A Thyroid nodule is an abnormal and excessive growth of cells occurring within the thyroid gland.  So typically a patient with thyroid nodule presents to the ENT specialist with a small bump in front of the neck, observes Dr. Shree Rao. Thyroid nodules are very common and occur in about 5% to 10% of women and about 1% to 5% of men. 95% of Thyroid nodules are benign i.e. they are non- cancerous.

When a patient presents to ENT Specialist Dr. Shree Rao with Thyroid issues, she first takes a thorough history of the symptoms and present illness, followed by a clear family history, as thyroid problems are known to run in families. Then a general physical examination is done to record the pulse, blood pressure and respiratory rate. Next comes a thorough head and neck examination. Dr. Shree Rao inspects the neck and palpates it to feel for any abnormal limb nodes or thyroid nodules. If she feels or suspects any abnormal growth, she may ask for an ultrasound scan of the thyroid gland to double check if the bumps or nodules are actually arising from the thyroid gland. A thyroid blood investigation will also be recommended, if found imperative.

If the tests reveal that the production of thyroid hormones is lesser than adequate, Dr. Shree Rao will start the patient on thyroid hormone supplementation in the form of medication or pills. These pills are to be taken once a day on an empty stomach lots of water. The dosage prescribed depends on the body weight of the individual and the degree of hypothyroidism he or she has. Dr. Shree Rao monitors the patient every 3 to 6 months to check whether the thyroid hormones are within the required and acceptable limits.

Thyroid problems typically have a genetic trait. They run in families. So, even if you do not have any of these symptoms but are aware that your immediate relatives like mother, father, brother or sister have thyroid-related issues, it is advisable to get your thyroid checked annually, cautions Dr. Shree Rao.

A well-balanced diet which includes a wide spectrum of vitamins, minerals and all the trace elements, and regular exercise are vital for thyroid health, informs Dr. Shree Rao, ENT Specialist. Iodine is most required to maintain thyroid hormone production levels and for synthesis within the thyroid gland. About 150 micrograms of iodine is required (as per the recommended dietary allowance) per day
for the normal functioning of the thyroid gland. Just a spoonful of iodized salt contains 400 micro grams of iodine. So we Indians are
getting enough of iodine from our daily diet, Dr. Shree Rao assures.

Also of importance are certain trace elements like iron, zinc, chromium and cilium which are very important for the conversion of the inactive form of thyroid hormone into the active form and for the transportation of thyroid hormone within our body. So, we need to consume foods that are rich in these trace elements viz red meat, eggs and for vegetarians, chick peas, cashew nuts, almonds in order to keep the thyroid gland and the body healthy, lists Dr. Shree Rao.

Dr. Shree Rao, ENT Surgeon advises patients to get admitted on the day of the surgery, and stay for 1 to 2 days after surgery since a small drain is placed at the operated site. The drain is removed once she is satisfied that the patient’s vitals are stable after which the patient is allowed to go home. The post-op medication includes antibiotics, pain medications and calcium supplements. The patient is called for a review after 10 days by Dr. Shree Rao.

Yes. A scar of about 2 to 2.5 inches in the lower part of the neck can be seen from where the surgeon removes the thyroid gland. But Dr. Shree Rao being a skillful microsurgeon ensures that the cosmetic part is taken care by minimizing the scar as much as possible. She uses dissolvable stitches to make sure that the skin formation is perfect. Dr. Shree Rao assures that the scar will fade away within a year or two.

Thyroid surgeon Dr. Shree Rao will advise the patient not to avoid wetting or scrubbing the incision site, climbing stairs and lifting heavy objects for about 1 to 2 weeks after the surgery. There is no restriction on food. Most patients return to their work place very soon after the surgery, Dr. Shree Rao says.

Goiter is an abnormal and diffused enlargement in the Thyroid gland which can be seen in the front of the neck. It can be caused by both hypothyroidism or underactive thyroid and hyperthyroidism or overactive thyroid, explains Dr. Shree Rao, Ear Surgeon.

Goiter does not require surgery most of the the time. When the demand for thyroid hormone is more, our body tries to compensate by increasing the size of thyroid gland to produce more amount of thyroid hormone. This leads to the growth of a Physiological Goiter. When the thyroid hormone demands reduce, the thyroid gland also comes back to normal size. So this condition does not require any active intervention or surgery, says Dr. Shree Rao. 

However, in a Multinodular goiter where there are bumps or nodules within the thyroid gland which make the thyroid gland appear larger, it is better to get rid of them by surgery because there is a 2 to 6 percent chance that they can turn cancerous, explains Dr. Shree Rao, Thyroid specialist. 

Also, at times the Goiter becomes so huge that it causes pressure symptoms over certain parts of the body i.e. compression of wind pipe or trachea leading to difficulty in breathing or compression of the food pipe causing difficulty in swallowing.  It is also seen to infiltrate into the voice nerves causing changes in the voice or hoarseness of voice. In such extreme cases too, surgery is the solution, says Goiter specialist, Dr. Shree Rao.

