Thyroid and parathyroid

Thyroid problems are very common and frequently require investigation and sometimes surgery. Charles regularly treats both benign and malignant thyroid disease.

The thyroid is a butterfly shaped gland in the front of the neck responsible for producing the thyroid hormone called thyroxine. Sometimes the thyroid may produce too much hormone (hyperthyroidism, eg Graves’ disease) and sometimes too little (hypothyroidism). It may become enlarged (goitre) over many years, develop nodules or occasionally cancer. Nodules are very common, especially with increasing age, but thyroid cancer is not.

Goitres become slowly larger with increasing age, but unless symptomatic or predicted to become so, may not require surgery. If very large they may compress the trachea (breathing tube) or oesophagus (swallowing tube). Enlarged thyroid glands from multiple nodules, causing discomfort, may be removed by surgery.

Nodules require evaluation to exclude suspicious processes, this is commonly done with ultrasound and a needle test (FNA). A CT scan may be requested to identify or exclude any abnormal lymph nodes.

Thyroid cancer may have no symptoms or present with a lump in the neck. There are several types of thyroid cancer that may be confined to the thyroid, involve the local lymph nodes or very rarely spread to other parts of the body. Papillary cancer is the commonest and has a good prognosis. It is treated by surgery and frequently radioactive iodine afterwards. Follicular thyroid cancer is

less common and has a good prognosis in the majority. It is also treated by surgery and frequently radioactive iodine treatment. Medullary thyroid cancer is a rarer cancer and carries a more serious prognosis. It may be related to syndromes that run in families or not, and the mainstay of treatment is surgery. Anaplastic cancer is very rare but is the most aggressive and serious. Surgery may not be appropriate, and radiotherapy may be used under the guidance of a multidisciplinary team.

Surgery of the thyroid may remove half (hemithyroidectomy) or the whole gland (total thyroidectomy) depending on the indication.

The parathyroid glands are small (each about the size of a pea) and usually number four. They are located behind the thyroid gland, two on each side, and are responsible for the regulation of the body’s calcium. Tumours of the parathyroid glands may cause calcium abnormalities producing problems such as: kidney stones; excessive urination; abdominal pain; tiring easily or weakness; depression or forgetfulness; and bone and joint pain. Investigation is by blood tests for calcium, vitamin D and parathyroid hormone, ultrasound and nuclear medicine scans (sestamibi or SPECT -CT). These can localise the abnormal parathyroid gland for the mainstay of treatment, surgery.