Enlightenment Now by Steven PinkerJuly 23, 2018
How Much Fuel Do You Need?July 23, 2018
The thought of undergoing thyroid surgery can cause a stir of emotions: fear, panic, worry… During this time, you also have to make a very important decision that is going to affect your health, leaving you wondering, “Am I making the right choice?”
Not to worry, because we are about to dive into some very important information, giving you the knowledge to make an empowered and informed decision for your health (as well as your thyroid!).
Your Thyroid Gland: What You Should Know
The thyroid gland is located at the base of your neck, just below your Adam’s apple. Noticing a lump or enlargement in this area can be cause for alarm, which might leave you wondering, “is this cancer?” or “do I need surgery?”
Key Insight: Sometimes, danger can be lurking beneath the surface, remaining hidden before symptoms (or lumps) ever appear.
If you, or someone you know, are struggling with a thyroid condition (1), or are at risk of developing thyroid cancer (2) and considering thyroid surgery (3) then we have important information for you. We will discuss when surgery is absolutely needed and when it is not, measures that can be taken to avoid surgery, and the importance of proactive detection.
Want to dive in and get your thyroid better? This can be your time:
Thyroid Growths: Different Types
You may be familiar with the terms “goiter” and “thyroid nodules.” Let’s take a closer look at these two terms.
A goiter is a non-cancerous swelling of the thyroid and nodules are lumps or growths occurring within the thyroid. The risk of developing thyroid nodules parallel the decade in life (ie. 30% chance of developing nodules in your 30s and 50% in your 50s, etc.)1.
While nodules can be the primary sign of thyroid cancer, it is important to remember that 95% of the time these nodules are benign or harmless. In fact, both goiters and nodules can be common side effects of thyroid conditions like Graves’ disease or Hashimoto’s disease.
In the case of Graves’, the thyroid is forced to secrete its hormone excessively and one way it achieves that is by creating more tissue.
In Hashimoto’s, the thyroid is trying, unsuccessfully, to produce enough hormone to meet demand and tries to overcome this by growing more tissue.
Bottom Line: These resulting growths can leave one wondering if they may be cancer. Even though the odds are low for nodules being cancerous, it is still crucial to have nodules assessed for safety’s sake – especially when you are a female over 30 years old.
Is It Easy to Tell If You Have Nodules?
The short answer, not always!
Sometimes one may have nodules that don’t cause any symptoms and sometimes they remain small enough to where they cannot be felt.
Since thyroid cancers grow slowly, these slow-growing nodules can be missed if they are too small to surface. So it is important to take these 3 measures if you have any risk of developing thyroid cancer:
- Perform a self-evaluation, or “neck check”
- Get a doctor’s examination
- Get an ultrasound
While the first two measures are important to perform, they are accurate about 5-10% of the time. The third option, an ultrasound, is:
- Safe (radiation-free)
- Painless (during an initial screening)
Ultrasounds produce images by bouncing sound waves off your thyroid. The information details if nodules are present, their number and size, and whether a nodule is fluid-filled, solid or calcified.
Certain characteristics of nodules are more worrisome than others, however, ultrasounds cannot diagnose thyroid cancer2. It is typically used to see whether a biopsy may be needed.
Bottom Line: If you already know you have thyroid nodules and wondering what you can do to reduce them naturally, read our in-depth guide about thyroid nodules (4).
When Is A Biopsy Needed?
If any of the nodules are:
- Greater than 1 centimeter
- Vascular – have too many blood vessels
The next step is to get a biopsy using Fine Needle Aspiration3. Each nodule is biopsied using a very thin, and relatively painless, needle to collect sample tissue.
The samples are then looked under a microscope and can result in one of the following conclusions:
- No thyroid cancer present
- Not enough tissue gathered
- No cancer found, but cells look suspicious
- Thyroid cancer present
When Is Surgery Required?
The first result is great news, however, surgery may still be needed if the benign nodules have grown too big and are causing difficulty in swallowing or breathing.
Bottom Line: If a biopsy showed thyroid cancer or looks suspicious enough to justify pursuing a definitive answer, surgery is performed.
Do you ever need surgery for Hashimoto’s?
Typically Hashimoto’s does not require surgery. There are many other treatment options available and ones that more comprehensively address the underlying cause better than surgical intervention. Check out this savvy guide on Healing Hashimoto’s (5).
Key Insight: In severe, unresponsive-to-treatment cases of “Hashimoto’s Encephalopathy” would surgery be needed.
Do you ever need surgery for Graves’ disease?
It is more common to hear about thyroid surgery related to Graves’ disease, however, it is not the most commonly used treatment for Graves’.
A thyroidectomy is considered as a treatment for Graves, though, when:
- Patients are allergic to antithyroid medication or when they are resistant to radioactive iodine
- Thyroid goiter has grown dangerously too large
- Significant eye changes exist with Graves’ disease (exophthalmos)
Do you need to have nodules removed?
