the thyroid gland is a gland at the base
of the neck that controls our metabolism
or how much fuel we burn.
There are essentially three reasons why the thyroid
glands may require removal. Firstly the
glands may become overactive, secondly
nodules or lumps can begin growing
within the thyroid gland which produces
a condition called goiter which can lead
to cosmetic or even compressive concerns
for the patient, and finally some of the
lumps within thyroid gland can be
cancerous
the parathyroid glands are glands in the
base of the neck that control calcium
metabolism. Occasionally one or more of
these glands can become overactive which
leads to calcium being taken out of the
bones and results in a high calcium level.
So these patients will be referred
for surgery to remove the offending
glands or glands to restore normal
calcium levels.
The thyroid glands produce a hormone called thyroxine which is essential
to life. Without thyroxine, all our bodily
processes would tend to slow down so it is
very important for normal health that we
receive thyroid hormone.
The parathyroid glands are important for
controlling calcium metabolism in the
body it´s vital that we have parathoid
hormone function because without that
our calcium would drop to levels where
essentially the muscles will go into a spasm.
Thyroid surgery essentially
involves either removing half or all of
the thyroid gland. The length of the
operation can be anything from 30 minutes
to approximately two hours depending on
the complexity.
The risks of thyroid surgery have to be carefully discussed
with the patients so that all patients
have informed consent.
Like all operations there is a small risk of
bleeding and infection
which is very low with thyroid surgery.
Specific to the operation itself are
first of all injury to the nerves which
are very closely approximated to the
thyroid glands particularly the nerves that
control the voice so it is possible for
these nerves to be injured either
temporarily or permanently which might
lead to hoarseness.
The second very specific complication, and this really
only applies when you removed all the
thyroid gland, is that the parathyroid
glands that control calcium can also
become either temporarily or permanently
dysfunctional which leads to a drop in
the calcium level.
Parathyroid surgery in most cases involves just removal of one
gland but on occasions, in fact not uncommonly,
all four glands have to be
inspected, identified, and then the
abnormal ones removed. Parathyroid surgery
can take anything between 20 minutes or
two hours or more depending on how
difficult is to find the abnormal gland
or glands. The risks are very much
generic like all surgery; bleeding,
infection. Again, the nerves of the
voicebox are very close to the
parathyroid glands so there's a very
very small risk of these nerves
could be temporarily or permanently
injured but the risk is much less when
compared to thyroid surgery.
There is also a risk that the first operation may
not cure the patient of the condition,
as occasionally the parathyroid glands are
in an abnormal situation anatomically
such as in the chest.
Thyroid surgery essentially involves two approaches.
The most common and conventional approach is to
make an incision in the neck recently
pioneering techniques involving
a robotically assisted surgery entails an
incision made not in the neck but in the
armpit to avoid scarring.
And this is particularly appropriate for patients who
give a poor history of scarring
which we describe as keloid or even
hypertrophic scarring and that's very
attractive to many patients as the vast
majority, in fact 80% of all thyroid
surgery is performed in women. Parathyroid
techniques essentially depends on
probative localization. For single gland
disease then patients may be enabled to a
middle invasive technique which involves
a small 2 centimeter incision
within the neck which enables the
preoperatively identified parathyroid to be
removed alone without disturbing the
rest of the parathyroid glands.
If preoperative localization does not
identify the offending parathyroid, then
a 4 gland approach is required. This
involves a larger incision of
approximately 4 centimeters so that all
four parathyroid glands can be
visualized and then the pathological
glands removed.
Results of thyroid and parathyroid surgery are very much
determined by the volume of thyroid and
parathyroid surgery. There's very good
evidence that the best results are
produced by those surgeons that perform
high volume thyroid and parathyroid
surgery.
The British Association of thyroid and endocrine surgeons has a
national database and I would very much
encourage all patients to look at the
database as it is now in the public
domain, it's been mandated that all
thyroid and parathyroid surgeons should
enter their data into the registry.
Other important roots of referral are of course by
the general practitioner and
particularly endocrinologist which will
be very aware of the surgeons results as
a thyroid and parathyroid surgeon has to work very
closely with the endocrinology specialty.