Guest: Eric J. Lentsch - Otolaryngology - Head and Neck Surgery (ENT)
Host: Dr. Linda Austin – Psychiatrist
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Eric Lentsch, who is an Assistant?Professor of Otolaryngology here at the Medical University of South Carolina. Dr. Lentsch, a word that people hear a lot without maybe understanding exactly what is this goiter, just what is a goiter?
Dr. Eric J. Lentsch: Well, part of the reason that they don’t understand it and I think it’s a fairly generic term that means a lot of things. Boiled down to the simplest thing, a goiter just simply means an enlarged thyroid gland and as we have discussed, the thyroid gland is a gland that sits low in the neck and is responsible for producing a vital hormone for the body. In some patients, the gland itself can get to 2, 3, even 5 or 10 times to its normal size in which case it becomes palpable or able to be felt in the neck and in these instances, we often call this a goiter because this is simply an enlarged thyroid gland.
Dr. Linda Austin: How this cause problems aside from just the size of it?
Dr. Eric J. Lentsch: There are several things that can happen and typically, a lot of these patients are actually asymptomatic, but as it gets larger, it can affect the structures that it is next to and so if you think about what’s next to the thyroid gland, your windpipe or trachea is to next to it and so with enough enlargement it can actually compress your windpipe and I have seen patients, who have a difficult time walking up a flight of stairs because their windpipe is so narrow that they can't get enough air in. Behind the trachea or windpipe sits the esophagus and so some patients, as it gets larger, actually have a difficult time swallowing and that’s actually one of the more common things that we see with patients with massively enlarged goiters and then lastly may be not quite as importantly medically, but certainly from a social standpoint as it can be a very large cosmetic distraction, something -- one of the first places we look in a patient right after we look at their face, their neck and if you have a large mass sitting in the lower part of your neck, it becomes a cosmetic problem as well.
Dr. Linda Austin: How common is goiter?
Dr. Eric J. Lentsch: It’s actually not that common in the United States mainly because of the efforts of US Government to supplement our diets with iodine that’s put in the salt. We probably see these days somewhere between 5% and 10% of our thyroid patients come in because of goiter. So, it’s not something that we see all the time and areas outside the United States, it is much more common and in patients who don’t use iodized salt, it’s much more common.
Dr. Linda Austin: So, how does that affect the functioning of the thyroid gland to have a goiter?
Dr. Eric J. Lentsch: It can do several things. It can have no effect, which is actually the most common thing that we see. It can affect the thyroid gland, however, also by decreasing the function or the amount of thyroid hormone that is produced and that is because the actual functional components of the gland are squeezed out as the scar tissue and other components fill the gland. In rare instances, however, it can also increase the function of the thyroid by having it produce more thyroid hormone. So, the effects are somewhat variable on the thyroid gland and it’s something that we usually test with a simple blood test to try to determine whether it has affected the function of the gland one way or the other.
Dr. Linda Austin: Now, if you have too much thyroid hormone, what are the symptoms of that?
Dr. Eric J. Lentsch: Again, lots of time it’s asymptomatic because the increase in hormone occurs so gradually that the patient becomes used to it, but overtime you will get symptoms such as a nervous feeling or jittery-type feeling and you can have severe weight lose or a gradual or severe weight lose because of it, you can have thinning or loss of hair, which is often actually the thing that brings in a lot of people. They notice that their hair is much more friable or easily broken and becomes much thinner and then there is a host of less common symptoms, which can occur as well.
Dr. Linda Austin: And how about the opposite condition?
Dr. Eric J. Lentsch: Well, actually just the opposite of some of the things that I told you about, the biggest thing we see in hypothyroid patients those with the low thyroid levels is actually weight gain and in fact if a patient comes in with a large amount ? or having gained a fair amount of weight without explanation, one of the first things that should done is the thyroid gland should be tested or the thyroid hormone level should be tested because weight gain is one of the symptoms associated with that and again there is often a slow lack or loss of energy drive in patients with low thyroid hormones such that they become very lethargic and lack any energy or desire to do anything.
Dr. Linda Austin: And may seem depressed perhaps?
Dr. Eric J. Lentsch: It’s actually a very common cause of depression, and the one that’s actually very easily treatable with a simple medication.
Dr. Linda Austin: What kind of surgery do you perform for a goiter?
Dr. Eric J. Lentsch: Surgery for a goiter is dependent on symptoms that the patient is having and so if a patient is having either hyper or hypothyroid state, especially hyperthyroidism or if they are having symptoms such as dysphagia, difficulty swallowing, difficulty breathing, or pain, we often recommend surgery and that surgery usually encompasses removal of the entire thyroid gland or what we call a subtotal removal where we try to remove about 90% of the gland leaving some tissue behind in effort to supply enough thyroid hormone for the patient, but typically we would revolve around removal of the enlarged gland.
Dr. Linda Austin: How long does that procedure take?
Dr. Eric J. Lentsch: Anywhere from a 2 to 4-hour operation and would require a postoperative stay often of two to three days.
Dr. Linda Austin: Now, I know you are interested in minimally invasive surgery, but this cannot be done that way, is that right?
Dr. Eric J. Lentsch: The answer is no and it’s not that we can’t do the surgery as my partner 05:40 and I talk all the time. We can do anything endoscopically through about a 2 cm incision, but unfortunately these glands are often upwards of 10, 12, or even much larger than that, and we found no way yet to get a 10 cm or 12 cm tumor or goiter out of a 2 cm incision. So, it can be done endoscopically, but in the end, we actually have to make the incision large enough to remove the gland itself.
Dr. Linda Austin:Dr. Lentsch, thanks so much for talking with us today.
Dr. Eric J. Lentsch: Thank you.
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