The thyroid gland can be thought of as an engine that regulates the body’s metabolic rate. If the engine idles too fast the patient is “hyperthyroid”, and if the engine idles too slow the patient is “hypothyroid.” The latter is commonly associated with weight gain. However, most of the time the engine runs normally and patients are labelled “euthyroid.” General surgeons frequently see patients with thyroid nodules and goiters. The latter is defined as diffuse enlargement of the thyroid, symmetrical or asymmetrical, that can be associated with low iodine consumption. Thyroid function can be assessed with a simple blood test.
Patients with thyroid nodules usually present with a painless lump in the neck. However, the physician will routinely ask about neck pain, enlargement, and difficulty swallowing. A neck ultrasound and a needle biopsy are used to establish the diagnosis and direct treatment. Benign nodules are observed, suspicious nodules require a hemi-thyroidectomy, and malignant nodules require a total thyroidectomy.
The management of goiters is more complicated, but in general treatment is conservative and consists of medication and occasionally radioactive iodine. A total or near total thyroidectomy is reserved for patients who have pressure symptoms, who fail medical therapy, and who have a suspicion of malignancy.