What is Goiter?
It is the uncontrolled growth of cells, follicles and the gland itself in the thyroid gland. Iodine deficiency is blamed for its development. There are usually many large cystic nodules within the gland, and this condition is called multinodular goiter. It is followed by specialist doctors experienced in thyroid diseases. However, when the goiter reaches a certain size, rapid growth of nodules or signs of cancer are detected, or puts pressure on the esophagus or trachea, surgery may be required. In this case, a surgeon with experience in thyroid surgery should be consulted. What is a Thyroid Nodule?
It is very common to have a nodule in the thyroid gland, especially in young women. Not every nodule means cancer. The risk of cancer is very low, especially in completely cystic (fluid-filled) nodules. When ultrasound shows suspicious images such as increased blood flow in the nodules, border irregularity, and punctate calcification, there may be a risk of cancer in these nodules. In addition, the risk of thyroid cancer is higher than normal in some situations, such as a family history of thyroid cancer, a nodule in a patient over 55 years of age, or exposure to radiation. Ultrasound-guided needle aspiration (a type of cell biopsy) is highly recommended in these patients.
What is Thyroid Cancer?
Thyroid cancers, which occur as a result of the cells in the thyroid gland turning into cancer, are usually seen as a nodule in the thyroid gland or as a mass in the neck. Thyroid nodules are common in young and middle-aged women, and not every thyroid nodule is cancer. There is a possibility of cancer in nodules that do not secrete hormones, called cold thyroid nodules. For this reason, patients with thyroid nodules should be followed meticulously, and if necessary, a thyroid biopsy should be performed with a thin needle for suspicious nodules. The purpose of needle aspiration (a type of cell biopsy), which we prefer to perform with ultrasonography in modern clinics, is to determine whether there is cancer in the thyroid nodule.
What are the Symptoms of Thyroid Disease?
Goiter; It can be noticed by symptoms such as swelling in the neck, tightness in the throat, difficulty in swallowing, difficulty in breathing, hoarseness, fatigue, involuntary weight gain or inability to lose weight, irritability, thinning or loss of hair and dry skin.
Hormone levels of the thyroid gland. Deterioration in perception primarily affects metabolism and thus negatively affects all organ systems.
Goiter and Thyroid Cancer Diagnosis Methods
For diagnosis, T3, T4, TSH hormone levels are measured in the blood and thyroid scintigraphy tests are performed. can be done. Diagnosis and treatment of thyroid diseases often requires team work. In addition to the examination, there may be a need for cell removal by fine needle aspiration, depending on the findings in the ultrasonographic follow-up and follow-up, which is usually done by radiologists.
If the result of the 'fine needle aspiration biopsy' is suspicious or if thyroid cancer is diagnosed, surgery will be required for patients. There must be a thyroid surgeon in the team for the surgery.
Treatment Methods According to Thyroid Cancer Types
Treatment success is quite high when the correct treatment is applied in common types of thyroid cancer. In thyroid surgery, either half or the entire thyroid gland is removed.
There are four main types of cancer in the thyroid gland.
1.Papillary Type:80 percent of thyroid cancers are papillary type. This type of cancer usually occurs in young to middle-aged women. Again, the most common type of thyroid cancer in children is papillary cancer. It is sometimes found incidentally in cases where the thyroid gland has been surgically removed due to goiter or hyperthyroidism. With check-up examinations and screening ultrasonography, which have become widespread in our country in recent years, the detection rates of thyroid nodules and cancer have increased.
Treatment: Surgical: usually the thyroid gland is completely removed (total thyroidectomy). Sometimes there is spread to the lymph nodes just below the thyroid gland. In this case, central neck dissection surgery is performed to clean these glands. Sometimes, in addition, there is spread to the lymph nodes around the carotid artery on the side of the neck, in which case modified radical or functional neck dissection surgery, which is a more comprehensive surgery in which these glands are cleaned, is performed.
In addition, Radioactive iodine treatment may be required.
After the surgery, patients are monitored with TSH and Thyroglobulin measurements and whether the patient needs extra hormones, whether there is any tumor tissue left behind or not. Predict whether the tumor comes back or not It can be killed
2. Follicular Type: Patients in this group are women between the ages of 40 and 60, who account for approximately 10 percent of all thyroid cancers. The most important feature of follicular cancer is that it is the most difficult to diagnose type of thyroid cancer. It is almost impossible to determine whether the lesion is a follicular cancer, both in the preoperative fine needle biopsy and in the frozen section examination during the surgery. The definitive diagnosis is made by examining the surgically removed thyroid gland.
Treatment: Treatments, as in the papillary type, are total thyroidectomy and often postoperative radioactive iodine treatment.
3. Medullary Type:It constitutes 5 percent of thyroid cancers. While familial types with genetic transmission are seen in childhood or even infancy, non-familial types appear after middle age and often spread to the neck lymph.
Treatment: Total thyroidectomy (complete removal of the thyroid gland) and neck lymph dissection must be performed together. Since medullary cells are different from other thyroid cells, they cannot retain iodine, so radioactive iodine is not used after surgery. In postoperative follow-up, unlike the papillary type, calcitonin value is measured in the blood.
4. Anaplastic Type:This type is much rarer. It usually occurs at advanced ages (>60 years) and when the biological behavior of papillary or follicular cancers that have remained untreated for many years suddenly changes. It is very difficult to treat, usually surgical treatment cannot be applied, only interventions that will relax the patient and provide airway and external radiation therapy (radiotherapy) are applied. The life expectancy of patients is generally limited to months.
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