THYROID AND PARATHYROID GLAND SURGERY

Types of Surgery

THYROID GLAND SURGERY

What is the thyroid gland?

The thyroid gland is a butterfly-shaped organ located in the front of the neck, just below the Adam's apple. It plays a crucial role in regulating various metabolic processes in the body by producing hormones.

Thyroid hormones affect almost every organ and cell in the body and are essential for maintaining normal bodily functions, including:

  • Regulation of metabolism
  • Growth and development
  • Body temperature
  • Heart and nervous system function
  • Blood pressure
Common conditions of thyroid gland
  • Hyperthyroidism

Hyperthyroidism is the opposite of hypothyroidism, characterized by excessive production of thyroid hormones.

  • Hypothyroidism

This condition occurs when the thyroid gland doesn't produce enough thyroid hormones

  • Hashimoto's thyroiditis (an autoimmune condition) 

Ιnflammation of the thyroid gland, which can cause temporary changes in thyroid hormone levels.

 
  • Thyroid cancer

Thyroid cancer is relatively rare compared to other cancers but is the most common cancer of the endocrine system.Typically have a slow progression and can cause local swelling in the neck, voice hoarseness, or difficulty breathing.

  • Multinodular Goiter

Benign thyroid nodules causing neck swelling or discomfort.

 
Symptoms of hyperthyroidism
  • Increased appetite
  • Weight loss
  • Nervousness and anxiety
  • Muscle weakness
  • Tremors
  • Difficulty sleeping
  • Heat intolerance
  • Irregular menstrual periods
  • Exophthalmos
  • Increased heart rate
 
Thyroidectomy::

Thyroidectomy is a surgical procedure to remove part or all of the thyroid gland. In total thyroidectomy, the entire thyroid gland is removed. In partial thyroidectomy, only one lobe (half) of the thyroid gland is removed.

Thyroidectomy is typically performed under general anesthesia by a surgeon specialized in head and neck surgery or endocrine surgery. The surgeon makes an incision in the front of the neck in the skin creases, for a better aesthetic outcome, to access the thyroid gland.

Total thyroidectomy using a nerve stimulator involves the use of a specialized device to locate and preserve the recurrent laryngeal nerves (RLNs) during the surgical procedure. The recurrent laryngeal nerves are crucial nerves that supply the muscles of the voice box (larynx), and their preservation is essential to maintain normal vocal function after thyroid surgery.

Total thyroidectomy using a nerve stimulator can help reduce the risk of RLN injury and postoperative vocal cord dysfunction, ultimately improving the safety and outcomes of the surgery.

Complications of thyroidectomy can include bleeding, infection, damage to surrounding structures (such as the parathyroid glands or recurrent laryngeal nerves), and hypothyroidism or hyperthyroidism if too much or too little thyroid tissue is removed. However, with careful surgical technique and appropriate postoperative care, complications are relatively uncommon.

The duration of the surgery is approximately 90 minutes, and hospitalization does not exceed one day. The patient can return to their activities within a few days.

After thyroidectomy, patients may experience temporary or permanent changes in thyroid hormone levels, which can be managed with thyroid hormone replacement medication.

Symptoms of hypothyroidism
  • Fatigue
  • Weight gain
  • Irregular menstrual periods
  • Constipation
  • Brittle nails
  • Hair loss
  • Dry skin and hair
  • Cold intolerance
  • Depression
 
Diagnosis of thyroid conditions:
  • levels of thyroid hormones (T3, T4) and thyroid-stimulating hormone (TSH)
  • ultrasound
  • thyroid scan (scintigraphy)
  • Fine Needle Aspiration (FNA) biopsy
 
Treatment of thyroid conditions:

Once a diagnosis is established, treatment can be tailored to the specific thyroid disorder, which may include medications, radioactive iodine therapy, surgery, or other interventions aimed at managing symptoms and restoring thyroid hormone levels to normal.

 
Indications of thyroid surgery

May be indicated for various thyroid conditions that cannot be effectively managed with medication alone or require immediate intervention due to complications or suspicion of cancer. Here are some common indications for thyroid surgery:

  • nodules that continue to grow despite medical treatment or surveillance.
  • toxic multinodular goiter,non responsive to medical treatment
  • toxic adenoma (nodule)
  • benign thyroid nodules or thyroid inflammation (thyroiditis) recur despite conservative management
  • single nodule with rapid increase is size
  • presence of thyroid nodules suspicious for cancer based on biopsy results (fine needle aspiration biopsy
  • thyroid cancer
PARATHYROID GLAND SURGERY

What are the parathyroid glands?

The parathyroid glands are small, almost the size of a pea, usually four in number and located on the posterior surface of the thyroid gland.

What is the function of parathyroid glands?

The parathyroid glands are responsible for regulating calcium levels in the blood. They produce parathyroid hormone (PTH), which helps to control calcium levels by acting on the bones, kidneys, and intestines.

Hyperparathyroidism:

Is a condition characterized by excessive secretion of parathyroid hormone (PTH) from one or more of the parathyroid glands.

Hyperparathyroidism can be primary,secondary or tertiary

Primary hyperparathyroidism is the most common cause of hypercalcemia in the general population. It occurs more frequently in women over 45 years of age.

Autonomous secretion of parathyroid hormone from the parathyroid glands may be due to:

  • Solitary adenoma, meaning a solitary benign tumor in one gland - the most common cause.
  • Hyperplasia of all glands (increase in size and functionality of all 4 glands)
  • Parathyroid carcinoma
  • Multiple adenomas (multiple benign tumors in more than one parathyroid gland)
Diagnosis

The diagnosis of hyperparathyroidism is established through the following examinations:

  • Blood tests-Hormone levels
  • Bone scan
  • Ultrasound
  • Scintigraphy

What is the treatment of hyperparathyroidism? θεραπεία του υπερπαραθυρεοειδισμού;

The only effective treatment for primary hyperparathyroidism is the removal of the adenoma, which means surgically removing the affected gland. In cases of hyperplasia of all parathyroid glands, 3½ glands are removed. The remaining parathyroid gland can be marked and left in place in the neck or transplanted to the patient's forearm to facilitate easier access if needed in the future.

The surgery is performed under general anesthesia, with an incision similar to that of a thyroidectomy. The surgical incision is made in such a way that it "hides" within the natural skin creases, and the wound is closed with subcuticular sutures (plastic surgery stitch).

The patient is discharged from the clinic, usually within 24 hours. After surgery, the parathyroid hormone levels, which should be low (confirming the removal of the adenoma), and the calcium levels are monitored.