Head and Neck

 Thyroid

The thyroid gland is a hormone producing gland which is located in the neck.  It lies around the trachea (wind pipe) and larynx (voice box).  It mainly produces thyroid hormone which helps regulate metabolism.

Problems can arise in the thyroid which require partial or total surgical removal of the gland.  These include:

  • Thyroid nodules – these represent growth of abnormal thyroid tissue within the gland. These nodules are most commonly benign but some will be malignant. Removal is required when the nature of the nodule cannot be determined by less invasive investigations, when the nodule is large enough to cause pressure symptoms eg difficulty swallowing and/or breathing, or when the nodule is “toxic” ie producing too much thyroid hormone.

  • Thyroid cancer – the most common type is papillary thyroid cancer, but can also be follicular, medullary or anaplastic cancers. Usually thyroid cancer necessitates the total removal of the thyroid gland.

  • Goitre – this is a benign nodular enlargement of the thyroid gland. Goitres can be removed when “toxic”, causing pressure symptoms in the neck, or for cosmetic reasons.

  • Graves disease – this autoimmune disease causes an overactivity of the thyroid gland. When medication is unable to control this problem removal of the thyroid gland is often used.

Usually the thyroid gland is removed through a 5 cm incision at the front of the neck.  When half of the thyroid gland is removed there is an overnight stay in hospital.  When a total thyroidectomy is performed a hospital stay of 2 – 3 days is required.  In our practice we also offer minimally invasive video assisted thyroidectomy (MIVAT) in appropriate patients where the thyroid is removed through a 1.5 – 2 cm incision.

Thyroid surgery is generally very safe, however there is always a risk of bleeding, injury to the recurrent laryngeal nerves (nerves to the voice box) and injury or removal of the parathyroid glands.  Thus it is important to have this operation performed by an experienced thyroid surgeon.

Parathyroid

The four small pea-sized parathyroid glands lie behind the thyroid gland.  Their primary function is the regulation of calcium levels within the body.

Hyperparathyroidism

This occurs when one or more of the parathyroid glands produces too much parathyroid hormone (PTH).  This is most commonly due to a benign tumour forming within the gland called a parathyroid adenoma.  High PTH levels causes calcium to be reabsorbed from the bone resulting in a high calcium level in the bloodstream.  This problem is most commonly identified by a high calcium level being found on a routine blood test by a GP.  However hyperparathyroidism can also cause the following problems:

  • Fatigue

  • Depression

  • Bone pain

  • Osteoporosis and bone fractures

  • Kidney stones

  • Heart problems

The primary treatment of hyperparathyroidism is to surgically remove the overactive parathyroid gland.  In most patients there will only be one parathyroid adenoma and it can usually be located by preoperative scans.  In these cases the abnormal gland is removed via a minimally invasive approach.  This involves a 1.5-2 cm incision over the abnormal gland. The remaining normal parathyroid glands return the body’s calcium metabolism to normal.