Archive Article – The Thyroid Society (1998 – 2003)
Sam C. Weber, M.D. is a practicing otolaryngologist, head and neck surgeon and Associate Clinical Professor at the Baylor College of Medicine in Houston, Texas. He is Chief of Otolaryngology at St. Luke’s Hospital and Senior Attending Surgeon at Methodist Hospital. Dr. Weber is a member of the American Thyroid Association, Past President of the Houston Otolaryngological, Head and Neck Surgery Society, Past Vice Chair of The Thyroid Society and numerous other professional organizations.
The Thyroid gland is situated low in the central compartment of the neck. This area is below the “Adam’s apple” and above the inner aspect of the collarbones. The gland lies under the muscle of the neck and is therefore hidden from view.
The solitary thyroid nodules are of concern because of the possibility that it might be malignant (cancerous). Generally, the solitary nodule produces no symptoms or signs, unless it is enlarged enough to be visible with inspection of the anterior neck. The majority of these nodules are found during a neck examination performed by family practitioners, internists, obstetricians or otolaryngologists (head and neck surgeons). The nodule, once diagnosed, needs to be evaluated.
The most important study is the Fine Needle Aspiration (FNA). The FNA entails placing a fine gauge needle into the nodule and withdrawing a drop of blood. The cells are studied under the microscope by an experienced cyto-pathologist. The advantage of the FNA is that 75% of the solid nodules avoid being removed surgically. If the nodule is read as benign, surgery can be avoided and the nodule can be followed by the patient’s physician. Many patients with benign thyroid nodules will be advised to take thyroid hormone. On the other hand, if the nodule is cancer on FNA, surgery is indicated. The third category in reading the FNA is indeterminate, inclusive or suspicious. This last reading also requires surgery.
Other studies may be ordered by the physician. Thyroid ultrasound uses ultrasonic waves to map out the gland and identify any nodule or nodules which may be present. A thyroid image or scan may be obtained using radioactive iodine or technetium. The nodule may take up less radioactive material than the surrounding tissue and show up “cold” on the scan. Ten to twenty percent of the cold nodules will be malignant. If the nodule takes up more radioactive iodine than the surrounding tissue, it is called a “hot” nodule and the chance of malignancy is very small (less than 1%).
When the patient has surgery, the nodule is generally removed by excising the entire lobe. A frozen section is then performed. If the diagnosis from that test is benign, the other lobe is left alone. Generally, if the frozen section indicates malignancy, a total thyroidectomy is executed. The patients who undergo total thyroidectomy surgery to remove cancer will receive treatment with radioactive iodine six weeks after the surgery.
Find more archived articles from The Thyroid Society (1998 – 2003) below: