Thyroid Surgery

Porto • Clínica • Consultations and Surgeries

AddressRua da Venezuela, 139
4150-744 Porto, Portugal

GPS41.1571893, -8.6433279

Phones(+351) 225 432 321
(+351) 226 009 494

Fax(+351) 225 432 371

Emailgeral@clinicalusoespanhola.com

ScheduleMonday to Friday, from 9h to 21h

Lisboa • Consultations

AddressCampo Grande, 220 D 1º C
1700 - 094 Lisboa, Portugal
(Dr. Tallon Clinic)

GPS38.753766, -9.1502962

Phone(+351) 225 432 321

Emailgeral@clinicalusoespanhola.com

Contact us

1. Thyroid Cancer

Thyroid cancer is a type of cancer that responds very well to treatment in most cases.

 

A. WELL DIFFERENTIATED THYROID CANCER

The types of cancer are differentiated:

1. Follicular Tumor
2. Papillary Tumor

The diagnosis is generally made with palpation of a nodule or by finding a nodule in ultrasound. Next, a biopsy should be done to make the diagnosis. However, in many cases, only if you are sure of whether it is cancer or not after thyroid removal and done the pathology.

 

The first step in the process of treatment for well-differentiated thyroid cancer is surgery to remove the thyroid gland. This is called a total thyroidectomy. Thyroid surgery is a very delicate procedure and, therefore, must be made by experienced surgeons (the thyroid gland is surrounded by many blood vessels and nerves that must be preserved).

In most cases, surgery of total or near-total excision of the gland is recommended. We recommend this approach based on our experience and in more advanced countries.

After surgery, the patient must take levothyroxine (letter, eutirox, etc.) to reset the values of thyroxine in the blood. Replaces one of the hormones that was produced by your thyroid gland.

 

 

 

 

Excision of remnants
After the surgery, some patients may require a second step to end up removing some rest of thyroid that may have stayed. This is done in the case of patients with follicular tumor, in which normally only is removed half thyroid and after confirmed malignancy, the removal of the rest of the thyroid (ipsilateral thyroidectomy). In other cases it may be necessary to take a dose of radioactive iodine to destroy a small rest of tissue that might have been. In these cases, one can take before a dose of TSH for iodine is absorbed more quickly by the remaining thyroid cells. Is administered in 2 shots before thyroid ablation procedure.

 

Tracking queries
There are three main tests that we can use after initial treatment to determine whether thyroid cancer cells remain in the body: tireoglobulina test (Tg), ultrasound and imaging studies (CT and gamagrafias).

Up to 30% of patients have a recurrence or recurrence. Most occurs within 10 years after the initial treatment; other occur decades later.

The prognosis of recurrence is improved when it is caught early. Therefore, routine exams are important for the rest of your life, especially in the first 5-10 years after surgery, when the risk of return of their cancer is greater.

 

B. PAPILLARY CARCINOMA

Papillary cancer represents 60 to 70% of all thyroid cancers. Women present papillary cancer two to three times more than men. However, because the nodules are more common in women, a lump of a man always raises further suspicion of cancer.

It is more common in young individuals, but grows and spreads more rapidly in elderly individuals.

Individuals undergoing radiotherapy of neck, usually to treat a benign condition on breastfeeding or in childhood or by another cancer in adult life, have a higher risk of developing cancer, papillary.

The papillary cancer treatment is surgical, but sometimes spreads to the lymph nodes neighbors.

Almost always surgery cure these small cancers.

As the papillary cancer can be stimulated by thyroid-stimulating hormone, are administered doses high enough to suppress the secretion of thyroid stimulating hormone and to assist in preventing recurrence.

Papillary cancer is almost always cured.

 

C. FOLLICULAR CARCINOMA

Follicular cancer represents approximately 15% of all thyroid cancers and is more common among the elderly.

Follicular cancer is also more common in women than in men. However, just as in the papillary cancer, a lump of a man has more likely to be cancerous.

More aggressive than the papillary cancer, follicular cancer tends to spread through the bloodstream, spreading cancer cells to various parts of the body (metastasis).

The follicular cancer treatment requires the maximum possible thyroid removal and the subsequent destruction of the remaining tiroidiano tissue, including the Mets, with radioactive iodine.

 

D. HÜRTHLE CELL CARCINOMA

Can be considered a subtype of follicular cancer and is characterized by the presence of oncocytes rich in mitochondria (Hürthle cells). The cutting surface is brown color. Microscopically, the Hürthle Cell Carcinoma diagnosis is made through the identification of capsular or vascular invasion, similar to follicular carcinoma. Rarely produces metastasis from a distance, although it produces all the well-differentiated (34% of cases).

