Thyroid Disease Treatment in New Jersey and Pennsylvania

Thyroid disorders can indeed lead to weight fluctuations. Hypothyroidism, characterized by an underactive thyroid, can cause weight gain, while hyperthyroidism, an overactive thyroid, may result in weight loss.

There are several types of thyroid cancer, including papillary carcinoma, follicular carcinoma, medullary thyroid carcinoma, and anaplastic carcinoma. Each type has distinct characteristics and treatment approaches.

Thyroid hormone imbalances can impact heart rate, rhythm, and overall cardiovascular function. Both hyperthyroidism and hypothyroidism can lead to changes in heart rate and, in some cases, may increase the risk of heart-related complications.

Certain thyroid disorders, such as autoimmune thyroid diseases, may have a genetic component. A family history of thyroid conditions may increase the risk of developing similar disorders.

The frequency of thyroid function tests depends on the individual's condition and treatment plan. Typically, healthcare providers recommend regular monitoring every six to twelve months for stable thyroid function. However, specific recommendations may vary based on individual needs and medical history.

The thyroid gland is an endocrine organ. Endocrine organs produce hormones that help multiple processes in our body. The thyroid gland produces the hormone thyroxine that essentially impacts the metabolic rate of our body and is essential in many bodily functions. 

The thyroid gland is located in the neck. It has a butterfly shape with two lobes lying on either side of our trachea, or windpipe.

When thyroxine levels are too low in the body this is called hypothyroidism. Hypothyroidism is quite common, affecting up to 5% of the general population. The early symptoms of hypothyroidism are varied; common symptoms include cold intolerance, constipation, weight gain, menstrual irregularities, fatigue, itchy skin, brittle fingernails, depression, poor muscle tone, and joint pain. Hypothyroidism and its possible causes can often be identified on blood tests and is treated with thyroid replacement medications. Response to treatment is monitored by symptom control and serial blood tests.

Lodine deficiency is the most common cause of hypothyroidism worldwide, however supplementation of our table salt has limited this cause. In the US, the most common cause is an auto-immune condition called Hashimoto’s thyroiditis. Some medications such as lithium, amiodarone, and thalidomide have been known to cause hypothyroidism. Exposure to radiation is another important source of hypothyroidism.

When thyroxine levels are too high in the body this is called hyperthyroidism. Major clinical signs include weight loss (often accompanied by an increased appetite), anxiety, intolerance to heat, hair loss, muscle aches, weakness, fatigue, hyperactivity, irritability, and low blood sugar. Panic attacks, inability to concentrate, and memory problems may also occur. Some patients may experience cardiac arrhythmias; symptoms that are more present in elderly patients. A high percentage of hyperthyroidism in the US is caused by an auto-immune condition known as Graves’ disease.

The word nodule is not specific. It simply means a growth or mass within the gland. They can be a variety of sizes and can present as a single nodule or multiple nodules within the gland. In order to determine if the nodule is benign or malignant further investigations are necessary. It is important to know that a thyroid gland can have nodules and still have normal function.

The term “goiter” refers to the abnormal enlargement of the thyroid gland. A goiter can occur in a gland that is producing too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of hormone (euthyroidism). A goiter can be overall enlargement of the gland or a collection of multiple nodules. A large goiter can be clearly visible and cause compressive symptoms of shortness of breath and difficulty swallowing.

An ultrasound exam of the neck is the optimal method for evaluating the structure of the thyroid gland. The ultrasound can determine the location, number, and size of nodules. It also helps in determining the character of the nodules and looks at internal architecture and blood flow. This assessment helps characterize nodules as likely benign, suspicious, or concerning for underlying malignancy. The lymph nodes in the neck can also be examined for any enlargement indicating possible spread of cancer. Other tests such as CT scans may also be ordered to evaluate thyroid nodules.

Although an ultrasound can provide information regarding the likelihood of malignancy, tissue is required for definitive diagnosis. For some nodules an ultrasound guided fine needle aspiration (FNA) biopsy acquires cells from within the target nodule for pathological analysis. This FNA biopsy is an office based procedure that requires only local anesthesia. In the vast majority of cases, the FNA is sufficient for diagnosis of cancer. Occasionally, cellular features do not allow for definitive diagnosis. 

There are three common types of thyroid cancer. Papillary thyroid cancer represents 70% of all thyroid malignancies. It can present in multiple parts of the thyroid simultaneously, so complete surgical excision is recommended. Follicular carcinoma represents another 25% of thyroid cancers and is treated in a similar fashion. It is more likely to have spread to the lymph nodes at the time of diagnosis, however still carries a good prognosis. A much more aggressive variant, Medullary carcinoma is fortunately rare, comprising less than 5% of thyroid cancers. It is also treated surgically, however more extensive lymph node dissections are typically performed in addition to gland excision. Anaplastic carcinoma, a very rare form, presents in the elderly and is often fatal.

Thyroid surgery is performed under general anesthesia. Although minimally invasive options are being developed, an anterior neck incision is still commonly utilized. The surgery is typically 2 to 3 hours and due to the cosmetically sensitive area, closure is performed carefully. An attempt is made to “hide” the incision in existing neck folds and this area typically heals very well. For a hemi-thyroidectomy, patients often go home the same day. For a total thyroidectomy, patients may stay overnight in the hospital to monitor calcium levels.

As with most surgeries, there are common risks of bleeding, infection, and those associated with general anesthesia. Infection is very rare postoperatively in thyroid surgery. Occasionally, the parathyroid glands are affected by the local manipulation of tissue. Following total thyroidectomy some patients will have a transient drop in calcium levels and will require supplementation. A dangerous or precipitous drop in calcium is uncommon, but can occur. As a result, calcium levels are often followed closely in the post-operative period with serial blood tests. Permanently low calcium levels are rare. The thyroid gland overlies the recurrent laryngeal nerve, the nerve that controls our vocal folds. In the event this nerve is injured during surgery, vocal fold paresis or paralysis can occur. This can lead to a weak, hoarse voice, difficulty swallowing, and shortness of breath with exertion.

The recovery from thyroid surgery is typically quite quick. Normal daily activities can resume quickly with the exception of heavy lifting. Neck soreness and discomfort with swallowing are the most common complaints. Pain medicine, occasionally antibiotics, and supplemental calcium are often provided. If the entire gland has been removed, the patient begins thyroid replacement medication.