The thyroid gland is a butterfly-shaped gland that lies over trachea (the tube that carries air to lungs). It produces thyroxin which helps to regulate body’s metabolism.

Thyroid nodules are very common in women of the reproductive age group (15-45 years). Palpable nodules are present in 4-7% of females. On ultrasonography 50-60% of women will have nodules in the thyroid gland. Most of these are benign. Treatment of these nodules is needed when they are malignant, are cosmetically deforming, cause compressive symptoms (airway obstruction, facial oedema), or cause functional symptoms (hyperthyroidism).
SYMPTOMS

Malignancy should be suspected when there is a

Prior history of radiation
Rapid growth of the nodules
Extremes of age (less than 15 yrs or more than 45 yrs)
Family history of medullary cancer
Associated with difficulty in swallowing and change in voice

Thyroid cancer usually presents with solitary nodules and neck node metastasis (swelling on side of neck). It may also present with compressive symptoms (airway obstruction, facial oedema, etc) and bone pain (mainly flat bones). Diffuse enlargement of the thyroid gland occurs in benign conditions (hypo or hyperthyroidism). It is managed medically and will not need surgery.

Ultrasound done by an expert sonologist is the investigation of choice. It helps to characterise the nodule (benign or malignant). It can be used to target a biopsy (FNAC). Ultrasound is used in the follow–up of benign nodules. FNAC (fine needle aspiration cytology) from the nodule is done as an outpatient procedure. A tissue sample is aspirated using a small bore needle and sent for pathological examination. It helps in reaching a diagnosis and planning treatment.

Thyroid cancers are various types. These are papillary, follicular, medullary and anaplastic carcinomas of the thyroid. Papillary cancer is the most common form of thyroid cancer (80-85%). It usually spreads to lymph nodes in the neck. 95% of the patients are usually cured of this cancer.
TREATMENT

The main stay of treatment is surgery. Any tumour more than 1.5 cm will need total thyroidectomy with central compartment nodal clearance. Neck dissection needs to done if lateral neck nodes are present. Tumours invading trachea, will need either wedge resection or resection and end to end anastomosis. Tumours invading vascular structures (IJV), will need removal of the vein or the vein can be opened and thrombus can be delivered.
Radioactive Iodine Therapy (RAI)

This causes the destruction of the thyroid remnant and it is also used to treat metastatic cancer.

Medullary thyroid cancer accounts for about 5% of thyroid cancers. They are usually treated by total thyroidectomy and neck dissection. Calcitonin (tumour marker) is used to follow up medullary carcinoma patients. Anaplastic cancer is a relatively rare cancer, and is the most aggressive form of thyroid cancer.

Article by
Apollo Hospitals