Thyroid and Parathyroid
At CCHNS, we treat all facets of thyroid and parathyroid disorders. The thyroid gland is a butterfly shaped gland which sits just below the larynx in the neck, and which secretes thyroid hormone. Thyroid disorders include goiters, thyroid nodules, thyroid cancer, autoimmune conditions, and hormonal alterations. The parathyroid glands are 4 small glands which are adjacent to the thyroid, which control calcium levels in the body, and when the glands are dysfunctional this can impact a person’s calcium metabolism and affect multiple systems. As head and neck surgeons we work closely with our medical, endocrinology, and radiation oncology colleagues to create a team approach to patient care.
Thyroid nodules are very common and are often found by chance after imaging of the neck such as a CAT scan or ultrasound. Some nodules can be felt on examination or a patient may notice this with the sensation of pressure in the neck, difficulty swallowing, or a prominent bulge under the skin. The majority of nodules are benign, meaning that they are not cancer. In general, if a nodule is noted, then certain tests are performed including thyroid hormone function ( a blood test ), an ultrasound, and sometimes a needle biopsy.
A goiter refers to an enlarged thyroid gland which is usually filled with multiple nodules of different sizes. The goiter and nodules typically grow slowly over time and can eventually cause symptoms such as neck pressure, difficulty swallowing, or a visible/cosmetic bulge under the skin. Occasionally it can become so large that breathing becomes difficult. Nodules within the goiter are usually benign, but they still have the potential for harboring cancer. The treatment for a goiter is with a partial or total thyroidectomy.
Although most nodules are benign, they may occasionally represent cancer. While a needle biopsy can often make this diagnosis, surgical removal and pathology evaluation is often needed to make sure a nodule is not cancerous. Fortunately, most thyroid cancer is very slow growing with an excellent 99100% long term survival. The main types are papillary thyroid carcinoma and follicular thyroid carcinoma. However, there are subtypes of these and different types of cancer which can be more aggressive and may need more extensive treatment. The treatment of thyroid cancer is surgical removal of the thyroid, involving one half of the thyroid gland with the cancer, or removing the entire gland. In some cases radioactive iodine is given after the surgery as part of the treatment. There are many subtleties based on pathology which determine the risk of relapse/recurrence of the cancer, and the need for radioactive iodine.
This refers to when the parathyroid glands become too active and secrete excessive hormone called parathyroid hormone ( PTH ) . While the body needs this hormone to maintain calcium absorption and metabolism, an excess of the hormone can be harmful over time, causing bone loss/osteoporosis, fractures, kidney stones, abdomen pain, and depression/mood changes. This excess hormone can be detected with blood testing of calcium as well as PTH. Often the cause of this elevated PTH is a small abnormal growth in one of the parathyroid gland called an adenoma. More rarely more than one of the glands is affected, with 2 or more adenomas or increased production by all glands, called hyperplasia. The treatment is primarily surgical, and the condition can be cured with removal of the adenoma or involved glands. There can be immediate normalization of a patients calcium levels and PTH hormone after surgery.