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Thyroid & ParathyroidThyroid Nodules A thyroid nodule is a growth in the thyroid gland. Thyroid nodules are extremely common, and may be solitary or multiple (multinodular goiter). It is estimated that approximately 5-10% of the population has a palpable thyroid nodule, and between 30-85% have tiny thyroid nodules that are too small to palpate. In most people with thyroid nodules, the gland produces a normal level of thyroid hormone (euthyroid state). Statistically, approximately 5-10% of nodules are cancerous. Some patients have findings that increase the risk of malignancy. A history of exposure to ionizing radiation to the neck is such a risk factor, as is a family history of thyroid cancer. Hoarseness, lymph node enlargement, and fixation of the nodule can also increase the risk of malignancy. Fortunately, the vast majority of thyroid cancers are treatable and carry an excellent prognosis. Most thyroid nodules do not require surgery. The primary indications for thyroidectomy are suspicion of cancer, large size, substernal location (nodules that grow inferiorly into the chest), or symptoms (throat pressure, difficulty swallowing, respiratory distress, or cosmetic disfigurement from a visible goiter). Over-functioning nodules are sometimes best treated by surgery, as well. The most important tests to evaluate a thyroid nodule are a TSH level (a blood test that evaluates the function of the gland) and a fine needle aspiration (FNA) biopsy to evaluate the nodule for malignancy. Although FNA is highly accurate, it is not 100% accurate in making a diagnosis. FNA is usually performed in our office, but for smaller nodules and others that are difficult to palpate, the biopsy is done by the radiologists under ultrasound guidance. There are some types of thyroid nodules (follicular tumors) where FNA cannot distinguish benign from malignant nodules- these nodules are usually best managed by thyroidectomy. ThyroidectomyA thyroidectomy is an operation that removes part or all of the thyroid gland. The most common indications for this operation are suspicion of malignancy, large nodules, substernal nodules (nodules that grow inferiorly into the chest), and nodules that cause symptoms (throat pressure, difficulty swallowing or breathing, or nodules so large they cause cosmetic disfigurement). Occasionally hyperthyroidism is treated surgically. The three most common types of thyroidectomy are total, subtotal (removes most of the gland), and hemi (removes one lobe of the thyroid). The extent of the operation depends upon the nature and extent of the pathology. The patient is usually admitted on the morning of surgery, and the operation is done under general anesthesia. It generally takes about 1- 2 hours to perform, and is done through a horizontal incision (usually placed within a skin crease) in the low, anterior neck. Recovery is usually rapid- most patients are ambulatory the day of surgery, and most experience little or no pain after the first 24 hours. Most return to work with no restrictions within 2 weeks of surgery. Surgery Risks & ComplicationsUnfortunately, all operations entail some risk, and thyroidectomy is no exception. All operations carry a risk of anesthesia, bleeding, and infection. The risk of general anesthesia is often related to one’s underlying medical status, and is greater in patients with significant heart and/or lung disease. A preoperative visit with your internist or cardiologist may be beneficial for those in this situation. The most common complication of thyroidectomy is hypoparathyroidism, or low calcium. The parathyroid glands are tiny glands in the neck that sit behind the thyroid. Although they are usually identified and protected during thyroidectomy, they often do not function properly after the surgery. It is thought that only 1 or 2 functioning parathyroid glands are needed to maintain a safe level of blood calcium. Since most people have 4 parathyroids (2 behind each lobe of the thyroid), patients having only a hemithyroidectomy are at no significant risk for hypoparathyroidism and are therefore usually discharged from the hospital the morning after surgery. Patients who undergo total thyroidectomy must take thyroid hormone after surgery. This usually entails taking 1 pill daily. Since it is easy to measure the level of thyroid hormone in the bloodstream, it is usually easy to determine the necessary dose of thyroid hormone for each patient. HyperparathyroidismThe parathyroid glands are tiny glands in the neck that help to regulate the level of serum calcium. When the blood calcium level drops, the parathyroid glands release parathyroid hormone (PTH), which helps to raise the level of serum calcium. Once the serum calcium level returns to normal, PTH production usually stops. In hyperparathyroidism one or more parathyroid glands become independent and continue to produce PTH. As a result, the serum calcium climbs. The resulting hypercalcemia can result in metabolic complications such as kidney stones, osteoporosis, brittle bones that can easily fracture, and abdominal pain. The most common symptom of hyperparathyroidism is probably fatigue, however, since there are so many other potential causes for fatigue, you can never be certain if it is parathyroid-related until after surgery. Some patients with hyperparathyroidism are completely asymptomatic. |
The thyroid gland is a butterfly-shaped gland located in the low anterior neck. It produces thyroid hormone, which helps to regulate the body’s metabolism. The functional capacity of the thyroid is measured by blood tests. Excessive production of thyroid hormone (hyperthyroidism) can cause palpitations, tremors, weight loss, and heat intolerance. Conversely, an under-active thyroid gland (hypothyroidism) can result in fatigue, weight gain, and cold intolerance.