Thyroid & Para Thyroid Surgery
Insight Into Complications and Treatment
- What is a thyroid disorder?
- What treatment may be recommended?
- What is thyroid surgery?
- and more…
Your thyroid gland is one of the endocrine glands that makes hormones to regulate physiological functions in your body, like metabolism (heart rate, sweating, energy consumed). Other endocrine glands include the pituitary, adrenal, and parathyroid glands and specialized cells within the pancreas.
The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and wraps around the front half of the trachea (windpipe). It is shaped like a bow tie, just above the collarbones, having two halves (lobes) joined by a small tissue bar (isthmus.). You can’t always feel a normal thyroid gland.
What is a thyroid disorder?
Diseases of the thyroid gland are very common, affecting millions of Americans.
The most common thyroid problems are:
- An overactive gland, called hyperthyroidism
(e.g., Graves’ disease, toxic adenoma or toxic nodular goiter)
- An underactive gland, called hypothyroidism
(e.g., Hashimoto’s thyroiditis)
- Thyroid enlargement due to overactivity (as in Graves’ disease) or from under-activity (as in hypothyroidism).
An enlarged thyroid gland is often called a “goiter.”
Patients with a family history of thyroid cancer or who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy.
If you develop significant swelling in your neck or difficulty breathing or swallowing, you should call your surgeon or be seen in the emergency room.
What treatment may be recommended?
Depending on the nature of your condition, treatment may include the following:
If you experience this condition, your doctor will propose a treatment plan based on the examination and your test results. He may recommend:
An imaging study to determine the size, location, and characteristics of any nodules within the gland. Types of imaging studies include CT or CAT scans, ultrasound, or MRIs.
A fine-needle aspiration biopsy – a safe, relatively painless procedure. With this procedure, a hypodermic needle is passed into the lump, and tissue fluid samples containing cells are taken. Several passes with the needle may be required. Sometimes ultrasound is used to guide the needle into the nodule. There is little pain afterward and very few complications from the procedure. This test gives the doctor more information on the nature of the lump in your thyroid gland and may help to differentiate a benign from a malignant or cancerous thyroid mass.
- Thyroid hormone replacement pills
- Medication to block the effects of excessive production of thyroid hormone
- Radioactive iodine to destroy the thyroid gland
- Surgical removal of the thyroid gland
Thyroid surgery may be required when:
- the fine needle aspiration is reported as indeterminate, suspicious or suggestive of cancer
- imaging shows that nodules have worrisome characteristics or that nodules are getting bigger
- the trachea (windpipe) or esophagus are compressed because one or both lobes are very large
Historically, some thyroid nodules, including some that are malignant, have shown a reduction in size with the administration of thyroid hormone. However, this treatment, known as medical “suppression” therapy, has proven to be an unreliable treatment method.
What is thyroid surgery?
Sometimes, based on the result of the frozen section, the surgeon may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck.
As an alternative, your surgeon may choose to remove only one lobe and await the final pathology report before deciding if the remaining lobe needs to be removed. There also may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure. If you have specific questions about thyroid surgery, ask your otolaryngologist to answer them in detail.
What happens after thyroid surgery?
After surgery, you may have a drain (tiny piece of plastic tubing), which prevents fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the next day.
Complications are rare but may include:
- Bleeding under the skin that rarely can cause shortness of breath requiring immediate medical evaluation
- A hoarse voice
- Difficulty swallowing
- Numbness of the skin on the neck
- Vocal cord paralysis
- Low blood calcium
Following the procedure, if it is determined that you need to take any medication, your surgeon will discuss this with you prior to your discharge.
Medications may include:
- Thyroid hormone replacement
- Calcium and/or vitamin D replacement
Some symptoms may not become evident for two or three days after surgery. If you experience any of the following, call your surgeon or seek medical attention:
- Numbness and tingling around the lips and hands
- Increasing pain
- Wound discharge
- Shortness of breath
If a malignancy is identified, thyroid replacement medication may be withheld for several weeks. This allows a radioactive scan to better detect any remaining microscopic thyroid tissue, or spread of malignant cells to lymph nodes or other sites in the body.
How is a diagnosis made?
- Evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope
- An ultrasound examination of your neck and thyroid
- Blood tests of thyroid function
- A radioactive thyroid scan
- A fine-needle aspiration biopsy
- A chest X-ray
- A CT or MRI scan
Para Thyroid Surgery
The parathyroid glands are four small glands in the neck that are part of the endocrine system. They produce parathyroid hormone (PTH), which maintains calcium and phosphorus levels in the blood. The primary disease associated with the parathyroids is overproduction of PTH, known as hyperparathyroidism.
Several problems can occur when the parathyroid glands secrete too much parathyroid hormone (PTH).
- The blood calcium level rises in a condition known as hypercalcemia. The bones lose calcium (osteoporosis) while the body absorbs too much calcium from food. Calcium levels may also increase in the urine, leading to kidney stones.
- A benign tumor called an adenoma usually forms on the overproducing parathyroid gland. It is important to note that benign tumors are not cancerous and that hyperparathyroidism is only very rarely associated with cancer.
- PTH also lowers blood phosphorus levels by increasing excretion of phosphorus in the urine.
Causes and Symptoms
Hyperparathyroidism is twice as common in women as in men, and the risk increases with age. In most cases, the cause of hyperparathyroidism is not known. Symptoms are often subtle and may include:
- Weakness, fatigue, and depression
- Nausea, vomiting, loss of appetite, and constipation
- Impaired thinking and loss of memory
- Increased thirst and urination
- High blood pressure
Surgical removal of one or more parathyroid glands is called a parathyroidectomy.
During the operation, you will be given either a general or local anesthetic. Your doctor will make a small incision in your neck and remove the gland. Your particular problem will determine how many of the parathyroid glands need to be removed. Some parathyroid tissue must be left in place to help prevent hypoparathyroidism (decreased parathyroid activity).
However, in most cases of hyperparathyroidism, only one gland has to be removed and a less invasive procedure called minimally-invasive radio-guided parathyroid (MIRP) surgery can be performed. MIRP surgery only involves a local anesthetic, requires a much smaller incision, and has a very high success rate. The operation usually takes less than 30 minutes and you may return home within one to two hours. You will be able to return to your normal daily activities after just one day.
Risks and Complications
Complications of parathyroid surgery are more common in the traditional procedure than in the MIRP procedure, but both procedures are generally safe and successful. Less than 1 percent of patients undergoing surgery experience damage to the nerves controlling the vocal cords, which can affect speech. Patients requiring more extensive surgery could develop hypoparathyroidism, resulting in low calcium levels, which may require treatment with calcium or vitamin D.