THYROID AND PARATHYROID

The thyroid gland is a critical hormone gland that sets the rate of our body's metabolism and is vital in development and regulation of body functions. It is surrounded at its 4 corners by additional glands called parathyroid glands that help regulate our calcium levels, required for strong bones, muscle function and nerve conduction. These two types of glands can malfunction or develop tumors and even rarely cancer. This may require evaluation, treatment and occasionally surgery for the health of our bodies systems.

THYROID SURGERY

The thyroid is a gland in the center of your neck below the Adam's apple and above your collar bones that is shaped like a butterfly. It has two halves and center connecting called an isthmus. The thyroid can sometimes form nodules, and in fact 7% of people have some nodules in the thyroid. These nodules can have features on ultrasound examination making them suspicious for containing cancer. A needle biopsy called an FNA may be required to evaluate this. Additionally, genetic testing on that needle biopsy may give even further information regarding your nodules. Occasionally, an endocrinologist may also refer you to a surgeon for evaluation. If surgery is required there are 4 main reasons:

A nodule is suspected of being cancer
You have needle biopsy proven cancer in a thyroid nodule.
The nodule or nodules are causing symptoms such as swelling, dysphagia, or compression of the trachea
The thyroid is producing excess thyroid hormone or abnormal fluctuations in thyroid hormone requiring surgery for control.

During your evaluation for surgery, Dr. Kelsch will examine your ultrasound results, laboratories and any biopsies performed. You may require a new biopsy or ultrasound to obtain more information in order to make the best decision possible. Not everyone is a candidate for thyroid surgery. Occasionally, for specific concerns, an endocrinologist may be consulted. This is a non-surgical thyroid doctor who manages all the hormone systems in the body. Once a decision for thyroid surgery is made, a plan for removing half or all-of-the thyroid is made. It is very rare to remove just a small portion of the thyroid. Surgery is usually booked within 2-3 weeks depending on scheduling and your availability. You are often kept overnight for comfort and ease. Surgery will typically take 2 hours but may be longer if intraoperative pathology evaluations are performed. That includes looking at your tissue under a microscope while you're still asleep!

Recovery is different for everyone, however the far majority of patients go home the next morning and will likely need to take 4-7 days off surgery depending on their at lifestyle demands. Postoperatively, you may experience low thyroid or calcium levels and these can cause some symptoms that Dr. Kelsch will review with you for early identification and treatment. You may also briefly take calcium replacement after surgery. After total removal of the thyroid you will require thyroid hormone replacement and this will be monitored and adjusted to your specific body's needs. You will see Dr. Kelsch 1 week after surgery and he will examine your wound and evaluate your pathology (microscopic findings). At the point, any additional therapies will be discussed.

PARATHYROID SURGERY

The parathyroid glands are 4 glands on the back side of the thyroid gland, typically at the 4 corners of the thyroid. These glands are critical in the regulation of calcium in your blood. If parathyroid levels are high, your calcium may be very elevated and this can cause symptoms. Symptoms of hyperparathyroidism (high parathyroid level) include: Hypertension, depression, fatigue, muscle weakness, kidney stones, renal failure, gastritis, pancreatitis, abdominal pains, hair loss, bone pain, broken bones, osteopenia (loss of calcium in bones), headaches and even hair loss. Hyperparathyroidism is often identified by your primary care as an elevated calcium level, often with no symptoms. In fact, most people requiring surgery on their parathyroid glands may have no symptoms at the time of the referral. However, under the surface, the high calcium level is doing damage which may be preventable. Typically, an endocrinologist will evaluate this and refer patients to a surgeon. There are 3 types of hyperparathyroidism: Primary, Secondary and Tertiary. The most common is primary and is due to a small tumor around the thyroid gland. This can be removed and cure patients of the disease in 95% of patients.

During your consultation, Dr. Kelsch will evaluate your thyroid ultrasound, laboratories, history and any recommendations by Endocrinology. Typically the patient will undergo a special imaging study called a CT SPECT Sestamibi Scan to try to localize the tumor which is typically around the thyroid, but can be anywhere in the neck from under the jaw to below the collar bone. After a decision for surgery is made, a surgical plan and timing of surgery will be discussed. Enhancing measures may be taken to improve localization of the gland that is affected, and this may include injection with a dye that stains the glands or use of intraoperative radioactive iodine with a detection instrument. Typically, surgery is only a few hours and often patients go home the same day or the next morning. Complications are rare, and success is around 95% or higher. Recovery is often quicker than for typical thyroid surgeries. Laboratories will be followed after surgery to ensure no recurrence of symptoms.

Dr. Kelsch and his staff look forward to helping you with your thyroid concerns.