Therapy
An enlargement of the thyroid gland should always be clarified by a doctor. A mere enlargement does not cause any symptoms at first. However, if the thyroid gland reaches a volume of around 2 liters (standard value 20-60 milliliters), postural deformity and impairment of head and neck movements are to be expected due to the weight alone.
This can lead to permanent postural deformity, simply because of the high, unphysiological weight. In addition, extreme thyroid enlargement naturally affects the respiratory and digestive tracts, resulting in breathing problems and difficulty swallowing. This is the most favorable course of action in case the enlargement was caused by iodine deficiency and not by a tumor metastasis, adenoma, or other malignant disease.
Thus, thyroid carcinomas generally have a good 5-year survival rate of 60-90% with early treatment. In anaplastic thyroid carcinomas, however, the 5-year survival rate is only 10%, which shows that even an enlargement of the thyroid gland can be fatal. Therefore a prompt clarification by the family doctor is necessary.
Due to the slow growth, however, patients usually wait until the last moment, otherwise they will not feel any discomfort. In principle, there are 3 treatment approaches to treat thyroid enlargement. They all have different indications, as well as advantages and disadvantages.
Firstly, the drug treatment by substitution of the missing thyroid hormones, and administration of iodide.To take up the previous example, if 100 cells have enough iodine available to produce enough thyroid hormones for the body, the remaining 100 glandular cells can be dispensed with, they become superfluous and can be broken down. Thus the thyroid gland shrinks again. The substitution of the thyroid hormones also has the additional effect that the thyroid is not further fired with TSH via the thyrotropic regulatory circuit – TSH ultimately stimulates the thyroid tissue to grow and produce.
However, the drug treatment can only be used if there is no concomitant hyperthyroidism. After all, if iodine is administered, one would then pour additional oil into the fire and provide the thyroid gland with further “fuel” to produce more hormones. Also any (uncontrollable) autonomies or carcinomas in the thyroid gland must not be supplied with iodine, since they cannot be controlled and can continue to grow.
Drug treatment is given over a period of one to one and a half years, but lifelong follow-up care and control is necessary. The second treatment approach is surgery. It is indicated when thyroid carcinoma is suspected, or when the trachea and esophagus are narrowed.
Cold nodules and suspected malignant tumors may also be a reason for surgery. The danger with surgery is that the thyroid tissue has already grown into adjacent structures and infiltrated them. Specifically, the laryngeal recurrent nerve and the vessels supplying the brain can be affected.
A so-called recurrent-paresis, which occurs after damage to the vocal cord nerve, results in one or both vocal folds no longer being able to move. Although the complication rate for thyroid surgery is only 1%, voice training is necessary after vocal cord paralysis to prevent the voice from sounding permanently hoarse. The vessels supplying the brain can also be injured, although the risk is not so much from an insufficient supply of blood to the brain as from excessive bleeding in the neck.
The brain is supplied with blood via a total of 3 large vessels, so an injury to one of the three vessels can be easily compensated. However, bleeding in the neck area is not without its consequences, as a lot of blood can be lost here and the pressure in the vessels is relatively high due to the proximity to the heart. However, struma surgery is one of the standard operations, and is usually performed without complications.
Small operations leave only a small, thin scar under the larynx. This scar will initially appear slightly reddish, but in the course of the operation it will hardly be visible. After the operation, a lifelong treatment with L-thyroxine and iodine is usually necessary, since the body first of all wants to produce the missing thyroid tissue again.
In order to prevent this, the above mentioned drugs are used. Stopping would result in renewed growth. The third and last treatment option is radioiodine therapy.
In this therapy – simply put – radioactive iodine is introduced into the thyroid gland, which then destroys it from within. The special trick with this method is that the radioactive iodine is only absorbed by the thyroid gland and not by any other body cell. This ensures an absolutely precise treatment.
Since only thyroid cells absorb iodine, the radioactive iodine isotopes are deposited in the cells of the thyroid. There they radiate highly energetically onto the surrounding tissue. Since after (oral) application, the patient himself radiates radioactively and could thus harm other people, a minimum of 48 hours accommodation in a radiation-proof building is required by law. Radioiodine therapy may also be necessary as a pre-treatment before surgery.