 

D. HÜRTHLE CELL CARCINOMA

Can be considered a subtype of follicular cancer and is characterized by the presence of oncocytes rich in mitochondria (Hürthle cells). The cutting surface is brown color. Microscopically, the Hürthle Cell Carcinoma diagnosis is made through the identification of capsular or vascular invasion, similar to follicular carcinoma. Rarely produces metastasis from a distance, although it produces all the well-differentiated (34% of cases).

 

 

AND POORLY DIFFERENTIATED THYROID CANCER

1. Anaplastic Carcinoma
Anaplastic cancer accounts for less than 10% of thyroid cancers and occurs more often in older women. Grows very quickly and usually produces a large tumor on his neck. Almost 80% of patients with anaplastic cancer die within the first year.

The treatment is surgical excision. Treatment with radioactive iodine is useless. However, treatment with antineoplasmic drugs and radiation therapy before and after surgery has produced some cures.

2. Medullary Carcinoma
In Medullary cancer, thyroid produces excess amounts of calcitonin, a hormone produced by cells of thyroid parafollicular Cells (C) calls.

The cause of this neoplasm is a mutation that changes the RET proto-oncogene on chromosome 10. Can also produce other hormones, which can cause unusual symptoms.

Has a tendency to spread (metastasize) through the lymphatic system to the lymph nodes and through the blood to the liver, lungs and bones. Can occur along with other types of endocrine cancers in multiple endocrine neoplasia syndrome (MEN-2.And MEN-2.(B)).

The treatment requires the total excision of thyroid.

Survival at ten years old can be in excess of 60% in patients with multiple endocrine neoplasia. However, if the Medullary cancer occurs in isolation, survival is not so good. The multiple Endocrine Neoplasia can be hereditary and should be investigated. Even if family members have not yet Medullary cancer tests shall be made to verify that calcitonin is high or rises quickly after a stimulation; If applicable, the thyroid also must be removed to pre-empt cancer appearance.

The follow-up is done on serum calcitonin and periodic ultrasounds.

 

2. THYROID NODULES

In people subjected to an ultrasound, even 25% have thyroid nodules. Are more frequent in females and rarely give symptoms. Are rarely malignant. The risk of being malignant increases if: 1 a history of thyroid cancer, 2 history of endocrine neoplasms, 3. cervical radiation Background.

Can be hiperfuncionantes and produce hyperthyroidism or hipofuncionantes. Can produce compression of surrounding structures: dysphagia (difficulty swallowing), Dyspnea (difficulty breathing) and changes in voice.

In the case of lump tiroideu, must be made a thin needle aspiration biopsy puncture.

1. In case of being benign, the result will be: multinodular goitre, hyperthyroidism focus, simple cyst or colloid cyst.

2. If the result is to be suspected before a follicular tumor that may be malignant (carcinoma) or benign (adenoma), but only after we are sure taken half thyroid and analyzed the lump.

3. If the result is inconclusive; the biopsy should be retried.

4. If the result is evil: we are facing a papillary carcinoma, follicular, Medullary, Hürthel cells or Anaplastic.

 

3. HYPERTHYROIDISM

Is a medical condition caused by too much of the hormone tiroidea stock. The symptoms of hyperthyroidism are hyperactivity, mood changes (irritability), sweating and heat intolerance, palpitations, fatigue, weakness, weight loss and increased appetite (weight gain is rare), increased frequency of bowel movements, changes of menstruation (in General).

The doctor may notice signs such as: tachycardia, cardiac arrhythmias, fine tremor, hot and wet skin, alopecia (hair loss), eyelid retraction, among others.

Graves ‘ disease is the most common cause of hyperthyroidism associated with diffuse goitre (enlarged thyroid gland), exophthalmos (protruding eyes “) and skin changes.

Has its origin in the production of antibodies that attack the gland, simulating the TSH (thyroid stimulating hormone).

There is also the toxic multinodular goitre, which features tiroideos nodules (single or multiple) that produce hormones regardless of body control (hot spots). More common in the elderly, can occur in all ages and in women of reproductive age.

 

The available treatments for Graves ‘ disease are:
1. Antiroideas Drugs: what dose and Methimazole, which act on decreasing the gland hormone production.
2. Radioactive iodine Therapy: is given a small dose of radioactive iodine that provokes a reaction of tiroideana cell injury, leading to decrease of hyperthyroidism.
3. Surgery: it is an extremely efficient method of resolution of the hyperthyroidism.

In multinodulares toxic goiters usually indicate the surgical treatment or radioactive iodine.

Many patients abandon treatment for difficult to tolerate the use of so many medications and their side effects. In Spanish, we believe in Clínica Luso Espanhola that the best treatment option is surgery. The ideal condition to perform the surgical treatment of hyperthyroidism is when it gets control of hormonal levels with the use of medication antitiroidea and beta blockers.

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