Endocrine glands are a group of glands in the body which secrete hormones. These hormones then evoke a response from other cells in the body which are located far away from the endocrine gland. They are secreted into the blood stream, so they have access to every cell in the body. Sometimes surgery is needed to remove part or all of these endocrine glands when they are malfunctioning, or contain cancer.
THYROID GLAND: This gland is located in the front portion of the neck. This gland secretes thyroid hormone and regulates the body’s overall metabolism. (that is why when a person is hypothyroid, they usually gain weight)
PARATHYROID GLAND: Para means “around”. These glands, usually 4 in number are located around the thyroid gland. They secrete parathyroid hormone which controls CALCIUM metabolism.
ADRENAL GLANDS: These glands are located above the kidney and they secrete many hormones which maintains our blood pressure, helps kidney function and overall fluid concentrations in our body. “adrenaline” comes from these glands.
PANCREAS: Located behind the stomach, this gland secretes many hormones, but the one that is most famous is INSULIN.
PITUITARY GLAND: Located at the base of the brain. This is the “quaterback” of the endocrine system.
SURGERY ON THE ENDOCRINE GLANDS:
THYROID:
Many disorders may affect the thyroid gland. You may here goiter, graves disease, hashimoto’s disease, etc. Theses disorders can cause the thyroid gland to grow and become enlarged. This may then lead to symptoms such as hoarseness or dysphagia (which is difficulty swallowing). When this happens, the thyroid gland may need to be removed to help relieve those symptoms. Most people fear surgery in the head and neck area prior to the operation. After the operation, most say their fears were not warranted. We understand these concerns. Nowadays, this operation is done under smaller incisions and the recovery time is much less. Most patients are eating the night after surgery and they usually go home the day after surgery from the hospital.
Sometimes a nodule is found in the thyroid gland. This always concerns patients because it may represent a thyroid cancer. Most nodules however are not cancerns, but most need an evaluation. We usually perform a physical exam, an ultrasound and a FNA. (please see below). We may remove the portion of the gland the nodule is located in, or we may removed the entire thyroid gland. This decision is usually made at the time of surgery, but we always discuss the possibilities with our patients preoperatively.
Ultrasound:
Most disorders of the thyroid gland are diagnosis with a simple outpatient, non-painful test called an ultrasound. A technician uses a specialized machine along with a water-soluble substance to visualize the thyroid gland.
FNA (fine-needle aspiration):
Sometimes a nodule or area that is suspicious needs a biopsy. A small needle is then placed into this area and cells are aspirated and then sent to the pathologist to be examined under the microscope. A lot of patients ask us about this procedure, because they “fear” needles. This procedure takes less than 5 minutes to do and after the procedure, most patients ask “are you done?”, because they can’t feel the small needle. They can drive themselves to the office and home and this is performed under local anesthesia.
Thyroid Surgery
If the gland or part of the gland needs to be removed, we schedule a thyroidectomy. This is an operation that is done in the hospital under general anesthesia. This operation usually takes an hour, but may vary depending on the size of the thyroid gland and/or nodule within the thyroid gland. Most patients stay is overnight, but can sometimes be two days in the hospital. A drain is usually left in place at the operation and usually is removed the next day at the bedside. Recovery time is usually one to two weeks.
PARATHYROIDS:
These glands regulate calcium metabolism. Some people may have recurrent kidney stones, may complain of a lot of aches and pains all over, or may have chronic abdominal pain and back pain. Sometimes patient’s families say that the patient has had a lot of mental status changes, and disoriented. These may all be due to calcium metabolism. In medical school the old saying is stones, bones, and groans. This should alert you to problems with calcium metabolism. Two major disorders may be affecting the parathyroid gland. One is an adenoma and the other is hyperplasia. Both of these are benign conditions. Parathyroid cancer is a very very rare disease.
Diagnosis:
Usually a blood test is ran and shows an elevation in the blood calcium. This is usually followed by a blood test that looks at the PTH level (parathyroid hormone). This too will likely be elevated in parathyroid diseases.
Confirmation:
This is the newest line of MINIMALLY-INVASIVE ENDOCRINE SURGERY. A test called the sestamibi parathyroid scan may be ordered if you are found to have an elevated calcium and pth level in the blood. This test is done in radiology and helps the surgeon “localize” this abnormal gland. Using a handheld device, the surgeon can make a “small” incision over the gland and removed the diseased gland. (see photos of the parathyroid adenoma to the right).
Most of the time this can be done under a little sedation, but if the patient desires can be done under general anesthesia. Most patients can go home from the hospital later in the day or the next day after surgery.
