weighs approximately 20-30 grams and consists of two lobes. It is a butterfly-shaped gland. It is located just in front of the trachea and partially surrounds the trachea. 70-80% has another small lobe called pyramidal lobe. The pyramidal lobe (thin and long thyroid tissue located in the midline) originates mostly from the left lobe.
When viewed from the front, it is in the region just below the cartilaginous protrusion (Adam's apple) located under the chin in the neck and seen more clearly in men. is available. It moves by swallowing. The thyroid gland is extremely important for life. It is the place where thyroid hormones, which have an important role in providing the energy of all cells, are secreted. The thyroid gland accumulates iodine in order to perform this function. It produces T3 and T4 hormones using iodine. The production of T3 and T4 hormones is provided and regulated by the hormone called TSH secreted from the brain. Thyroid hormones take part in the activities of cells. It is effective in providing energy to cells. It also has important functions in the maintenance of cell development and survival. Its effect is seen in all tissues. It is necessary for growth, development and continuation of life.
What is goiter?
The enlargement of the thyroid gland located in the middle of the neck is called goiter. Enlargement of the entire (thyroid) gland or swelling in only a part of the gland can be called goiter.
Where is the thyroid gland located in the body?
The thyroid gland is in the middle of the neck. It is a butterfly-shaped organ consisting of two eyes, the right and left lobes, located in front of the windpipe (trachea). In normal cases, the thyroid gland is not visible and can only be seen in case of enlargement of the thyroid gland, that is, goiter.
What is the function of the thyroid gland?
The function of the thyroid gland is; It produces thyroid hormones called thyroxine (T4) and tri-iodothyronine (T3). Thyroid hormones regulate the body's basal metabolism, that is, its energy, mobility, strength and power. Many cells in the body need thyroxine (T4) and tri-iodothyronine (T3) hormones to maintain their normal functions.
Hyperthyroi. What causes di (overactive thyroid gland)?
Basedow-Graves disease Thyroid nodules: It is rarely the cause of hyperthyroidism. Due to some medications. : Amiodarone and lithium may be the cause of hyperthyroidism. What is Basedow-Graves disease?
It is an autoimmune, that is, hereditary disease. Normally external diseases occur. In Basedow-Graves disease, the antibodies that are supposed to protect the body against factors cause the immune system to be triggered for an unknown reason, causing the release of large amounts of thyroxine (T4) from the thyroid gland. In half of the Basedow-Graves cases, the eyes are damaged. is affected and thrusts forward (proptosis). Double vision may be a problem due to problems developing in the eye muscles. What is the characteristic of hypothyroidism (underactivity of the thyroid gland)? It is often seen in older ages. It is more common in women. It may be due to iodine deficiency in the diet. Autoimmune hypothyroidism; It is one of the most common causes of hypothyroidism. What is autoimmune hypothyroidism?
Antibodies, which normally protect the body against external factors, cause thyroid cells to destroy themselves in the case of autoimmune hypothyroidism.
It is one of the most common causes of hypothyroidism. The most common type is called Hashimoto's thyroiditis. If there is no goiter, it is called atrophic thyroiditis or primary myxedema. Autoimmune (hereditary) hypothyroidism is more common in people with diabetes, vitiligo and Addison's disease. Are there types of goiter? Yes, there is.
Simple goiter (goiter):Nodular or diffuse goiter with normal hormone levels Nodular goiter :Goiter containing single or multiple nodules (lump, mass), these are divided into three groups as hot, warm and cold. What are the characteristics of simple or diffuse goiter? strong>
When examined manually, the thyroid gland feels soft but enlarged. Basedow-Graves disease: It is an autoimmune or hereditary thyroid disease. It causes enlargement of the thyroid gland and the release of excess thyroxine (T4). Thyroiditis:Due to many reasons. Swelling of the thyroid gland due to diseases (virus infections, etc.). Iodine deficiency: It occurs when thyroxine (T4) and tri-iodothyronine (T3) are inadequately taken from the diet. Drugs:Some medications, such as lithium, cause swelling in the thyroid gland. Hereditary:Some people may have hereditary swelling of the thyroid gland at certain periods of life. What are the types of nodular goiter?
Nodules are frequently seen in the 30-50 age group.
Multinodular goiter (multinodular goiter – goiter):Many nodules are found on the thyroid gland. These thyroid nodules look like the lumps on the potatoes you buy from the market.
Single nodule goiter (solitary nodule):Single thyroid nodules: cyst, adenoma (benign tumor) > or they occur due to cancer.
Are thyroid nodules risky?
