Diagnosis and Treatment of Thyroid Gland Diseases

Dr. Thomas Winkler

Thyroid nodules - which nodules need treatment?

Every node in the thyroid gland is considered pathological and must be examined more closely. 20-30% of adults in our latitudes have lumps of >1cm in the thyroid gland. In areas with iodine deficiency, the percentage is almost 50%. The incidence of thyroid carcinomas is increasing across Europe and is increasingly affecting the younger population. 

In Eastern Europe, the incidence is ten times higher and in some areas even higher than in  Central Europe. A distinction is made between "hot nodes" with independent hormone production and "cold nodes" without hormone production. Since cold nodes have a higher risk of malignant malignancy, these nodes require precise clarification, regular checks and in many cases an operation.

How is the diagnosis made?

A precise medical history and risk profile as well as regular tactile examination, checks of thyroid hormones ​​such as TSH, fT3 and fT4, possibly tumor markers (TG and calcitonin) are just as important as an ultrasound of the thyroid gland and scintigraphy. With the last-mentioned examinations, the individual risk and the need for therapy can be evaluated quite precisely. Further information can be obtained using a fine needle puncture.

When should thyroid nodules be operated?

Cold nodules with a diameter over 1cm in an otherwise healthy thyroid gland or a significantly enlarged node in a thyroid gland with many other small ones). Furthermore, (autonomous) growth or a suspicious result of fine needle puncture represent a clear indication for surgery.Hot nodules should be operated when they cannot be controlled by medication as the thyroid gland produces uncontrolled and too much thyroid hormone.

Hot nodes in children shows a clearly increased tendency to become malignant and almost always represent an indication for surgery.Suspected or diagnosed carcinoma, Graves' disease, goiter (enlarged thyroid) with compression of other surrounding organs are other important surgical indications.

How is the operation performed?

First, the specialists discusses with the patient therapy options, the surgical techniques, the planned extent of the resection and possible complications. In principle, the smallest possible resection and maximum thyroid maintenance is always the aim - depending on the type of disease, the size and location of the pathology, whereas the focus is on the patient and his safety. 

With state-of-the-art instruments and techniques, microsurgical interventions are realized with the help of neuromonitoring, during which the vocal cord nerve is displayed and thus safely spared. ICG-NIR, a new technique is used to maintain parathyroid gland. Complication rate can be reduced to a minimum, namely to less than 1%. The operation is carried out over the smallest possible skin incision which results in an excellent cosmetic result with an almost invisible scar after a few weeks.

How long is the stay in the clinic? Are there any restrictions after the operation?

12 hours monitoring ensures maximum safety for the patient. On the first postoperative day, calcium and parathyroid hormone are determined in the blood and an ENT examination to check the function of the vocal cords. The discharge takes place on the 2nd to 3rd postoperative day.After discharge, physical protection over 2-3 weeks is recommended.

Regular dressing changes are important. The dosage of the thyroid hormones is usually only necessary temporarily.
After total thyroidectomy, hormone substitution must be taken permanently. 6 weeks after prescription of the thyroid hormones, a new determination of the thyroid values ​​is carried out to fine-tune the medication.

Are further examinations necessary at regular intervals?

Six weeks after the start of taking the thyroid medication, thyroid hormones have to be determined again in order to make a fine adjustment of the thyroid medication. A blood check and sonography shall be done after one year.

What additional steps have to be taken in the case of a tumor disease?

In the case of follicular or papillary thyroid carcinomas over 1 cm in size, radioiodine therapy must be started a few weeks after the operation. Microcarcinoma usually do not require further treatment, just a consequent aftercare.

Medullary thyroid carcinoma does not require any follow-up treatment and chall only be followed up with ultrasound and calcitonin. Other types of carcinoma require a multimodal therapy concept that is set individually in the tumor board.