What are thyroid conditions?
The thyroid is an endocrine gland in the neck that regulates metabolism. Its main surgically relevant conditions are:
- Nodules and nodular/multinodular goiter.
- Overactivity (hyperthyroidism, toxic goiter, Graves' disease).
- Thyroiditis and underactivity.
- Thyroid cancer (differentiated, medullary, anaplastic).
How common are they?
Thyroid nodules are very common: palpable in about 5% of the population but detectable on ultrasound in up to 50–60%, especially in women and with age.
The vast majority of nodules are benign; an estimated 5–7% are malignant, which is why correct evaluation is decisive.
How do they present?
Many conditions are asymptomatic and found incidentally. When symptoms occur:
- A palpable swelling or "lump" in the neck.
- A sense of pressure, difficulty swallowing or breathing (with large goiters).
- Hoarseness — a finding that requires investigation.
- Symptoms of hyperthyroidism (palpitations, weight loss, anxiety) or hypothyroidism (fatigue, weight gain).
How are they diagnosed?
Evaluation combines hormonal, imaging and cytological assessment:
- Neck ultrasound: characterises nodules (TI-RADS) and neck lymph nodes.
- Hormonal tests (TSH, free hormones, antibodies): assess function.
- Fine-needle aspiration (FNA): cytological diagnosis by Bethesda — the key tool for distinguishing benign from malignant.
- Laryngoscopy (vocal cord check) and CT for large or retrosternal goiters.
How are nodules categorised?
Two systems guide the surveillance-vs-surgery decision:
- TI-RADS: ultrasound risk categorisation of a nodule, determining whether FNA is needed.
- Bethesda (I–VI): cytological categorisation of FNA material, from benign to malignant, determining the treatment strategy.
Combining them allows an individualised decision that avoids unnecessary surgery.
Modern treatment options
Management depends on the nature of the condition. Many benign nodules are simply monitored, while surgery is indicated in specific cases, prioritising protection of the voice and the parathyroid glands.
Total thyroidectomy
Removal of the entire gland. Indicated for multinodular goiter with pressure effects, Graves' disease and thyroid cancer. Performed with intraoperative nerve monitoring (IONM) and protection of the parathyroids.
Lobectomy (hemithyroidectomy)
Removal of one lobe. Indicated for unilateral disease, for indeterminate nodules (Bethesda III–IV) to reach a definitive diagnosis, or for selected small differentiated cancers.
Active surveillance
For benign, small and asymptomatic low-risk nodules. It involves periodic ultrasound and hormonal review, avoiding unnecessary operations.
Neck lymph node dissection
In thyroid cancer with involved neck lymph nodes, a targeted dissection (central and/or lateral compartment) complements thyroidectomy according to oncological principles.
Frequently asked questions
Is my nodule cancer?
In the vast majority, no. An estimated 5–7% of nodules are malignant. Ultrasound (TI-RADS) and, where needed, FNA (Bethesda) reliably identify suspicious nodules.
Will I need hormones after surgery?
After total thyroidectomy, lifelong thyroid hormone replacement (thyroxine) is needed. After lobectomy, a proportion of patients retain adequate function.
Will there be a visible scar?
The classic incision is small and planned to leave a discreet result. In selected cases, alternative approaches without a visible neck incision are available.
Is my voice at risk?
The risk of permanent voice change is low, particularly with intraoperative nerve monitoring (IONM), which helps identify and protect the nerve of the voice.