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Thyroid Surgery for Benign Nodules

Thyroid Surgery for Benign Nodules

Surgery for benign lumps of the thyroid gland

Most lumps of the thyroid gland are benign. The thyroid gland is made up of microscopic cystic structures which store thyroxine in protein rich colloid. These colloid cysts can occasionally enlarge dramatically, producing a colloid goitre. Bleeding occasionally occurs into these cysts, causing rapid fluidic enlargement. These haematomas (blood clots) can usually be drained by needle aspiration.

Rarely, a cyst can occur in association with a tumour, and it is good practice to test the fluid from cysts in the laboratory to characterise the contents.

Benign colloid cysts

These are usually best left alone after characterisation. Occasionally, a large colloid nodule may need to be removed on cosmetic or symptomatic grounds.

Adenomas

An adenoma is a solid and independent nodule of growing thyroid tissue which may or may not secrete excessive amounts of thyroxine, causing hyperthyroidism.

Adenomas are difficult to distinguish from small tumours on triple assessment. In particular, the follicular adenoma has many cytological features of a follicular carcinoma.

A follicular lesion is thus best treated by a total lobectomy, as for a cancer, as confirmation of its nature may not be made until it has been properly assessed in the pathology laboratory.

If the lesion is subsequently shown to be a carcinoma, further surgery may be needed to remove the remaining thyroid tissue.

A unilateral (one sided) thyroid lobectomy can usually be undertaken safely through a short skin crease incision centred on the midline. Hospital stays are usually less than 24 hours, and recovery is rapid. There is a small risk of voice change and a very small risk of
low calcium levels.

Text provided by Mr David Rew, Copyright 2003


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