Questions to Ask Before Agreeing to any Surgery on Your Thyroid!

Filed in Articles and Presentations on March 28, 2014

Parathyroid gland anatomyLast year an important report came out showing how thyroid cancer had dramatically increased out of all proportion to expected incidence rates.   The report clearly laid the door at the over treatment and radiation of patients.   It emphasised with the investment in portable imaging physicians were using this to find small and indolent tumours in the thyroid which if left alone would have been dealt with by the body and no one known the wiser that the patient had had a brush with cancer.   Through interference via surgery, radiation the initial problems or nodules were magnified out of all proportion and created full blown cancer.

It is known that the province of Ontario has an endemic sub clinical hypothyroid problem in its population and our thyroid cancer rates are rising in women faster than breast cancer.  So this article is devoted to questions you should ask before agreeing to any form of surgery.  Imaging alone is not diagnostic and surgery is irreversible.  The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis; (Brito J, Gionfriddo M et al.; Journal of Clinical Endocrinology & Metabolism (Nov 2013) Concluded that this means ( ie. ultrasound ) was only for evaluation and  not predictive of potential thyroid cancer. As an example, solitary nodules where there is undetectable TSH,  is often a thyroid follicular adenoma and is usually always benign.  There is also a rare condition called De Quervain’s thyroiditis which may give a misleading impression of thyroid carcinoma.  However,  it is a condition triggered by fever and reversible.  Watch and wait is always a better option and going to a Medical Herbalist may well resolve the issue as we have many plants for thyroid conditions whereas OHIP essentially only has one drug.

Question No.1

Have you had blood work done ?  Blood work should give data on TSH, free T3, free T4, thyroglobulin, thyroid peroxidase.  These are the principal signalling hormones associated with the Thyroid.  They need to be within certain parameters, individually, and in relation to each other.  Viral infections and gluten can increase the level of thyroglobulins impairing the function of the thyroid.   T3 and T4 reflects the molecules of iodine which are broken down to achieve the necessary bio chemical reactions and signalling in the body.  You may just have a simple deficiency of iodine.

Question No.2

Do you have a zinc or selenium deficiency?  The lack of these key minerals also affect the thyroid.

Question No.3

If you have a gluten intensive diet you may have an impairment of the thyroid as it builds up anti bodies in the thyroid which prevent the release of T4.   Simple solution – gluten free diet! It is not a thyroid in need of removal.

Question No. 4

If I have my all or part of my thyroid removed what are the implications.?

Well, we have to consider what are the major functions of the thyroid.  Firstly, there is the issue of fertility.  The thyroid is responsible for the gonadtrophic ( sex ) hormones in the body under the direction of the hypothalamus.   Any loss of the thyroid gland will affect the quantity and timing of such hormones being made, which in turn reduces fertility, and sub optimal performance in women of their regular cycle and in men spermatogenesis.  There is also the issue and being able to hold a pregnancy until term as a malfunctioning thyroid is known to cause spontaneous abortion.

The next major function is the regulation of the bone formation and calcium.   Calcitonin in the parathyroid and the function of Vitamin D3 is regulated by the thyroid and the parathyroid gland contained with the thyroid.  Removal of the thyroid may, down the line, mean calcium loss, and bone disorders such as osteoporosis, osteopaenia, osteoarthritis although in the described bone disorders calcium is only part of the picture and reflects nutritional deficiencies in other areas.

A poorly performing thyroid has a direct impact on metabolism and when the thyroid is removed it will always perform poorly as the feed back mechanism on which the gland depends has been broken.  It is replaced with a drug call thyroxine which is inorganic and poorly monitored resulting in poor physiological function.  All thyroxine does is to replace T4 in the body but it cannot respond to increased or decreased demand for T4 as it is inorganic.  Women particularly suffer in this area as the female hormones have a 28 day cycle which varies considerably in those 28 days.  Metabolism in this context means the digestion and absorption of food integrating the roles of the liver, pancreas, and kidney.  Constipation for example can be a direct result of a hypothyroid.

The kidneys work on a direct signalling system with the thyroid and the regulation of osmolarity i.e fluid volumes in the body.  This means your kidneys are impacted by the removal of the thyroid with the potential to reduce the absorption of Vitamin D, the creation of new red blood cells, another important function of the kidneys.

Question No 5.

If I agree to go ahead with the operation what are the risks?

Firstly, there is likely to be a scar, depending on the skill of the surgeon.

As the location of the thyroid is under the chin and wrapped in a butterfly shape around  the oesophagus ( throat ) and the voice box can be damaged. The jugular and carotid arteries are directly either side of the thyroid they maybe nicked and cause haemorrhage. Nerves may also be affected.

Removal of the thyroid does not stop cancer.  Cancer is a biochemical disease with a multi factorial multi pathway disease.  Removal of any active tumour increases the spread of cancer for example into leukaemia.

Radiation of the thyroid will eventually make the situation worse as radiation is an inflammatory process and it destabilizes DNA .

There is no effective chemotherapy regime.  Sorafenib has recently been approved for thyroid cancer but there are huge negative side effects especially in the liver and again the drug only deals with a specific pathway.

Any infection in the vicinity such as the mouth or salivary glands should be cleared up before any surgical intervention. Post surgery a patient will in all probability have to take Thyroxine for life, and constantly monitor calcium homeostasis and kidney function.

JAMA Otolaryngol Head Neck Surg. Published online February 20, 2014. doi:10.1001/jamaoto.2014.1

An exponential growth in Incidence of Thyroid cancer: Trends and impact of CT imaging. Hoang JK, AJNR Am J Neuroradiol 2013 Oct 10

Britto JP et al. BMJ Too much Medicine Campaign Aug 27 2013

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