Thyroid & Parathyroid Surgery Details

The Parathyroid Glands
In primary hyperparathyroidism, increased secretion of parathyroid hormone (PTH) occurs because one or more of the glands have become enlarged. Secondary hyperparathyroidism can cause kidney failure because all four glands enlarge and secrete the parathyroid hormone. Although medication is available to treat hyperparathyroidism, surgery is most often recommended and is the only cure with a 95 percent success rate. Surgical removal of one or more parathyroid glands is called a parathyroidectomy and the operation is performed under general or local anesthetic depending on your circumstances. During your surgery, Dr. V will make a small incision in your neck and remove the gland and your situation will determine how many parathyroid glands need to be removed.

If more than one parathyroid gland has to be removed, the procedure will involve general anesthesia and may take up to three hours. In most cases of hyperparathyroidism however, only one gland has to be removed and a less invasive procedure called minimally invasive radio-guided parathyroid (MIRP) surgery can be performed in less than 30 minutes. Some parathyroid tissue must be left in place to help prevent hypoparathyroidism, which is decreased parathyroid activity and although the conventional approach presents more risks, both the traditional and MIRP procedures are safe and effective.

The Thyroid Gland
Any enlargement of the thyroid gland is called a goiter and when the gland is diffusely enlarged, it is called a diffuse goiter. If there is a single nodule, it is known as a solitary nodule and although the majority of goiters are not cancerous, it is highly recommended that all thyroid swellings (goiters) be investigated. During your initial consultation at The Virginia Institute of Surgical Arts, Dr. V will take a detailed history of your problems and assess any issues you might have. This will be followed by an ultrasound scan and during the scan, if necessary a small needle may be inserted into the lump to collect a sample of cells. This is called a fine needle aspiration cytology test (FNAC) and the cells taken will be analyzed under the microscope to determine the nature of the swelling. Other tests, such as a CT scan, MRI scan, or a nuclear isotope scan may be required in some cases and when needed, surgery may be recommended.

There are many different terms used to describe thyroid surgery: a total thyroidectomy implies the removal of all of the thyroid gland whereas a hemi-thyroidectomy or lobectomy is a procedure where only part of the gland is removed. Your surgery will be performed under a general anesthetic and Dr. V will make the incision across the midline in your neck over the gland. This cut is usually placed along a crease line so that it will heal less visibly and the required part or entire gland will be removed after making sure that all of your important nerves, blood vessels, and parathyroid glands are preserved. Possible side effects will be discussed during your consultation and the chances of complications are small because great care is taken to avoid any risks.

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