Surgery of the Thyroid and Parathyroid Glands

Thyroid & Parathyroid Surgery
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Contents:

  • Parathyroid Disease and Thyroid Disease Commonly Occur Together
  • Too Little Parathyroid Hormone Production
  • Parathyroid Gland Removal
  • Treatment for Thyroid and Parathyroid Conditions

    • Skip to main content. Share Reports Upload. Files must be less than 15 MB. Allowed file types: gif jpg jpeg png pdf doc docx rar zip. Leave this field blank. Doc Connect Hospital :. Rahul Yadav, Dr. Neeraj Awasthy, Dr. Reena Anand, Dr. Raj Kumar, Dr. Divya Malhotra, Dr. Kanika Arora, Ms. Nafisa Shakir Batta, Dr.

    Parting with your Parathyroid

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    Case Studies. Get Second Opinion. Clinical Directorate Clinical Excellence Reports. Overview Thyroid is a butterfly shaped endocrine gland that is responsible for producing thyroid hormones to provide energy to cells as well as regulate body's metabolism. Thyroid Gland The function of thyroid gland is regulated by a feedback mechanism, which involves the brain. There are specific kinds of thyroid disorders that include: Hypothyroidism An underactive thyroid Hyperthyroidism An overactive thyroid Goitre An enlarged thyroid Thyroid nodules Lumps in the thyroid gland Thyroid cancer Thyroiditis — Inflammation of the thyroid Symptoms of Thyroid Losing or gaining weight : Extreme change in weight signal an abnormal function of thyroid gland.

    Which is more common? Hyperthyroidism or hypothyroidism? Diagnosis of Thyroid A physical examination and laboratory tests that measure the amount of thyroid hormone thyroxine, or T4 and thyroid-stimulating hormone TSH in your blood are necessary. What are the Treatment Options of Thyroid Two types of surgeries are available for treatment: Open surgery Endoscopic surgery Endoscopic thyroidectomy Thyroidectomy is the surgical removal of part or all of the thyroid gland.

    The various types of thyroidectomy include: Partial thyroid lobectomy : Only one of thyroid lobe is removed. Total thyroidectomy : The entire thyroid gland is removed. Procedure A viewing instrument called an endoscope and small surgical instruments will be inserted into your neck through three or four small incisions. Each incision is about 3 millimeters to 5 millimeters long.

    Parathyroid Disease and Thyroid Disease Commonly Occur Together

    The surgeon uses a tiny camera on the endoscope to guide the instruments and remove thyroid tissue. Tumors or lumps within the thyroid gland can be either benign or malignant cancerous. To define a nodule as either benign or malignant, a fine needle aspiration biopsy is the most direct and reliable test.

    A small amount of tissue is removed with a very small needle placed inside the mass that is easily accessible from the front of the neck with ultrasound guidance. The tissue sample is smeared on a glass slide and stained before viewing under the microscope. If the cytopathologist a pathologist trained to evaluate cellular architecture and other characteristics is unable to exclude cancer with adequate tissue sampling, then surgery is usually required to remove a part or all of the thyroid gland for a definitive diagnosis and treatment of a possible cancer.

    For a biopsy result indicating a nodule of undetermined significance grey zone , additional biopsies are subjected to special immunostains for tumor markers or molecular genetic analysis to help achieve a more definitive diagnosis.

    Too Little Parathyroid Hormone Production

    Please try after some time. Kim and Dr. The parathyroid glands were the last of the endocrine glands to be discovered, this perhaps being one of the reasons that justify the difficulties in the evaluation of patients with hyperparathyroidism in the last century. In brief, hyperparathyroidism is essentially not a preventable condition. Depending on the findings noted on the final pathology report e.

    Some of these nodules can be monitored further and only removed if there are signs of continued growth or changes occur suggesting more malignant characteristics on ultrasound imaging. Surgery may also be required for thyroid cysts, which return after multiple attempts to remove the fluid by needle aspiration fail to eliminate the problem.

    Most malignant thyroid tumors thyroid cancers require removal of the entire thyroid gland and involved lymph nodes in the central neck compartment for cure. Benign thyroid tumors, cysts and some goiters may also only require partial removal of the thyroid gland. Even after partial removal, many patients will still need to take thyroid hormone supplements after surgery to maintain normal metabolism and weight. Performing Surgery The operation is performed in the hospital operating room. Most patients are admitted the day of surgery and go home either that evening or the following morning.

    This depends on the time of day that the surgery starts as well as the extent of surgery.

    More complicated surgery will require a longer period of observation in the hospital before discharge. Anesthesia The operation is usually performed under general anesthesia medically induced sleep. Some surgeons do the operation with the patient awake and with light sedation and local anesthesia which numbs the area of the body being operated on. The safety of either approach is equal; however, many surgeons prefer to perform the procedure under general anesthesia for several reasons:.

