Cosmetic concerns for patients requiring thyroid surgery

A female patient in District 8, Ho Chi Minh City, went for a routine health check-up and discovered a thyroid nodule measuring 9×7 mm in size in the right lobe, TIRADS 4 (with signs of malignancy). Fine needle aspiration (FNA) gave the result of Bethesda group 4 (risk of malignancy 45-50%).

Doctors during a thyroid surgery on a patient.

On August 2, MSc. Le Thi Ngoc Hang, Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, said that the patient's thyroid nodule was less than 1 cm in size and did not cause symptoms, so it was very difficult to detect. If it were not for the thyroid ultrasound during a routine health check-up, the patient would not know that he had a thyroid nodule that threatened to progress to cancer.

Doctors consult to find the optimal treatment plan for the patient. According to Master, Doctor, Doctor Le Chi Hieu, Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, Bethesda group 4 thyroid nodules have a similar benign-malignant ratio, even more benign.

Therefore, in some cases, surgery is not indicated but only the development of the thyroid nodule is monitored. In the case of the patient mentioned above, the thyroid nodule is relatively large. If it is malignant, the possibility of progression and invasion is very high, with a risk of developing in a bad direction. Removal is recommended to prevent cancer.

The team performed surgery to remove the patient's right thyroid lobe using cosmetic surgery, making a very small incision (4cm) slightly to the right side of the neck.

This made it difficult for the team to approach the two poles of the thyroid gland as well as perform the thyroid lobe resection. Thanks to experience in handling goiters in difficult locations, the doctor performed the operation accurately and quickly. The surgery did not last long but took place in 45 minutes, equivalent to a normal thyroid surgery.

Dr. Hieu said that many patients, especially young patients, want cosmetic thyroid surgery to avoid long, raised scars on the neck. The female patient was initially hesitant when she heard about thyroid surgery, but after being advised about this method, she no longer had any concerns.

Instead of worrying about the day when the thyroid nodule will develop into cancer, she was able to completely remove the thyroid nodule in a simple surgery. After closing the incision, the doctor stitched it up and applied biological glue, leaving her with only a faint, barely visible line in the future.

The patient was discharged one day after surgery and was instructed to take calcium supplements after surgery. Pathology results showed that the lesion was benign.

Thyroid nodules are solid or fluid-filled lumps that form within the thyroid gland. More than 90% of thyroid nodules are benign, while about 4-6.5% are malignant (cancerous).

Most thyroid nodules do not alter thyroid function. However, some thyroid nodules can increase activity, producing excess thyroid hormones, causing hyperthyroidism with symptoms of weight loss, palpitations, hand tremors, muscle weakness, etc.

In some cases, bleeding in the thyroid will cause pain in the neck, jaw, and ears. In addition, a large enough thyroid nodule will compress the airway or esophagus, making it difficult for the patient to breathe, swallow, or have a sore throat or cough.

According to Dr. Hang, people with thyroid nodules mostly have no symptoms, the disease is accidentally discovered during a general health check-up, examination for other unrelated diseases that indicate CT scan, neck ultrasound or abnormal thyroid function test.

Benign thyroid nodules are usually monitored without surgery. Patients are monitored by ultrasound, initially for 12-24 months, then gradually increasing over time from 2-5 years.

If the thyroid nodule has the following abnormalities, it must be carefully evaluated, including: significant growth such as a change in volume of more than 50% or a 20% increase in diameter with a minimum increase in two or more dimensions of at least 2 mm; the appearance of abnormal signs on ultrasound; symptoms of invasive compression of the neck area, suspicious cervical lymph nodes...

In malignant cases, including papillary cancer, medullary thyroid cancer, thyroid lymphoma, anaplastic cancer and metastatic cancer to the thyroid, patients are advised to undergo surgery to completely remove malignant cells.

The following subjects need to have their thyroid examined to detect early cases of malignant thyroid nodules (thyroid cancer): children 70 years old with detected thyroid nodules, thyroid nodules that grow rapidly in size, symptoms of hoarseness, history of radiation therapy to the head, face and neck area, or family history of thyroid cancer.