Life without a thyroid
Sometimes the thyroid gland needs to be removed in whole or in part. Doctors want to take away the fear of such an intervention. Medicines can replace the function of the organ well
According to estimates, 25 percent of all adult Germans have lumps or cysts on the thyroid gland (source: German Society for Endocrinology)
© W & B / Henning Ross
Who thinks of the thyroid gland when they have difficulty swallowing? Petra K. didn't worry. "I was just wondering why my chain is so tight. I felt how thick my neck suddenly got." The Cologne resident was also unable to classify the weight fluctuations and sleep disorders. "I thought it was menopause." Then there was high blood pressure. "My heart was racing, it felt like it was jumping out of my chest."
Over the years, Petra's complaints came to a head. Until a blood analysis, an ultrasound examination and finally a so-called scintigraphy of the thyroid gave the decisive clues.
Hormone levels out of whack
"I was found to have several lumps," said the patient. One of them a hot one. This is what doctors call tissue overgrowths on the thyroid that produce uncontrolled hormones. The resulting increased hormone level in the blood has messed up the ingenious natural interplay between the thyroid and pituitary glands in Petra K.
This interplay works according to a kind of level principle: If the amount of thyroid hormones in the blood falls below a certain value, the gland in the brain releases the hormone TSH.
This in turn stimulates the thyroid gland to produce the important hormones thyroxine and triiodothyronine (see infographic below). If the level of these thyroid hormones rises above the normal level, TSH is retained until the normal hormone ratio is restored.
"It is very easy to live without a thyroid gland"
In Petra K.'s case, so much thyroid tissue was diseased that this regulation failed to take place. She finally followed the doctor's advice to have the butterfly-shaped organ below the larynx removed. Because Petra works as a secretary in the St. Agatha Hospital in Cologne, she turned to head surgeon Professor Hans Udo Zieren there. The visceral surgeon is also the founder of the German Thyroid Center.
Professor Hans Udo Zieren examines his patient Petra K. He surgically removed her thyroid
© W & B / Henning Ross
Many of his patients - like Petra K. - are afraid of the operation and the loss of the thyroid gland. Zieren respects the frequent desire to save at least part of the organ: "In principle, however, all diseased tissue should be removed and only healthy tissue left. Otherwise, there is a high risk of repeated growths, so that another operation may be necessary later."
Medic Zieren wants to take away the fear of loss: "It is very easy to live without a thyroid gland."
Influence on the body and mind
For Petra K., the operation was ultimately a turning point for the better - especially since the removed tissue was examined afterwards and no malignant changes were found.
The woman from Cologne is glad that she no longer falls into bed dead tired at six o'clock in the evening. She used to be so weak that she didn't do any sport at all. Now she feels strong enough again. Only a small inconspicuous scar on the neck remained.
"Only since then have I known everything related to the thyroid gland," says Petra K. Its hormones are involved in regulating our metabolism and energy consumption. They also affect nerves, muscles, stomach and heart. An under- or over-function can also change the mental and sexual well-being.
Adjust medication precisely
If the thyroid gland is completely or largely removed, these hormones must therefore be supplied to the body in tablets. "In most cases, the drug can be adjusted without any major problems," reports Zieren.
Depending on the illness, remaining tissue and body weight of the patient, an appropriate initial dose of thyroxine and possibly also iodine should be administered in the hospital.
It is estimated that 100,000 thyroid operations are performed in Germany each year.
(Source: Institute for the Hospital Remuneration System (inEK))
The attending physician - usually the family doctor, endocrinologist or nuclear medicine specialist - checks the patient's blood values at regular intervals and adjusts the dose as required.
100,000 operations annually
Petra K. also has to take thyroid hormones every morning on an empty stomach, at least half an hour before her first cup of coffee. "My family doctor checks the blood values once a year to see whether the hormone level is correct."
There are no very precise data, but medical societies assume that around one in three Germans suffers from a thyroid disease. This is also confirmed by surgeon Zieren, who and his team in Cologne perform more than 1,000 operations on the organ every year. Nationwide there are around 100,000 operations annually, and the number of interventions has recently decreased.
Goiter, knot formation and Hashimoto
An enlargement of the organ (goiter) or the formation of nodules are the most common causes, says Zieren. In addition, he operates if a malignant degeneration is suspected. In the case of autoimmune diseases such as Graves' disease or other overactive thyroid glands, surgery can be an alternative to radioiodine therapy with radioactive iodine molecules.
Barbara S. no longer has a thyroid gland for another reason. She is sick with Hashimoto. Your immune system produced antibodies that slowly destroyed the tissues of the organ. "After 15 years there was nothing left," she says.
According to the Professional Association of German Nuclear Medicine, Hashimoto's thyroiditis is one of the most common autoimmune diseases. It is not uncommon for those affected to suffer from or develop other autoimmune diseases - for example type 1 diabetes.
An underrated organ
Barbara S. from Bonn is also suffering from an autoimmune gastric mucosal disorder. The absorption of vitamin B12 into the body is blocked, so it has to be injected regularly.
"The thyroid is still an underrated organ," says Barbara. "Early therapy is extremely important." The patient advocates more education, warns of misinformation from Internet forums and, as chairwoman of the Thyroid League Germany, works in self-help for the Bonn, Düsseldorf and Dortmund regions.
In the early stages of her illness, she reacted very sensitively to the typical change between under- and over-function. She felt left alone; there were no regular checkups or adjustments to the medication. "But they are very important", Barbara S. knows today.
She recommends other sufferers to carry a thyroid pass with them, where all important values related to the disease are noted. It serves as a source of information for doctors, for example when one is admitted to the hospital. "So you are prepared for all emergencies."
Detailed information and contact to self-help groups in the region: