Thyroid and Parathyroid

Thyroid

The thyroid gland is one of the bodies endocrine glands and is part of a larger endocrine system of glands. Endocrine glands are similar in that they produce hormones that travel through the blood stream to reach distant locations. The thyroid is a butterfly shaped gland that is attached to the windpipe in the lower mid portion of the neck.  Thyroid hormone is the main product of the thyroid gland and is responsible for helping the body use energy appropriately and helps keep all other cells in the body functioning correctly.

Disorders with the thyroid can be largely grouped into functional issues with hormone production or release, inflammatory/autoimmune conditions and nodular disease which can be benign or malignant. As thyroid surgeons, we are most commonly involved in the management of patients with nodular disease although we may also be involved in working with your primary care provider or endocrinologist in aiding in other non-nodular conditions of the thyroid.  More information on the variety of conditions that can affect the thyroid can be found at https://www.thyroid.org/thyroid-information/.

  • Nodular disease of the thyroid is relatively common condition. Nodules may come to our attention in different ways.  Most commonly nodules are noted because patients or their physicians can feel them. Studies show that around 5% of females and 1% of males have thyroid nodules that can be felt on exam, the medical term for this is a palpable thyroid nodule. Imaging techniques, particularly ultrasound, are significantly more sensitive and find thyroid nodules at a much higher rate that we may not be able to feel.  Studies show that the rate of ultrasound detected nodule range from 19-68%, with higher rates in the elderly and women. It is important to note however that the US Preventative Services Task Force does not recommend routine screening for thyroid nodules or cancer by either exam or ultrasound in patients without symptoms or high risk history because the data does not support this to be a beneficial practice for patients. If a thyroid nodule does come to your doctor’s attention either by exam or incidentally during an imaging study, such as a CT or MRI, it is important to be evaluated because of the possibility a thyroid nodule may represent a cancer. Approximately 7-15% of thyroid nodules harbor cancer and this varies based on a patients age, sex and high risk history.

    1. This is the time point at which we usually evaluate patients. Now, if an ultrasound has not been performed we would arrange for one in our clinic. The ultrasound is a powerful tool for risk assessment of thyroid nodules. It allows us to assess size and features that are considered high risk. Based on specific ultrasound criteria outlined by the American Thyroid Association we determine the need to biopsy thyroid nodules. The biopsy, if necessary, is surprising easy to tolerate in the clinic.  
    2. The results of the thyroid biopsy, with additional information obtained from genetic assessment of the specimen if necessary, drive the decision-making process for observation of the nodule versus surgery. We would have a detailed discussion with you regarding risk and benefits of any recommended approach.  

Parathyroid

The parathyroid glands are responsible for the production of parathyroid hormone (PTH) which plays a crucial role in the rapid regulation of the bodies blood calcium levels. These glands are generally 4 in number and found in pairs on each side of the neck near the thyroid gland. PTH interacts with the bones and kidneys as well as indirectly with the gut, through vitamin D, to regulate the bodies calcium levels. Persistently abnormal elevations in blood calcium levels in adults are commonly related to inappropriate elevations in PTH however other serious conditions need to be ruled out. 

  • Abnormal elevations in calcium and PTH levels requires a thorough evaluation as there may be significant consequences on several systems in the body, most notably the kidneys and bones leading to conditions such as kidney damage, kidney stones and bone thinning with increased fracture risk. 
  • In many cases, elevated calcium levels in the setting of inappropriately elevated PTH represents a condition known as primary hyperparathyroidism. This is caused by an abnormality in one or more of the 4 parathyroid glands in the body. Doctors involved in evaluating this condition may be your primary doctor, an endocrinologist and an endocrine surgeon such as an ENT doctor. 
  • If intervention is deemed necessary based on a though workup surgery is the only known cure for this condition. This is successfully performed in our practice in most instances as an outpatient surgery.