THYROID AND PARATHYROID DISEASES: DIAGNOSIS, TREATMENT AND SURGERY WITH CURRENT APPROACHES

thyroid_and_parathyroid_diseasesnevinsakoglukapak1-0-25

SURGICAL INDICATIONS IN THYROID DISEASES

Mehmet Köstek

Ümraniye Research and Training Hospital, Department of General Surgery, İstanbul, Türkiye

Köstek M. Surgical Indications in Thyroid Diseases. Kesici U, ed. Thyroid and Parathyroid Diseases: Diagnosis, Treatment and Surgery with Current Approaches. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.59-66.

ABSTRACT

Thyroid surgery is one of the most common surgical procedures in the world. Diseases of Thyroid gland can be in a wide spectrum and mostly related with malignancy, hormone secretion or volume. Thyroid diseases should be evaluated precisely and available treatment options as well as medical con- ditions of the patient should be considered while having a decision for surgery. Multidisciplinary teams can be helpful for deciding on best treatment for patients with thyroid diseases. Malignancy of the thyroid gland is not rare and more detailed imaging studies with the advancement of imaging technol- ogies help clinicians to diagnose thyroid malignancies more often and earlier. Differentiated Thyroid Cancer, Medullary Thyroid Cancer and Anaplastic Thyroid Cancer are the main subgroups of thyroid malignancies. Main treatment modality for the thyroid cancer is Thyroidectomy. Suspicion for thyroid malignancy is another important topic of thyroid diseases. Thyroid gland nodules should be evaluated with ultrasonography and the risk of malignancy should be assessed. The thyroid nodules with mod- erate to high risk imaging findings should be considered for Fine Needle Aspiration Biopsy (FNAB). According to the results of FNAB, risk of thyroid malignancy is rated with Bethesda Classification and a decision for follow-up, repeat FNAB or thyroidectomy should be made. Hyperthyroidism is a disease that is related to increased function of thyroid gland. The most common etiologies for hyperthyroidism are solitary toxic adenoma, toxic multinodular goiter, and Graves’ Disease. Several treatment choices are available in these patient group, however, thyroidectomy is indicated in certain cases. For solitary toxic adenoma and toxic multinodular goiter, a definitive treatment such as thyroidectomy or Radio- active Iodine treatment is needed. Patients with bigger gland volume and nodule diameter, young age and suspicion for malignancy are mostly referred to the surgery. Graves’ Disease is mostly treated with anti-thyroid medications, however, in patients with ophtalmopathy, recurrence after medical treatment, thyroid nodules, young age and higher gland volume are mostly referred for surgery. Local compres- sive symptoms such as dyspnea, dysphagia or neck fullness may be caused by diffuse or multinodular goiter and the most effective way of treatment is thyroidectomy. Also, asymptomatic substernal goiter with findings of compression on imaging studies should be evaluated for surgery.

Keywords:Thyroidectomy; Thyroid diseases; Thyroid cancer; Fine needle aspiration biopsy; Thyroid nodule; Hyperthyroidism; Multinodular goiter; Substernal goiter

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