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Thyroid and Parathyroid surgery

We put these two together since they are in the same region of the neck and the surgical procedure is similar in location and impact.  from the stand point of recover. They are separate organs and their functions are different.

Thyroid Gland -It is the gland responsible for the power and energy in the body. It is located in the neck and has two lobes, a right and a left.

The thyroid can have nodules or growths that are usually benign, but at times we must remove them to determine if they are benign or malignant (cancer).  This is the main reason surgery is done, to remove a cancer or benign tumor.  The thyroid also can turn hypoactive or hyperactive.  These are conditions usually treated in the medical setting, but on certain circumstances the thyroid gets very large and must ben removed due to compression or hyperactivity that is not controlled with medication.  This is known as Graves disease or a thyroid goiter.  

The surgical approach to the thyroid is through a transverse incision in the mid neck about two finger breaths above the sternal notch.  This  incision heals very well and leaves little evidence of an operation.  When we operate on the thyroid we remove one lobe or the entire thyroid gland depending on the condition being treated.  

The operation is usually done in the outpatient setting or 24 hr observation and the patient usually goes back to work within a week.  

The main risks of the operation are damage to the recurrent laryngeal nerves unilateral or bilateral.  These nerves go to the vocal cords and if damaged, the patients voice ay be affected, usually on a temporary basis, but at times permanently.  Each person is different. There are solutions, if this happened. 

Another risk is the damaging of the parathyroid glands that seat behind the thyroid and are very small and hard to identify.  there are four of these glands and on occasions, during total thyroidectomy ( removal of the entire thyroid), all four are damage or removed without knowing.  If this were to happen, then the patient would need to take calcium supplements for life.  More about parathyroid function below.

Finally there is always risk of bleeding and infection with any surgery, but these are minimal. At times a drain is left in place for 24 hours if bleeding is a higher than normal risk.  Each patient is different, so we will discuss with each patient specific risks with him or her. 

After thyroid surgery wound care consists of washing with water and soap and all stitches dissolve.  there is also ways need to follow with the endocrinologist to then adjust thyroid medication.  If the entire thyroid gland was removed, then the patient will need thyroid medication for the rest of their life.  

Parathyroid Glands - The parathyroid glands are four in total and located usually behind the thyroid gland in the middle of the neck.  They are the main controllers of calcium levels in the body. The usual reason for surgical intervention is hyper functioning that causes the patient to waste calcium and affect the bone structure, cause kidney stones, cause hypertension, muscle weakness and even depression.  Sometimes the finding of hyperactive paratyroid glands is discovered during a routine blood work and by accident.  They are not easily palpable unless very large.

The most common scenario is that of a single enlarged gland or parathyroid adenoma.  In that case we need to identify the particular gland through a combination of neck Ct and nuclear medicine studies to find its location and remove the sick gland.  this usually cures the patient form the condition.  

Under other circumstances, all four glands must be removed and in that situation we reimplant a piece of one gland to try an prevent the total loss of parathyroid function, which would render the patient dependent on calcium supplements for life.  This condition is less common than the single gland disease. The operation is done through a transverse incision in the low neck area and it is usually done in the out patient setting, or at times 24 hour observation.