Thyroid nodules are seen in approximately 10-30% of the population. The risk of cancer in thyroid nodules is generally accepted as 10%. Colloid or follicular type thyroid nodules do not carry a risk of cancer. If the nodules secrete hormones, they are called 'autonomous nodules' and cause hyperthyroidism. If fluid or blood is found inside the nodules, they are called 'cystic nodules'. What are the symptoms of goiter?
Swelling in the neck Most of the cases are painless, it may be painful only in case of thyroiditis, that is, inflammation of the thyroid gland. Shortness of breath:towards the windpipe (trachea) Shortness of breath develops due to the pressure of the enlarged goiter (goiter). Difficult in swallowing: It enters the esophagus (esophagus) >It develops due to the pressure of the overgrown goiter. What are the symptoms of hyperthyroidism (overactive thyroid gland)?
Increased moisture in the skin, sweating in the hands Weight loss Tremor in the hands (tremor) Increased pulse rate Insomnia Intolerance to heat Palpitations Irritability Thinning and loss of hair Menstrual irregularities Difficulty getting pregnant Diarrhea Muscle weakness Feeling of fatigue Eyes protruding outward (especially in Basedow-Graves disease) What are the symptoms of hypothyroidism (underactive thyroid gland)?
Weakness Dry skin Difficulty in concentration and memory Breaking of nails Coarse hair Depression Coarse voice Menstrual irregularities Intolerance to cold Change in facial expression Slowness and weakness in movements Weight gain Constipation Difficulty getting pregnant Decrease in pulse rate How are thyroid nodules diagnosed?
Examination: Some nodules are palpable during examination. Blood tests: Especially thyroxine (T4) and thyroid stimulating hormone (TSH) levels are investigated. Ultrasonography Scintigraphy: Cold nodulel (does not retain the radioactive substance, FNAB (Fine Needle Aspiration Biopsy)is required due to cancer risk, hot nodulel (does not retain the radioactive substance) It retains more than a normal cell, the risk of cancer is very low, FNAB is not required), functional nodule (it retains the radioactive substance as much as a normal thyroid cell, the risk of cancer is low, FNAB is required), Needle aspiration biopsy (FNAB): A biopsy is taken from the nodule directly or with a needle using ultrasonography and sent for pathology analysis. How are the results of thyroid needle aspiration biopsy (NAB) evaluated?
Benign (benign) cells: 50-60% are determined as benign or benign.
Malignant (malignant) cells are determined as cancer in 5% of the cases.
Suspicious cells: Suspicious or benign in 10% of the cases. It is found indefinitely, that is, it remains in the middle.
Insufficient cells: In 20% of cases, the cells taken are found to be insufficient. This situation is especially seen in the presence of cysts. In such cases, tissue may need to be removed surgically.
What is the approach to nodules?
It is often not noticeable from the outside. The definitive decision is ultrasonography. It is given by. In determining the presence of nodule, scintigraphy, ultrasound It is not as effective as grapheme. (Thyroid scintigraphy is not sufficient, especially in nodules that are warm and less than 1 cm in size) Since nodules with solid content are rich in cells, they should be examined carefully for cancer. The nodule should be examined carefully for cancer. Its function is most accurately evaluated by scintigraphy. The most effective approach for large and solid nodules is to perform a needle biopsy under ultrasonography. To investigate the effect of the thyroid nodule on the hormone level, FT3, Ft4 and TSH hormones are detected in the blood. It must be measured by blood test. How is goiter treated?
Goiter, which does not carry a risk of cancer and has normal hormone levels. In cases of iodine deficiency, no treatment is required. In case of iodine deficiency in the diet, iodine treatment is required. If the thyroid hormone level is low or high, drug treatment is required. In some cases of advanced hyperthyroidism. Some medications containing thyroxine (T4) (in tablet or pill form) or radioactive iodine treatment may be required. In some cases, surgery is required. When is surgery required in the treatment of goiter?
Having pressure symptoms such as difficulty in swallowing and hoarseness due to goiter (functions of the vocal cords should be investigated before surgery) p>
Detection of cancer in one of the nodules Suspicion of cancer in the nodules (in case of follicular neoplasm) A gradual increase in the diameter of the nodule Multinodular (multinodular) ) hyperthyroidism in case of goiter Creating cosmetic defects What is the technique of goiter surgery?
Three main techniques are applied.
Lobectomy:It is the removal of only one lobe of the thyroid gland. This technique is preferred in unilateral large nodules. Near-total thyroidectomy:It is the removal of almost the entire thyroid gland and leaving a small part behind. It is preferred in cases of multi-nodular goiter (multinodular goiter). Total thyroidectomy:It is the removal of the entire thyroid gland. Preferred in cases of cancer, suspicion of cancer and sometimes multi-nodular goiter (multinodular goiter) Read: 0
