Thyroid Disorder

Your thyroid gland is one of the endocrine glands that produce hormones to regulate the body. It is responsible for setting your metabolism. The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and wraps around the front half of the trachea (windpipe). It is shaped like a bow tie, just above the collarbones, with two lobes which are joined by a small tissue bar.

Diseases of the thyroid gland are very common, affecting millions of Americans, mostly women. If your thyroid gland is not active enough, it can cause weight gain, fatigue, and difficulty with cold temperatures. If your thyroid is too active, producing more thyroid hormones than your body needs, it can cause weight loss, speed up your heart rate and make you very sensitive to heat.

The most common thyroid problems are:

An overactive gland, called hyperthyroidism

• Graves’ disease
• Toxic adenoma
• Toxic nodular goiter

An underactive gland, called hypothyroidism

• Hashimoto’s thyroiditis – the most common cause of hypothyroidism, resulting in fibrosis of the thyroid gland
• Nodules
• Cancers
• Thyroid enlargement or “goiter”

Goiter is the most common anatomic disease, and it is usually caused by an iodine deficiency. When simple goiter occurs in areas of adequate iodine intake, there appears to be a strong genetic component to the disease. In the United States, goiter is usually associated with Hashimoto’s thyroiditis, as the disease progresses to a hypothyroid state. Surgery to remove part or all of the thyroid gland may be required if the enlargement is compressing other organs in the neck or if malignancy is suspected. Thyroid cancer is the most common tumor of the endocrine system. The biological behavior of the different histologic types of thyroid neoplasms varies greatly.

During the operation, Dr. Leeman typically removes the lobe of the thyroid gland containing the lump, and possibly the tissue that connects the lobes. Sometimes surgeons may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This is a decision usually made in the operating room, based on findings at the time of surgery. Dr. Leeman will discuss these options with you preoperatively.

There may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure.

Dr. Leeman can diagnose thyroid function abnormality or a thyroid mass by taking a medical history and a physical examination. Blood tests and imaging studies or fine-needle aspiration may be required as well.

As part of the exam, your physician will examine your neck and ask you to lift your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps your physician feel the thyroid and any mass in it.