Taking care of thyroid diseases

Ultrasound is universally recognized as the most important examination for identifying suspicious thyroid nodules. Indeed, many studies have shown that thyroid tumors exhibit well-defined ultrasonographic features. Suspicious nodules are then subjected to fine needle aspiration(FNA) to obtain cellular material for analysis. When FNA is inconclusive for a diagnosis, the nodule may undergo a different biopsy(core needle biopsy, CNB), which allows analysis of material consisting of tissue and therefore much more representative than FNA. All these procedures are available in the EOC and are performed by a team of experts in the context of a multidisciplinary intake coordinated by the Thyroid Unit of the EOC Endocrinology and Diabetology Service (head Prof. Dr. med. Pierpaolo Trimboli).

Thyroid tumors are treated with a multidisciplinary approach involving surgery in the first instance. Indeed, removal of the entire thyroid(total thyroidectomy), and in selected cases one-half of it(hemithyroidectomy), ensures excellent long-term results with excellent prognosis. Although thyroid tumors are often contained within the thyroid gland, they sometimes metastasize to the lymph nodes in the neck. In these cases, therefore, a multidisciplinary approach is necessary to be able to locate the neck lymph nodes metastasized by the tumor and surgically remove all lymph nodes in those regions where metastases have been located(cervical dissection). This approach is essential in order to achieve a good prognosis. Removal of the thyroid gland or part of it is also the treatment of choice for patients with struma (increased thyroid volume) without suspected cancer. The thyroid surgery team (head Dr. med. Petra Makovac) regularly performs these procedures dictated by a multidisciplinary approach and is the only one in Ticino that participates in the European registry of these procedures with the goal of constant quality improvement.

In the thyroid field, nuclear medicine takes advantage of the fact that thyroid cells are iodine-hungry and thus uses iodine-like substances that will be picked up by thyroid cells, both malignant and benign. Patients with thyroid cancer, after undergoing total thyroidectomy, are generally treated with radioactive iodine with the intent to ablate any malignant cells that may still be present. This type of treatment is also used, with very good results, in patients with benign nodules that produce excessive amounts of hormones with the aim of making the thyroid gland normofunctional. The nuclear medicine of the EOC (head PD Dr. med. Gaetano Paone) is the only one able to perform these treatments in Ticino.