Most patients with thyroid goitres do not need surgery.  The indications for surgery are if the goitre is so large that it is compressing on the airway or affecting swallowing (Fig 1), or there is suspicion of cancer or proven to have cancer on a fine needle cytology (FNAC).  Sometimes toxic goitres are surgically removed if the thyrotoxicosis is not well controlled medically.  On rarer occasions some goitres are removed for reason of cosmetics.

All goitres will need to be assessed with thyroid function test, an ultrasound and for suspicious or obvious nodules with flab.  Sometimes FNAC (Fig 2) are not definitive especially for patients with reported follicular lesions and in such situations we would recommend surgical removal.

Thyroid cancers are of 4 main types.  The commonest and the one with best prognosis is papillary cancer.  This occurs in the younger age group (30-40 years).  The others are follicular, anaplastic and medullary cancers.  Anaplastic cancer stands out for being one of the most aggressive cancers in the human boy.  Fortunately they are infrequent, commonly see in elderly patients with fast growing thyroid goitres.  Most thyroid cancers are treated with a total thyroidectomy (Fig 3 and 4).  In this operation great effort is made not to damage the two recurrent laryngeal nerves which lie just behind the thyroid gland.  Care is also taken not to remove or damage the 4 parathyroid glands.  These control calcium metabolism.  In the postoperative setting some patients will require radioactive iodine ablation.  If so they will need to be admitted to the hospital as their body fluids will be radioactive for about 3 days.