1. Definition
Epithelial cells (vesicular cells), whose growth is controlled by TSH, give papillary and vesicular K.
Risk factors:
– Mostly among women
– Ionizing radiation
– Iodine deficiency
2. Diagnosis
– 90% of nodules are benign
– No action undertaken for nodules under 1 cm
– For nodules larger than 1 cm:
– TSH assay
– Thyroid ultrasound to identify the nodule
– Thyroid scintigraphy
– Hot nodules are always benign
– Cold nodules: 10% risk of cancer; cytopuncture must follow
– Cytology by biopsy
– Surgical exploration if necessary
PURPOSE: to let as little cancer through as possible
3. Surgical indication
– Family history
– Cervical irradiation history
– High Calcitonin
– Nodule > 3 cm (no involution, long-term risks of compression, unreliable cytopuncture)
– Nodule within a goitre
– Hard nodule
– Fixed nodule
– Suspicion of multiple nodules
– Compression
4. Surgical method
– Operating time: 1h
– If single nodule: thyroid lobectomy
– Advantage: no post-operative hormone therapy
– Total thyroidectomy in case of multi-nodular goitre
– Necessity of treatment with synthetic hormones (Levothyrox)
Explorative cervicotomy
Duration of hospitalisation: 48 hours for a lobectomy, 72 hours for a total thyroidectomy
Risks: recurrent laryngeal nerve damage resulting in bitonality; food occasionally going down the wrong way
– Recovery in 90% of cases with speech therapy sessions by a speech therapist
Risk of damaging the parathyroid glands
– Consequences: hypocalcemia, which leads to a tingling feeling in the hands and feet
– Correction with calcium supplements
