Mr Liew Fah Kong
Consultant General Surgeon
Understanding thyroid problems
The thyroid gland is one of the glands in your body which produces individual hormone or hormones that regulate various bodily functions. This gland is located at the front of the neck, in front of the windpipe (trachea) and comprises a right lobe and a left lobe connected by an isthmus, forming an H-shaped gland.
The thyroid gland produces thyroid hormones, namely tri-iodothyronine (T3) and thyroxine (T4), which are involved in controlling the body’s metabolism. In order to understand thyroid problems, you must first realize there are problems related to the function of the gland and problems related to the structure of the gland.
Problems related to function
All our bodily systems have to function within a normal range of values or else we fall ill. The production and release of thyroid hormones, therefore, must also be within a normal range of values. If too much hormones are produced and released, the thyroid function will automatically be suppressed to produce and release less thyroid hormones.
Likewise, if too little hormones are produced and released, the gland is automatically stimulated to produce more thyroid hormones, thus maintaining a normal range.
Diseases where the thyroid gland produces an excessive amount of hormones result in hyperthyroidism. You may feel irritable, sweat more, have a rapid pulse, hand tremors, protruding eyes, etc. Your doctor will take your medical history, examine you, order investigations that will include a “thyroid profile” and perhaps an ultrasound scan of your thyroid gland, and so on. A “thyroid profile” is a blood test which reveals the levels of thyroid hormones (which will be raised in this case). Your doctor then initiates treatment, which may include oral medication/radio-iodine/surgery.
There are also diseases where the thyroid gland produces decreased amounts of hormones, resulting in hypothyroidism. You may feel lethargic, slow, etc. Your doctor will go through the same above mentioned steps, but treatment in this case is usually oral thyroxine.
Problems related to structure
An enlargement of the thyroid gland is termed goitre. The whole gland may be smoothly enlarged, in which case it is termed diffuse goitre. A part of or the whole gland may be enlarged, forming a nodule or more than one nodule. This is termed single nodular goitre or multinodular goitre, respectively.
Various diseases of the thyroid gland produce diffuse goitres, like colloid goitres, thyroiditis and so on. Treatment is initiated accordingly.
Cancer of the thyroid can present as a single nodule. Your doctor will follow the same steps as above, but in this instant, a fine needle aspiration biopsy is done. Appropriate surgery and further treatment is initiated once cancer is proven.
A benign condition called multinodular goitre presents with multiple thyroid nodules. The same steps of medical history, examination and investigations are followed. If a multinodular goitre produces symptoms such as breathing or swallowing difficulties because of its sheer size, then surgery may be advised.
Both diffuse and single/multinodular goitres can be associated with hyperthyroidism or hypothyroidism.
As always, it is best to consult your doctor if you think you have a medical condition, in this case, a thyroid problem.
A single round swelling of the thyroid gland
A single round swelling of the thyroid gland can either be a cyst or a solid nodule, depending on an ultrasound examination. Your doctor will advise treatment based on your history, examination and investigation results.