Thyroid and Parathyroid Surgery
About the Thyroid Gland
The thyroid is a butterfly-shaped gland in the neck that lays over the trachea, or windpipe. It consists of two lobes and a narrow strip between them. The gland makes thyroid hormone, an important regulator of metabolism. Hyperthyroidism occurs when there is an over production of thyroid hormone. Symptoms of hyperthyroidism include nervousness, irritability, heat intolerance, rapid heartbeat, muscle weakness, fatigue, frequent bowel movements, light menstrual periods, weight loss and hair loss. Under production of this hormone is called hypothyroidism. Symptoms of hypothyroidism include decreased energy level, feeling cold, muscle pain, slowed thinking, constipation, long menstrual periods, weight gain, brittle nails and hair and depression.
Thyroid Nodules and Goiter
A nodule is a lump of tissue in the thyroid gland. The gland may develop one or many nodules. Most of the time, nodules do not affect the production of thyroid hormone and do not cause symptoms. It may or may not be possible to feel thyroid nodules. Most nodules are benign, but on occasion, they can be malignant. A goiter is the enlargement of the whole thyroid gland. You may be able to see or feel a swelling in the neck. Goiters can develop from enlargement of the gland tissue or from the presence of multiple nodules.
Surgical Treatment of Thyroid Nodules
Thyroid surgery is most commonly used in the treatment of thyroid nodules, which usually involves an aspiration biopsy. Biopsy results will determine if additional surgery is needed. Surgery may be recommended for the presence of cancer (papillary cancer), possible cancer (follicular neoplasm); or for nodules with benign biopsy results if it is large, continues to increase in size or if it is causing pain, difficulty swallowing, or any other uncomfortable symptoms. Surgery may also be a viable option in treating hyperthyroidism for large and multi-nodular goiters and for any goiter that may be causing pain, problems swallowing or other symptoms.
Thyroid surgery requires general anesthesia. The incision is two to three inches long and is placed across the front of the neck. Surgery usually involves removing either the entire thyroid gland (total thyroidectomy) or just one lobe (lobectomy). Total thyroidectomy is generally recommended if the entire gland is abnormally enlarged, if a fairly large cancer has been diagnosed, or if there are suspicious nodules in both lobes.
About the Parathyroid
Most people have four parathyroid glands located in the neck, in the region of the thyroid gland. These glands produce parathyroid hormone (PTH) which is responsible for controlling calcium metabolism. PTH regulates the deposition of calcium in the bones and excretion of calcium in the urine. Normal parathyroid glands are very small, about the size of the inside of a sunflower seed. Abnormal parathyroid glands are enlarged, about the size of a grape.
Diseases of the Parathyroid
Hyperparathyroidism is a condition in which the parathyroid glands are overactive. This leads to elevated PTH which causes absorption of calcium from bone thereby weakening the bones, a condition known as osteoporosis or osteopenia. This causes an elevation of the blood calcium level which in turn results in elevated levels of calcium in the urine and can result in kidney stones and, over time, kidney damage. Patients with elevated blood calcium levels can suffer from depression, fatigue and muscle symptoms.
In the majority of patients, only one of the four parathyroid glands is overactive. Imaging tests done before surgery usually allow surgeons to identify which of the four glands is overactive and needs to be removed. These patients may be candidates for minimally invasive radioguided parathyroidectomy (MIRP). During the MIRP procedure the patient receives a preoperative dose of a radioactive marker which allows the surgeon to use a hand held probe to localize the abnormal gland. This allows the surgeon to remove the overactive gland using a rapid, directed approach.