    Incisions The usual incision is placed in the midline of the lower neck and parallel to the natural horizontal tension skin lines or creases when present. In young patients the incision is situated low in the neck at the level of a shirt collar, above the level of the clavicles. The length of the incision depends on the size of the thyroid gland that needs to be removed.

    Usually it is no more than the size of the area between the two large muscles sternocleidomastoid that run up and down the neck. Some incisions can be as small as one inch. However, the key to an inconspicuous scar, regardless of its length, is the use of delicate soft tissue handling techniques and meticulous wound edge approximation. Longer incisions are needed for safe exposure of the surgical field, especially if the patient has a large goiter.

    Attempting to squeeze a large thyroid gland through a very small incision can cause excessive trauma to the wound skin edges and this may lead to poor healing and adverse scaring. If there is a prior scar from previous thyroid surgery that site will usually be used for the incision by removing the old scar. In young patients who heal quickly, scars generally are more elevated and red in the first six to eight months of healing but eventually flatten and lighten. Certain topical agents including fresh aloe vera gel and dimethicone silicone gel may be of benefit for the first 8 weeks of healing.

    Your surgeon will discuss methods of wound care to achieve the best possible scar. It is important to avoid direct sun exposure for the first year to prevent darkening of the scar. This prevents the accumulation of blood and fluid under the skin and reduces the need to drain this collection in the office.

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    Stitches sutures Most stitches are placed under the skin level and dissolve on their own. You can bathe with the strips on the skin after the initial bandage has been removed. Risks and Complications In skilled hands, there are several rare potential risks of thyroid surgery. However, a brief period of hoarseness or difficulty singing with pitch control, early voice fatigue and difficulty projecting the voice may occur from either minor swelling of the vocal folds themselves, trauma to the muscles that raise or lower the larynx voice box or from a weak or immobile vocal fold paralysis.

    Parathyroid Gland Removal

    Some surgeons will use a nerve monitoring system during the surgery when performed under general anesthesia to alert of inadvertent stretch or other injury to the laryngeal nerves. However, nerve monitoring has not been proven to reduce the incidence of vocal fold palsies, especially in the hands of expert surgeons. Vocal fold mobility is usually documented both prior to and after thyroid and parathyroid surgery using a thin flexible telescope for viewing the larynx.

    The majority of patients with voice impairment improve without treatment. Parathyroid Gland injury and Hypocalcemia Depending on the extent of surgery and number of bruised or autotransplanted parathyroid glands, temporary hypoparathyroidism under-production of parathyroid hormone can occur and blood calcium levels may drop below the normal range.

    Treatment for Thyroid and Parathyroid Conditions

    Within 6 hours following a total thyroidectomy, very low calcium levels in the blood will cause a spectrum of symptoms including muscle spasms, tingling or numbness around the lips paresthesias or upper or lower extremities and rarely difficulty breathing from vocal fold muscle spasms. Any time after surgery, the aforementioned signs of a low calcium levels should immediately be reported to your nurse or surgeon who will start you on supplemental calcium and Vitamin D to prevent further symptoms before hospital discharge and continued at home for weeks to months until there is recovery of parathyroid gland function.

    Bleeding Following Thyroidectomy In general, hemorrhage bleeding causing a hematoma or blood accumulation in the neck after thyroid surgery is a rare event but can occur suddenly within the first 24 hours following surgery. You should immediately report any rapid swelling of the neck, sudden tightness, difficult breathing or loss of voice to your surgeon or have someone call Complications from Anesthesia In general, complications associated with local or general anesthesia are exceedingly rare.

    Nausea in the immediate postoperative period can be managed well with medications given intravenously. Some patients will develop a sore throat and mild hoarseness associated with insertion of the endotracheal tube breathing tube. You may have a mild sore throat, as well as neck pain and you may need to urinate. The nursing staff in the recovery room will monitor your vital signs closely, administer fluids and adequate pain medicines to make you comfortable, and take care of your immediate needs to ensure a smooth recovery. You will be able to talk and can start drinking fluids when you are fully awake.

    The surgical team will follow you closely as well. If you have had your entire thyroid removed, blood will be drawn to follow your blood calcium levels and replace it, if it is too low. Once you are discharged from the recovery room you will be placed into a step-down unit where you will be able to get out of bed, eat and talk with visitors and family. The bandage on your neck will be replaced or removed before your discharge. If you have a drain present, it will usually be removed prior to discharge.

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    You will be sent home with either a waterproof protective bandage or just Steri Strips that will allow you to shower. The surgical team will give you prescriptions for pain medications and possibly antibiotics, as well as thyroid hormone replacement, depending on the extent of surgery. The duration of hospital recovery after thyroid surgery will vary from patient to patient and surgeon preference.