Thyroid & Parathyroid Glands

Thyroid and Neck Ultrasound

The thyroid is an organ in the lower neck that controls metabolism. Thyroid nodules are sometimes found on exam or on radiologic studies. Most thyroid nodules are benign, but some are cancerous. Initial evaluation of thyroid abnormalities often involves thyroid ultrasound to evaluate the anatomy.

Performed with in-office ultrasound equipment, the procedure requires a soft gel to be spread across the area of the neck to be observed, which will help the sound waves travel between the machine and the body. The procedure itself is completely painless.

Ultrasound-guided Fine Needle Biopsy of Thyroid Nodules and Neck Masses

Thyroid nodules are abnormal growths on the thyroid gland that appear as lumps in the neck. The cause of a thyroid nodule is not known, but they occur most often in older adults and are usually not cancerous. However, some thyroid nodules require careful evaluation to rule out malignancy.

A neck mass is a common condition that involves swelling that changes the shape of the neck. Neck masses do not usually cause any symptoms and often disappear on their own.

They may be caused by:

• Enlarged lymph node caused by infection
• Inflamed or infected cyst
• Trauma
• Inflammation of salivary glands
• Tumor

Neck masses caused by infection can be painful and may require antibiotic treatment. Those that last more than a few weeks should undergo diagnostic testing.

Fine needle aspiration biopsy is used to sample an abnormality within the neck or thyroid under local anesthesia. A small 22g needle is used guided by ultrasound to reach only the mass and sample tissue.

Small Incision Thyroidectomy with Laryngeal Nerve Monitoring

During a thyroidectomy, the thyroid gland or part of the thyroid is removed depending on the extent of the disease. This is the most common procedure when thyroid cancer is present to completely remove the disease.

If the entire thyroid is removed, you will need to take thyroid hormone replacement drugs for the rest of your life. Insufficient thyroid hormone will often bring about signs of hypothyroidism, or an underactive thyroid. Symptoms of hypothyroidism may include fatigue, exhaustion, depression, and difficulty concentrating. This can be corrected by taking thyroid hormone replacement pills.

Thyroid surgeries are performed through a small incision in the middle of the neck and the operation is less invasive than traditional surgery. The procedure usually takes about two hours and is done under general anesthesia. Most patients are able to resume normal activities one week after surgery. Strenuous activities should be avoided for at least 10 days after surgery. Thyroid surgeries are considered safe procedures with few complications. Some people may experience hoarseness or a sore throat because of the breathing tube used during surgery.

During thyroid surgery, the surgeon operates near the laryngeal nerves, which control movement of the vocal cords. Laryngeal monitoring helps identify the nerves to allow quicker and safer surgery.

Radio-Guided Parathyroidectomy

The parathyroid glands are four small glands in the neck next to the thyroid gland that are part of the endocrine system. They produce parathyroid hormone (PTH), which maintains calcium and phosphorus levels in the blood. The primary disease associated with the parathyroids is overproduction of PTH, known as hyperparathyroidism.

Surgical removal of one or more parathyroid glands is called a parathyroidectomy. In most cases of hyperparathyroidism, only one gland has to be removed, and a procedure called minimally-invasive radio-guided parathyroid (MIRP) surgery can be performed. MIRP surgery requires a much smaller incision and has a very high success rate. The operation usually takes less than 30 minutes and you may return home within one to two hours. You will be able to resume your normal activities after just one day. Sometimes rapid PTH testing is used during the procedure allowing your surgeon to be able to determine immediately when all of the abnormal parathyroid tissue has been removed. This helps make the surgery more precise and helps shorten the length of the surgery.