Latest Trends In Thyroid Surgery & FNAC

The last hundred years have witnessed a great transformation in thyroid surgery and its surgical management. Thyroid surgeries are performed all over the world regularly and with minimal morbidity and mortality, says Prof. G. Sivakumar, Consultant General Surgeon.

How important is the Thyroid Gland for our body?

The thyroid gland is an endocrine gland that is responsible for several vital functions:

  • It takes care of the metabolism of the entire body.
  • It produces thyroxin, which is essential for the functioning of every cell in the body.
  • It plays an important role in the normal growth and development.
  • Thyroid dysfunction, be it hyper functioning or hypo functioning, can lead to clinical diseases. Iodine in the diet is essential for the proper functioning of the thyroid.
  • Thyroid can also be the seat of tumours and cancers.

What happens if there are thyroid abnormalities?

When thyroid secretion is low

All body functions are slowed down. The patient becomes lethargic. The heart rate becomes slow. The intestinal movements are sluggish and the neuro muscular system is also weak. In women, the hormonal imbalance produces irregularities in menstruation and may lead to sterility. All the symptoms can easily be corrected by taking thyroxin tablets. (These are inexpensive). The medical term for hypo functioning is ‘myxoedema’.

When thyroid secretion is high

Hyperfunctioning of the thyroid gland, also known as the ‘toxic state’, makes every organ work at a faster pace. The patient is hyperactive, the heart rate is fast and the intestinal movements are rapid leading to a voracious appetite and diarrhoea. Rapid pulse rate for a long period can produce cardiac irregularities. This disease is also called ‘graves disease’.


Goitre refers to enlargement of the thyroid gland. People living in hilly areas are more prone to goitre due to iodine deficiency. Hence, iodised salt is essential to control thyroid diseases. When multiple nodules occur in goitre it can compress vital structures in the neck.

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When is surgery required?

Surgery for thyroid is often required to correct certain nodules occurring in the thyroid. The common indications for thyroid surgery are:

  1. Adenomas
  2. Cancerous nodules
  3. Multi nodular goitres
  4. Graves disease [thyroid hyper functioning]

Surgical treatment for thyroid diseases was pioneered by Theodor Kocher in the late 19th century. He was awarded the Nobel prize for medicine in the year 1909. Theodor Kocher was a pioneering surgeon of the last half of the nineteenth century. His major discoveries were in the field of surgery of the thyroid gland. The contributions of Theodor Kocher had a great impact on thyroid surgery. He was awarded the Nobel prize in medicine in 1909 for his achievement in this field.

Also read: Weight loss surgery for diabetics- is it needed?

Fine Needle Aspiration Cytology

Fine Needle Aspiration Cytology (FNAC) of thyroid nodules is performed routinely for the preoperative assessment of patients with thyroid nodules. FNAC has become a very important diagnostic test. FNAC, however, continues to have some limitations when used as the sole preoperative diagnostic test and should never overrule good clinical judgement.

FNAC has become a widely accepted diagnostic test for the preoperative assessment of patients with solitary thyroid nodules. It is an accurate, safe and cost-effective method. When performed by an experienced cytopathologist, FNAC has largely replaced radio-isotope and sonographic imaging in preoperative evaluation.

The main purpose of performing FNAC is to distinguish those patients who have thyroid neoplasms that require operative intervention from others who need medical treatment. FNAC has clearly decreased the number of unnecessary thyroid operations. The reported false-positive rates of FNAC generally range from 1 % to 9% whereas the false-negative rate ranges from 0% to 3%.

It has some limitations. First, in suspicious cytology, the accuracy is lower. It cannot say for sure in follicular malignancies. The imaging modalities are always required to quantify the nodule and nodal involvement.

Thus, FNAC should be the first investigation in the diagnosis and may be performed on the first visit itself as an office procedure.

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