The thyroid gland is the largest gland in the endocrine system in the body. It is located at the front of the neck, below the larynx, and has a butterfly-like shape with wings on both sides. Its main function is to produce and secrete thyroid hormones into the bloodstream to perform various roles in the body, such as aiding in metabolism to generate energy, ensuring normal cell function, maintaining body temperature, and stimulating the cardiovascular system, among others.
What types of thyroid diseases require surgery?
Thyroid disorders can present in various forms, mainly divided into two groups:
- The thyroid gland produces abnormal hormone levels, which may or may not involve tumors.
- The thyroid gland produces normal hormone levels but has tumors, which require different treatments.
If there is abnormal hormone production, doctors will treat by controlling thyroid hormone levels using medication or iodine radioisotope therapy to restore normal thyroid function. Surgery is not the primary treatment in this case, but if medication fails, surgery may be necessary.
For thyroid tumors, they are divided into two groups: benign tumors and thyroid cancer. For benign tumors, if the nodule is not large, surgery is not always necessary; hormone replacement therapy may reduce the tumor size. However, for cancerous tumors, surgery is required. The decision for surgery depends on several factors, such as the tumor compressing the airway, cases where the tumor appears suspicious for cancer even if not confirmed, or risk factors increasing the likelihood of cancer, such as a history of radiation exposure to the neck or a family history of thyroid cancer. In these cases, doctors will consider surgery more seriously.
Thyroid Surgery
Traditionally, thyroid surgery involved an open incision on the front of the neck, which was effective but left a long scar of 8-10 centimeters. If the tumor was very large, the scar would be even longer. Some patients might develop keloid scars, which are clearly visible and aesthetically unpleasing, potentially affecting mental health. Some patients rely on their appearance for work, so this could impact their life opportunities. Medical professionals have therefore sought ways to minimize the scar size by using endoscopic surgery (Direct Cervical Approach), but a small scar on the front of the neck still remains. Later, methods were developed to relocate the scar to less visible areas or perform scar-hidden surgery (Extra Cervical Approach), such as through the armpit, under the clavicle, or around the nipple area. These approaches allow access to the thyroid gland through the subcutaneous layer using specialized equipment like robotic cameras, sometimes requiring gas insufflation to expand the tissue layers. These techniques may cause some side effects from the equipment and potentially more postoperative pain due to the larger dissection area.
Recently, a method has been developed to make an incision behind the ear and directly approach the thyroid tumor. This method is advantageous because the distance from behind the ear to the thyroid gland is shorter than from the armpit, resulting in less pain while maintaining good outcomes and potentially similar side effects to open neck surgery.
Limitations of the scar-hidden surgery behind the ear
Thyroid surgery using the scar-hidden method behind the ear is almost no different from open neck surgery. The main advantage of this method is that it hides the scar from view.
However, there are some limitations. This method is suitable for tumors that are small, not exceeding 4-5 centimeters. If the patient has a thin neck and highly stretchable skin, surgery may still be possible. Additionally, scar-hidden surgery behind the ear is not a minor procedure; patients must prepare for surgery and postoperative care similarly to major surgery, including a hospital stay of 3-5 days (if no complications arise).
