If you have a lump in your thyroid it is important that your doctor looks it at. If the lump has been there for a long time (more than 2-3 weeks) your should get some tests including thyroid hormones, a neck ultrasound and possibly a fine needle biopsy. Most of these are not due to cancer and may be left alone.
Antibodies to your thyroid commonly cause hyperthyroidism. This typically leads to Graves' disease. Patients can have an enlarged thyroid. Usually checking a patient's thyroid function and antibodies makes diagnosis. Treatment is individually based depending on symptoms. The main treatment modes are medication, radioactive iodine, and surgery (removal of the thyroid).
Hypothyroidism is a common problem especially in women. This is due to the thyroid loosing its capability to produce thyroid hormone. Most commonly, antibodies cause this, as in Hashimoto's thyroiditis. Treatment is supplementation with thyroid hormone for life and routine evaluation of thyroid hormone levels with blood tests.
Hoarseness is not common with thyroid cancer but can occur. When it does it could be because the thyroid mass is irritating the nerve that controls the vocal cord that runs near the thyroid. In these situations patients should have their vocal cords evaluated by an
Some patients have a little bit of hoarseness after surgery for a couple of days. Bruising or injury to the recurrent laryngeal nerve that feeds the voice box causes hoarseness. However, 5 of every 100 patients that have a thyroidectomy or parathyroidectomy will have hoarseness that can last up to 6 months (temporary recurrent laryngeal nerve injury). If your hoarseness last for longer than 6 months we recommend that you are evaluated by an ear, nose and throat specialist.
Tremors are typically associated with a low calcium level in the body. This is due to hypoparathyroidism because of bruising or injury to the parathyroid glands during thyroid surgery. There are routinely 4 parathyroid glands that control your calcium level that lie below your thyroid gland. If you had your thyroid completely removed sometimes you can injure all 4 of these glands. Typically 5 of every 100 patients that have their thyroid completely removed will have temporary low calcium for up to 6 months as these glands have been bruised and need time to recover. These patients need some calcium supplements until their parathyroid glands recover. In 1 of every 100 patients that have their thyroid completely removed their calcium will remain low for life. These patients typically will not have recovery of their parathyroid glands and will require calcium supplementation for life.
Because your thyroid has been removed patients need to stay on thyroid hormone for life. They should routinely get their thyroid hormone level checked. If you get palpitation and agitation and tremors on thyroid hormone this may be because your dose of thyroid hormone is too high and needs to be reduced. If you get depression and low energy it may be due to not taking enough thyroid hormone. A simple blood test can determine what your hormone levels are.
If you had a history of high radiation exposure either occupational or being exposed to a natural disaster like and nuclear reactor disaster, you are at a higher risk of having thyroid cancer. You should get closer evaluation by your doctor and earlier referral to a center with a specific focus on endocrine disease.
Familial thyroid cancer increases your risk of getting thyroid cancer. Routine evaluation by a doctor and early referral to an endocrine center would be recommended depending on the number of family member affected. Genetic counseling may also be needed.
Fine needle aspiration (FNA) is a technique used by clinicians to determine if your thyroid lesion is abnormal. This technique is an office procedure typically done under ultrasound where the physician places a needle in any concerning lumps in your thyroid and takes a specimen for pathology. This test is very good for determining if your thyroid lesion needs to have surgery to remove it. Patients usually have no problems with the procedure and do not need to change their daily activities.
A benign FNA has a 97% odd of not having cancer in the lesion. These lesions can therefore typically be watched closely with yearly ultrasounds and blood work.
If your FNA showed the thyroid lesion was malignant therefore there is cancer in your thyroid lesion. Your thyroid depending on the malignancy should be removed. Further evaluation by and endocrinologist and endocrine surgeon are advised.
You should have yearly follow-up either by an endocrinologist or endocrine surgeon. This follow-up could be life-long.
After surgery you need to have routine thyroid hormone levels checked to ensure you are on the right dose of thyroid replacement. A thyroglobulin level (a marker for thyroid cells) should also be routinely checked. A neck ultrasound should also be performed yearly if you have thyroid cancer to make sure there is no recurrent disease.
Your scar should heal well after surgery. The scar will look better with time. Avoiding direct sunlight for a year to the scar will improve outcome.
Immediately after surgery you should avoid driving for a week or two until you are comfortable moving your neck from side to side without difficulty. You should have very little pain. You can start routine daily activities very soon after surgery. We recommend that you avoid activities that cause sweating and excessive strain on the neck for a couple of weeks.