Thyroid Surgery

Parathyroid/ Thyroid Parathyroid disease is usually manifested by high blood calciums and the consequences of such, including but not limited to: kidney stones, brittle bones and fractures, constipation, muscle weakness and oftentimes some type of mental problem that may vary from sleepiness and fatigue, to altered mental consciousness. The cause of these symptoms is overactive parathyroid gland/glands, which live beside the thyroid. The cause of usual hyperparathyroidism is not clearly known, but we believe it is due to long-standing Vitamin D deficiency or borderline deficiency. There are also genetic syndromes that cause hyperparathyroidism, but they are extremely rare.

Diagnosis is made by finding elevated blood calcium along with a high PTH (parathyroid hormone) level, low phosphorus, and high chloride levels. A nuclear scan is used to locate which of the usual 4 glands is the culprit so it can be removed in the operating room. There is no medical treatment for this, unless the problem is discovered early and high doses of Vitamin D are successful in bringing a remission. Unfortunately, this is uncommon. It is possible to have parathyroid cancer, but this is extremely rare and - to present - has never been seen in Albany.

After surgery, it is important to remain on adequate amounts of Vitamin D and get blood tests to prove you are taking a sufficient amount. This should be yearly. When this is not done, hyperparathyroidism will come back with another gland acting up. The main complication of surgery is hoarseness from damage to the nerves of the voice box. But, as with the 811 commercials, we look for the nerves before we dig. The thyroid is a gland in the neck, over the voice box. It makes thyroid hormone, which acts as a helper for lots of processes in the body. Too much, and you feel jittery and weak; but too little, and you feel sluggish, cold and can bring about hair and skin problems. In addition, the gland can get enlarged (called a goiter) which could be a failing gland, an overactive gland, or a cancer. Here in the south, we commonly see lots of lumps in the thyroid. 90% of these are benign (no cancer), but some are due to cancer, which require surgery. Most goiters are due to under-functioning glands, which a combination of lab and x-ray tests can determine. We treat this by replacing the thyroid hormone that the gland is struggling to make.

Hyperthyroidism is almost always associated with a large thyroid. The symptoms are: tremors, shakes, sweats, weight loss, rapid pulse or heart rate and hair loss. Here, the diagnosis is made with blood tests and a nuclear scan. There are 3 causes: Graves’ Disease, toxic nodular goiter and Hashimoto's Disease. All are treated with a combination of radioactive iodine (RAI) and beta blockers, which are usually used to treat high blood pressure. If the disease does not respond to RAI, then surgery may be necessary. In all cases, the patient will end up on lifelong thyroid hormone replacement, which is inexpensive. Thyroids with lumps are a "whole ‘nother story"!

Remember: most are not cancer, but 15-20% are cancer, so we have to try to find out what is what. The first thing we do is feel the gland. Soft bumps can be cysts which, when stuck with a needle, will resolve. Hard ones need a sonogram and a nuclear scan occ. If the lumps are solid, then needle aspiration biopsy is done to see if there are cancer cells, or other abnormalities that could force surgery. If it is a benign goiter, as mentioned above, the treatment is thyroid hormone replacement. If the biopsy is suggestive of cancer, then the treatment is to remove all (or part) of the thyroid, possibly followed by RAI and thyroid hormone replacement. The main complication with surgery, is injury to the nerves to the voice box, injury to all the parathyroid glands and post-op bleeding. Most patients are kept in the hospital overnight after surgery. They can return to work in a few days.