Common Thyroid Problems

 The thyroid gland can be prone to problems that may require surgery. Some of the more common thyroid problems include:

Thyroid Nodule
Sometimes the thyroid develops nodules or lumps which usually do not cause symptoms, but occasionally can be seen or felt in the neck. The occurrence of thyroid nodules increases with age and affects almost 10 percent of the adult population, most of whom are women. The great majority of nodules are benign.

Your physician will order tests to determine whether the nodule is benign or malignant. These tests may include:

  • Ultrasound
  • Nuclear medicine thyroid scan
  • Fine needle aspiration (FNA) of the nodule

In addition, surgery may be recommended based on a nodule that is painful, slowly enlarging, obstructing another process or causes discomfort.  

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Thyroid Cancer
Both FNA and pathologic evaluation of a removed nodule are used to establish the type of thyroid cancer present. There are four types of thyroid cancer (carcinomas): follicular, papillary, medullary and anaplastic. Regardless of type, the recommended treatment for thyroid cancer is total thyroidectomy with the removal of enlarged lymph nodes.

Papillary and Follicular Cancer
Approximately six weeks after surgery, patients with papillary and follicular cancers may be treated with radioactive iodine (I131) to destroy any remaining thyroid cells. I131 is readily absorbed by the cells, killing only thyroid tissue. Patients are then given oral thyroid replacement medication for life. This three-pronged treatment — surgery, I131 and thyroid replacement medication — is highly effective in treating papillary and follicular carcinomas and should lead to a normal life expectancy.

Medullary Carcinoma
Medullary carcinoma of the thyroid is rare, and often seen in patients or families with multiple endocrine tumors. Treatment of medullary carcinoma is to remove the entire thyroid and any enlarged lymph nodes. Unlike papillary and follicular carcinoma, medullary carcinoma does not usually benefit from I131 therapy.

Anaplastic Cancer
Anaplastic cancer of the thyroid is very rare. It is a highly aggressive cancer and is difficult to cure. Treatment for anaplastic cancer consists of a combination of surgery, radiation and chemotherapy.

Every patient diagnosed with thyroid cancer at Virginia Mason benefits from the collective expertise of the cancer care team. Surgeons, oncologists, radiologists, pathologists and others meet to discuss a customized care plan for each patient.

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Symptomatic Goiter
The term goiter describes any enlargement of the thyroid gland. The causes of enlarged thyroids are not well understood. Patients with a goiter may have normal thyroid function, or sometimes produce too little or too much thyroid hormone. Many people live with goiters without any problem. However, some people may find them unsightly or have difficulty breathing or swallowing as the enlarged gland presses on the windpipe and the esophagus. Some patients complain of a pressure sensation or discomfort in the neck. The usual treatment for a troublesome or symptomatic goiter is surgical removal.

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Hyperthyroidism
Hyperthyroidism occurs when the thyroid produces too much hormone. This is a serious condition that can cause increased heart rate, heat intolerance, weight loss, diarrhea, weakness and eye difficulties. In most cases, hyperthyroidism can be successfully treated with radioactive iodine (I131) or thyroid suppression medication. Removal of the thyroid is rarely recommended for patients with hyperthyroidism.

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