Strange? No, it actually looks like a butterfly from the front. The wings being the two right and left lobes, the body - the isthmus and the antenna - the pyramidal lobe, all of which are parts of an important structure in the body called the thyroid gland. It secretes a hormone for daily bodily functions called thyroxine. So?? Such a beautiful organ can go wrong in 3 ways: 1. Function — too active or too passive ( hyperthyroid / hypothyroid ) 2. Size — it can just swell up and press onto the trachea or esophagus causing difficulty in breathing or swallowing 3. Combination of both Medications can be used to control the function but surgery is usually the option for size or when medical treatment fails to control the dysfunction.Problem? — Surgery has a risk of injuring the nerve that supplies the vocal cords and in a case of one sided damage it causes hoarseness of voice and if both sides are damaged then it can cause loss of voice and difficulty and noisy breathing. thus the worry for both patients and surgeons though the risk is actually very small.
Well, there was this lovely 60 year old lady who came to see me for an swelling over the neck which had increased in size significantly over the last 6 months. A fine needle biopsy, an ultrasound and a CT scan all pointed to a non cancerous origin and made me more worried because clinically this looked and felt malignant.
So, after explaining in depth and a trip to redang, I came back to wiggle my scaple along the lady’s neck. So off I went chop!chop! swish! .. oops! maybe not! continue…… as the hours passed a huge 10cm by 8cm by 6cm left lobe mass was removed together with the nodular right lobe and isthmus. Total thyroidectomy done. At the end, it was a lesson in anatomy as all the structures were very visible.
Well, surgery went well. Though exhausted I was happy that her voice was salvaged.The butterfly gland was sent to pathology for reporting.
Probably will have a part 2 for the later outcome. Interested??