The thyroid is an endocrine gland located in the neck just below the voice box. By secreting appropriate levels of thyroid hormone the thyroid gland controls the metabolism of all the cells in the body. The metabolism is the rate at which every part of the body functions. A balanced metabolism helps to ensure a healthy temperature, heart rate, energy level and growth rate.
Most thyroid problems are related to issues concerning having too much of too little thyroid hormone secretion. When there is too little thyroid hormone this called hypothyroidism and is most commonly caused by Hashimoto’s disease. Symptoms include fatigue, weight gain, puffiness, dry skin, depression, constipation and cold intolerance. On the other hand, when there is too much thyroid hormone in our system it is called hyperthyroidism and this is typically secondary to Grave’s disease which is also an autoimmune problem. These patients may experience anxiety, elevated heart rate, weight loss, heat intolerance, tremors, sleeplessness and occasionally eye problems.
In addition to these thyroid function problems, thyroid pathology may also involve changes in the size shape or structure of the gland. The term goiter generally refers to a diffusely enlarged thyroid gland which can at times be multi-nodular. The thyroid nodules themselves are typically a benign lump which can be solid, cystic or both. Thyroid nodules are very common, usually asymptomatic, and occur most often in women. Any single solitary thyroid nodule measuring over a centimeter in size has approximately a 10 to 15% likelihood of being a well differentiated thyroid cancer. Thus, in these situations a fine needle aspiration is recommended as a biopsy to help rule out the need for surgery.
Most thyroid surgeries are done for enlarging multi-nodular goiters, Grave’s disease, and well differentiated thyroid cancer. Bellingham ENT physicians have over 60 years of combined experience performing all levels of thyroid surgery, including the minimally invasive techniques. The primary surgeon is assisted by one of his partners ( another surgeon) and over the past five years we have treated on average 134 patients per year with thyroid surgery.
The surgeries are done at either the Pacific Rim Outpatient Surgery Center or St. Joseph’s PeaceHealth Medical Center and patients go home the same day or stay one night in the facility. Drains are used periodically and patients may require pain meds and/or a soft diet for a few days. Most patients take a week off of work and a follow up in our office to get their sutures out in approximately five to seven days. The surgical scar, usually about 1 ½ inches long and hidden in a neck crease, is difficult to visualize after approximately three months. Patients may occasionally have some slight vocal change or hoarseness for a few weeks but recurrent laryngeal nerve monitoring is used on every case and less than 1% have a long term vocal concern.
Patients undergoing a total thyroidectomy will require lifelong thyroid replacement which is a very safe and simple process typically managed by their primary physician or an endocrinologist.
Parathyroid glands help to keep the level of the calcium in your bloodstream within a certain range. Keeping a normal level of calcium helps the muscles and nerves work properly and also keep bones strong. Typically there are four parathyroid glands which are all quite small and are located in the neck just behind the thyroid gland. These glands secrete parathyroid hormone (PTH) in response to the level of calcium. When healthy, more PTH is secreted in response to a low calcium level and less PTH is secreted when the calcium level is high. People with primary hyperparathyroidism continue to secrete too much PTH despite an already high level of calcium in their bloodstream. The symptoms of hyperparathyroidism include muscle weakness, depression, fatigue, poor memory, nausea and vomiting, abdominal pain and occasionally joint and bone pain. Hyperparathyroidism can lead to kidney stones and bone disease such as osteopenia or osteoporosis.
Approximately 90% of patients with primary hyperparathyroidism have a benign parathyroid adenoma growth replacing one of the normal glands. This non-cancerous mass can be easily removed per a minimally invasive technique which is often an out-patient procedure under brief general anesthesia. The surgery is done through a 1 inch incision in the lower neck and the adenoma, as identified on pre-operative parathyroid scan and ultrasound, is usually removed within 30 minutes to an hour. Intra-operative neoprobe monitoring and/or PTH measurement are available for all patients although these technologies are rarely required. In the past five year we have performed over 200 parathyroid surgeries at Bellingham ENT and our success rate is over 90%. Patients occasionally will require narcotic pain medication post-operatively but typically return to their routine activities within a few days.