The Thyroid gland is a butterfly-shaped gland in the neck, found below the Adam’s apple (Fig. 1). It secretes hormones to regulate many metabolic processes, including growth and energy expenditure. If the Thyroid gland is overactive or sluggish, the metabolism will be affected.
Lumps of the Thyroid are common, 90% of which are benign conditions, such as colloid disease, cysts, thyroiditis or hyperplasia (increased growth). The Thyroid can also be over (hyper) or under (hypo) active, regardless of whether there are lumps in the Thyroid. Approximately 10% of Thyroid nodules are cancerous.
Diagnosis of benign Thyroid diseases versus malignancy would depend on a combination of blood tests and imaging.
The basic blood test is a thyroid function test (TFT). This checks the level of your thyroid hormone produced by your thyroid (free T3 and free T4) and the Thyroid-Stimulating Hormone (TSH) produced by the pituitary gland. It will determine if you are hyper- (high) and hypo-(low) thyroid.
The ultrasonography is a simple test provides information about the features of the thyroid gland. A gel is placed on the skin to help facilitate the transmission of the sound waves, which are emitted from a small hand-held transducer. This test does not involve any radiation, is fast, and painless. Occasionally, the follow-up of a thyroid nodule may require multiple ultrasounds of the thyroid gland.
A small-sized needle is inserted into the nodule a few times to aspirate cells into a syringe. The cells are then placed onto a microscope slide, stained, and examined by a pathologist. The nodule is then classified as non-diagnostic, benign, suspicious, or malignant.
Low thyroid hormone levels are treated by thyroxin tablets with 6 monthly blood tests. Over-activity of the thyroid gland is treated with drugs that reduce the production of the thyroid hormones. If this is unable to control the thyroid hormone secretion or if the patient is unable to tolerate treatment, the entire thyroid can be removed surgically. Alternatively, the overactive thyroid cells can be killed with radioactive iodine. Your doctor will carry out a complete assessment of your pre-existing condition and your thyroid disorder before recommending the best treatment.
Surgery is recommended for thyroid nodules in some cases. Cancer is treated by surgically removing the thyroid gland. A multi-disciplinary approach to thyroid cancer management involves surgeons, endocrinologists and nuclear medicine physicians working jointly to provide holistic patient care.
A non-cancerous thyroid nodule may also require surgery, if the patient has difficulties breathing or swallowing due to the size of the nodule. Nodules diagnosed as indeterminate or suspicious by the fine needle aspiration biopsy as mentioned above, may also require surgery. Occasionally, the patient may choose to remove the nodule if it is large or unsightly.
Echotherapy is a non-invasive, high intensity ultrasound which delivers energy to destroy and shrink abnormal or enlarged tissues of thyroid nodules, tumours and goiters in the neck region.
The criteria to undergo echotherapy are:
The benefits of echotherapy are:
The risks include:
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