Thyroid & Parathyroid Surgery

  T H Y R O I D    

The thyroid gland, shaped like a butterfly, sits just deep to the skin and a thin muscle layer in the lower aspect of the neck. It's attached to the deeper neck structures (trachea and voice box) and elevates when we swallow. The thyroid gland secretes hormones that control a variety of systems including our metabolism and energy level. It is a very active gland; as a result, a variety of problems can arise which can result in hormonal imbalance or development of lumps (nodules or cysts). Nodules are solid structures while cysts are filled with fluid. Nodules and cysts are not uncommon findings and occur in up to 5% of the population. Nodules are more common in women and a great majority of them are benign in nature. All nodules, however, need to be carefully evaluated as a small percentage of nodules may be cancerous.

The first step in assessing thyroid nodules is a blood test for thyroid hormone levels, followed by a needle biopsy (fine needle aspiration), which can be performed in the office setting. Ultrasound visualization and thyroid scans are adjunctive tests that can help your physician develop a treatment plan. Thyroid malignancies are very treatable and carry a high cure rate, especially when discovered early.

Surgical treatment of thyroid masses includes removal of a portion or the entire thyroid gland. Partial removal of the thyroid, also known as hemi-thyroidectomy, is usually performed for large cysts or masses limited to one lobe of the gland. Total thyroidectomy is reserved for the removal of cancerous tumors to assure there are no microscopic cancer cells left. One of the risks of this operation is injury to the nerve controlling the vocal cord which would lead to hoarseness; to minimize the risk to this nerve we use a special nerve monitoring device that alerts us during surgery when we are in close proximity to the nerve. To minimize scarring, we have developed a two-team approach of working with facial plastic surgeons to ensure the best possible aesthetic outcome. Furthermore, we use state-of-the-art techniques such as video-assisted endoscopic thyroidectomy which allow removal of the gland through a small incision.

 

 

 P A R A T H Y R O I D    

The parathyroid glands are located at the front and base of the neck at the 4 corners of the thyroid gland. The glands produce parathyroid hormone (PTH), which regulates calcium and phosphorus balance in the body.

In primary hyperparathyroidism, increased secretion of parathyroid hormone (PTH) occurs because one or more of the glands have become enlarged. The effects of increased calcium are seen in several body systems including the skeletal (osteoporosis), gastrointestinal (ulcers), renal (kidney stones), and central nervous system (depression).

The disease is most common in people over 60, but can also be seen in younger adults. Women are more likely to be affected than men. Radiation to the head and neck increases risk. Hyperparathyroidism in childhood is distinctly unusual.

Secondary hyperparathyroidism is a consequence of kidney failure. In these patients, all four glands enlarge and secrete parathyroid hormone. Parathyroidectomy is the surgery to remove one or all parathyroid glands.

Our team of expert surgeons utilizes the technique of minimally invasive parathyroidectomy via a small incision as well as intraoperative PTH hormonal assay to ensure a more effective and less invasive procedure. Our patients' hospital recovery course is much simpler.


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David M. Alessi, MD, FACS  

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