• Dr Jeeve Kanagalingam ENT
  • Dr Jeeve Kanagalingam ENT
  • Dr Jeeve Kanagalingam ENT

Thyroid

Dr Jeevendra Kanagalingam

The thyroid gland is a complex endocrine organ that is butterfly shaped and sits in the centre of the neck, in front of the windpipe. It derives its name from the greek word thyros which means shield. The thyroid gland may be overactive and produce too much thyroid hormone – a condition called hyperthyroidism or thyrotoxicosis. Similarly, it may sometimes be underactive causing hypothyroidism or myxoedema.

The thyroid gland may contain nodules. One in 20 people will have a nodule in their thyroid that can be felt. With an ultrasound scan, up to 60% of women will have a thyroid nodule.This may be solitary but is often multiple – a condition known as multinodular goitre (MNG). Thyroid nodules may cause several problems:

  • 5-10 % nodules may contain cancer
  • Overactive nodules may cause hyperthyroidism or thyrotoxicosis
  • Large nodules are unsightly and may causing swallowing or breathing difficulties

The incidence of thyroid cancer in Singapore is rising. The current incidence is 6.5 cases per 100,000, up from 4.3 in 1968. The outcome of thyroid cancer is favourable if detected early.

There are five main varieties of thyroid cancer. The most common is papillary thyroid cancer. Together with follicular thyroid cancer, these two subtypes of thyroid cancer make up the well-differentiated thyroid cancers. Medullary and anaplastic thyroid cancers are more aggressive forms of thyroid cancer. They are rare and outcomes are poorer. A final category of thyroid cancer is thyroid lymphoma. Thyroid lymphoma responds well to drugs and does not require surgery to remove the entire gland.

Evaluation and Assessment

Patients with thyroid nodules or swelling should have a thorough evaluation by an Endocrinologist or Thyroid Surgeon. The key aspects of this evaluation include:

  • Comprehensive blood tests for thyroid function
  • Assessment of vocal cord function by nasal endoscopy
  • Assessment of the thyroid gland by high-definition thyroid ultrasound
  • Fine needle biopsy and cytology for nodules

My Training and Philosophy

I learnt thyroid surgery in London at the Royal Postgraduate Medical School, Hammersmith Hospital, London and then at the Royal Marsden Hospital, London. Surgeon-performed ultrasound is an increasingly important aspect of the surgical evaluation of the thyroid gland. I learnt this skill in San Francisco with the American College of Surgeons and now run a course on thyroid ultrasound with the College of Surgeons, Singapore. I believe that the surgeon-performed ultrasound improves surgical outcomes. I learnt minimal access endoscopic thyroid surgery from Professor Luong in Vietnam and trans-axillary gasless robotic thyroid surgery from Professor Chung in Yonsei University, Seoul, South Korea.

I adhere to international accepted guidelines and norms. Many thyroid nodules do not require surgery and it is important to operate only when necessary. When surgery is indicated, I use the Nerve Integrity Monitoring system and Harmonic Focus™ scalpel to ensure optimal voice outcomes and minimal blood loss. Safety is paramount.

Decision-making

Advanced-Surgical-Skills

Having a problem with your thyroid gland or the suspicion of thyroid cancer can be very distressing. Whilst removing the thyroid gland solves this problem, surgery is not without its risks. I believe in evidence-based medicine and the of use international guidelines to help inform patients of their treatment options.

Surgery and Advances

Thyroid surgery has evolved significantly since Professor Theodor Billroth performed the first operation in Zurich in the late 19th century. Billroth gave up on thyroid surgery initially as the risks were high. However, as surgical techniques improved, he returned to performing thyroid surgery. Today, thyroid surgery is safe and effective. The risks of complications is about 1%. Thyroid surgery is performed under general anaesthesia. I use a Nerve Integrity Monitoring system and Harmonic Focus™ scalpel to ensure optimal voice outcomes and minimal blood loss.

For patients with thyroid cancer, Mount Elizabeth Novena Hospital offers in-patient high-dose radioiodine treatment. We also have an advanced PET-MRI scanner which is ideal for detecting recurrent thyroid cancer which may escape detection by whole body radioiodine (I131) scans.