The good news is when thyroid conditions, like Graves’ or Hashimoto’s, are caught early and successfully treated, any existing benign goiters/nodules can stop growing and even shrink over time (6).
At Integrative Health, a few ways we go about shrinking thyroid nodules naturally are:
- Keeping precise TSH levels so nodules stop growing
- Maintaining appropriate iodine levels
- Reversing insulin resistance (7).
Still, there may be occasions when nodules need to be surgically removed:
- Multinodular goiters that constrict airways, the esophagus or blood vessels are present
- Thyroid nodules that have an indeterminate diagnosis or are deemed suspicious for cancer after biopsy
- Nodular goiter causing hyperthyroidism where treatment with radioactive iodine or antithyroid medications are not an option
- Goiters or nodules that are malignant (thyroid cancer)
Thyroid cancer is the most common malignant disease of the endocrine system and studies have shown thyroid cancer has been on the rise worldwide in the past few decades4.
It is unclear whether there is a true increase in thyroid cancer or whether we are getting better at detecting it, however, studies suggest that there may be an actual increase5.
Bottom Line: As scary as cancer is, when it comes to thyroid cancer, the good news is that the survival rate is good – over 95%. That’s because the most common type of thyroid cancer grows slowly and can be eliminated with surgery.
Risks of Thyroid Surgery
While thyroid surgery is important to pursue in these cases, it can carry significant risks since the neck houses some critical body parts. For example, nerves to your vocal chords are right next to the thyroid. If these nerves are injured during surgery it may reduce one’s voice to a whisper.
Also at risk are the parathyroid glands which live behind the thyroid – these important glands control the amount of calcium in blood and bones. Although great care is taken to protect these glands, accidental damage can occur.
Surgery can also cause long-term hypothyroidism, requiring lifelong thyroid medication. Certainly, the benefit of not having cancer outweighs some of these risks, however, there are steps one can make to ensure a good surgeon is found.
When surgery cannot be avoided there are certain steps you can take to ensure you are getting the safest and best surgical treatment.
- Find an Ears, Nose, and Throat (ENT) doctor who has special training in thyroid surgery and who performs at least 100 thyroid operations annually.
- Interview a few ENTs before making a selection. Do not be shy or embarrassed to ask how many of a certain type of operation a surgeon has done and what their personal complication rate is6.
- Choose a facility that has both a cytopathologist and cytology lab available during your procedure.
- It is important to watch for symptoms of hypothyroidism, whether full- or partial-thyroidectomy occurred (ie fatigue, hair loss, weight gain etc) so you can ensure optimal thyroid levels and health are maintained (8).
- Furthermore, keeping one’s TSH below 2.0 helps reduce the risk of thyroid cancer recurrence if any thyroid tissue remains post-surgery.
- Finally, in the case of full-thyroidectomy, desiccated thyroid medication provides a comprehensive blend of thyroid hormones providing a natural replacement your body is used to.
Curious about your optimal thyroid levels? This is a great place to start…
The Main Points Checklist
- If you notice a lump in the thyroid region of your neck, get evaluated.
Most thyroid nodules are benign, but it is important to rule out cancer.
- Thyroid cancer can grow slowly and may be present for years before notice. But the good news is it has a 95% survival rate.
- Ultrasound is a safe, inexpensive and painless initial screening that can detect hidden nodules.
- Thyroid surgery is recommended for large, symptomatic goiters/nodules and for eliminating thyroid cancer.
- If surgery is required, choose an ENT with specialized training in thyroid surgeries and who performs over 100 thyroid operations annually.
- After surgery, closely monitor for signs of thyroid malfunction.
- Schedule an appointment at IH to discuss what steps you can take to optimize your thyroid health.
Determining When You Need Thyroid Surgery
Today we discussed the importance of thyroid nodule screening, when to consider thyroid surgery, and when thyroid surgery is not needed.
Active surveillance and early detection screening are the key ingredients that can contribute to appropriate and helpful thyroid treatment outcomes that can impact the health of your thyroid.
Start with the Thyroid Quiz (9), in order to learn more about your thyroid than you ever thought possible.
1 – https://www.endocrineweb.com/conditions/thyroid/thyroid-nodules
2 – https://www.endocrineweb.com/conditions/thyroid/thyroid-nodule-ultrasound
3 – https://www.endocrineweb.com/conditions/thyroid/fine-needle-biopsy-thyroid-nodules
4 – https://www.ncbi.nlm.nih.gov/pubmed/29544469
5 – https://www.hindawi.com/journals/jce/2013/965212/
6 – http://endocrinediseases.org/thyroid/surgery_surgeon.shtml
Written by Dr. Raquel Espinol of Integrative Health. Dr. Raquel Espinol, Associate Physician with Integrative Health specializing in Thyroid, Adrenal, Male/Female Hormonal imbalances and weight loss management.
Learn more about Dr. Espinol here.