To put it simply, says Dr. Shree Rao, Thyroid cancer is the presence of cancer cells within the Thyroid gland. Unfortunately, Thyroid cancer does not have any symptoms in its earlier stages. The symptoms start to appear in only the last stages. Dr. Shree Rao lists the following symptoms to look out for:

• Abnormal or diffused enlargement in front of the neck or within the thyroid gland 
• Swollen lymph nodes in the neck 
• Pain or discomfort in the neck 
• Difficulty in breathing 
• Difficulty in swallowing 
• Change in voice or hoarseness of voice

Majorly, there are 4 types of Thyroid cancer that are common in India, informs Dr. Shree Rao, a well-known Thyroid doctor. 

Papillary thyroid cancer: It accounts for 70% to 80% of all the thyroid cancer cases and is more common in women. It occurs in the age group of 30 to 40yrs. Where this type of thyroid cancer is detected early, the prognosis is excellent.

Follicular thyroid cancer: Accounting for 15% to 20% of all thyroid malignancies in the country, it occurs in middle-aged women in their 40s and 50s. If detected early, prognosis is quite good for this type of Thyroid cancer. 

Medullary carcinoma: It accounts for 5 to 10% of all thyroid malignancies and arises from specialized parafollicular cells or ‘c’ cells that secrete calcitonin instead of the thyroid hormone within the thyroid gland. It can occur in newborns, infants, 20yr olds or middle aged people.  Since this type of thyroid cancer is associated with other cancers in our body and is usually hereditary, if a patient is diagnosed with Medullary carcinoma, Dr. Shree will insist on screening the family members too. The treatment for Medullary carcinoma is quite aggressive.

Anaplastic thyroid cancer: This is a rare type of thyroid cancer, occurring in about 1% to 2% of people. It begins in the follicular cells, grows rapidly and is very difficult to treat. It typically occurs in adults aged 60 and older, and its prognosis is not good.

The treatment differs for different types of thyroid cancer. All surgeries are done under general anaesthesia.

Papillary thyroid cancer: For patients of Papillary thyroid cancer, Dr. Shree Rao, Ear Surgeon would opt for total thyroidectomy, in which both the lobes of the thyroid gland are removed along with the central part i.e. the isthmus. The specimen is sent for histopathological examination and the patient is given post-operative radioiodine ablation therapy in the form of radio iodine pills.  Immediately after the radio iodine ablation is done, she will start the patient on Thyroid hormone suppression therapy or Thyroid replacement therapy. The patient is monitored regularly after 6 months until about 10 years.

Follicular thyroid cancer: If the patient is diagnosed with follicular type of neoplasm, hemithyroidectomy is the first step. In this procedure, Dr. Shree Rao, Ear surgeon will remove the lobe that is affected and send it for histopathological examination. If the pathologist confirms it as cancer, she will remove the other lobe too. She also checks for any other palpating lymph nodes or swollen nodes, and removes and sends them for histopathological examination if she thinks it is necessary. The patient is given post-operative radioiodine ablation therapy and started on Thyroid hormone suppression therapy or Thyroid replacement therapy. The patient is monitored regularly after 6 months until about 10 years.

Medullary carcinoma: The treatment for this type of thyroid cancer is aggressive. So Dr. Shree Rao, Ear Surgeon would remove the entire left and right lobes of thyroid along with the isthmus. Central compartment neck dissection i.e. removal of the lymph nodes at the back of the thyroid lobes and Lateral compartment neck dissection i.e. removal of lymph node chains on the left and right of the thyroid gland will also be done. The patient is monitored for serum calcitonin levels and carcino embryonic antigen levels every six months. Screening the family and checking their hormonal levels along with serum calcitonin and carcino embryonic antigen levels is undertaken.

Anaplastic thyroid cancer: Where the patient is diagnosed with anaplastic carcinoma, Ear Surgeon Dr. Shree Rao will directly advise total thyroidectomy with neck dissection followed radiotherapy or chemotherapy.

For the benign or non-cancerous  type, Thyroid surgery would take 1 – 2 hours including post-operative recovery time. But if it is for Thyroid cancer it takes 2- 4 hours. Where neck dissection or reconstruction is required, the surgery will go on for longer.

Thyroid surgery does not have any major complications, assures Dr. Shree Rao, Ear Surgeon. Some amount of intraoperative bleeding and infection at the operated site may be seen in a few cases.  

At times, as the parathyroid gland is just behind the thyroid gland, it may sustain some injury, resulting in temporary or permanent low level of calcium production. In such cases, the patient will be prescribed calcium supplements for long-term use. 

At other times, there may be injury to the voice nerve present behind the thyroid gland and within the trachea. This may lead to temporary or permanent change in voice or hoarseness of voice. To rule out which, Dr. Shree Rao, Ear Surgeon uses an ultramodern voice nerve monitor that alerts her if she is approaching the voice nerve during surgery.