Male patient with a large thyroid

Male patient with a large thyroid
Thyroid enlargement is very common among females of child bearing age. Thyroid is exposed to hormonal changes during puberty, pregnancy and lactation. There can be irregular growth of gland with nodule formation due to increased demand of thyroxine during these periods of high demand. It is rare to get thyroid enlargement among males. When a male has a goiter, we have to exclude malignancy as early as possible. Thyroid profile, ultra sound scan of thyroid and fine needle aspiration cytology of lump is done in any patient with a goiter. If the profile shows decreased production of thyroxine, hormone replacement therapy will reduce the size. Ultra sound scan reveals whether the enlargement is smooth or nodular, whether the nodule is hard or fluid filled, whether there is an extension of goiter in to the chest cavity. If the goiter is compressing the air way, surgery has to be done immediately to relieve the wind pipe. . If the fine needle aspiration cells reveals cancer cells ,whole thyroid gland has to be removed along with the enlarged lymph nodes if any. During post operative period , radio iodine treatment has to be given to ablate the residual thyroid tissue. Patient need life long follow up by a cancer specialist . If the aspiration is harmless we can plan the operation for cosmetic reasons. The thyroid gland is related to few important structures. Nerve supply to our voice box is underneath the thyroid gland. Extra precautions has to be taken to protect the nerve during surgery. Parathyroid glands which are responsible for bone remodeling and calcium metabolism are also under the thyroid gland. These glands are four in number. We have to Preserve at least two of them during surgery. If the nerve to voice box is damaged, patient's voice is hoarse. To correct the voice, speech therapy exercises are given for a long period. If the voice is not better with these exercises,another operation is required to correct the voice. If all four parathyroid glands are removed, patient will have serious consequences . Due to all these reasons, surgeons are reluctant to remove thyroid gland for cosmetic reasons.