Endocrine (Glands) Procedures

Understanding the Parathyroid Glands

Understanding Hyperparathyroidism

Role of the Thyroid

The thyroid is an endocrine gland located in the neck, just below the voicebox. Endocrine glands produce hormones. These are chemicals that carry messages through the bloodstream to other parts of the body. The thyroid gland produces thyroid hormone. It does this with help from a gland in the brain called the pituitary.

Keeping the Body Working Right

Thyroid hormone helps keep all the cells in the body working right. It does this by controlling the metabolism. This is the rate at which every part of the body functions. Thyroid hormone keeps the metabolism at a healthy pace. This helps the brain, heart, muscles, and other organs work well. A balanced metabolism also helps ensure a healthy temperature, heart rate, energy level, and growth rate.

The Thyroid Cycle

The thyroid hormone must be kept at a healthy level. A complex cycle maintains this level. The cycle starts with the pituitary. This gland monitors the level of thyroid hormone in the blood. Depending on the level, the pituitary sends TSH (thyroid stimulating hormone) through the bloodstream to the thyroid gland. TSH tells the thyroid how much thyroid hormone to make. In response to TSH, the thyroid makes thyroid hormone. Then thyroid hormone is sent into the bloodstream to the rest of the body. The pituitary senses the hormone level, adjusts the TSH level, and the cycle continues.

Common Thyroid Problems

Hypothyroidism

When you have hypothyroidism, your thyroid gland doesn’t produce enough hormone. The most common cause of hypothyroidism is Hashimoto’s thyroiditis. In this condition, the body’s immune system mistakes the thyroid gland for something it needs to attack. Hypothyroidism may also occur if there’s not enough iodine available for the thyroid to make hormone, if there are problems with the pituitary gland, or if the thyroid gland is removed.

Common Symptoms

Low energy, fatigue, depression
Feeling cold
Muscle pain
Slowed thinking
Constipation
Longer, heavier menstrual periods
Weight gain
Dry and brittle skin, hair, nails

Hyperthyroidism

With hyperthyroidism, the thyroid gland produces too much hormone. The most common cause of hyperthyroidism is Graves’ disease, a problem where the body’s immune system overstimulates the thyroid. Graves’ disease sometimes causes the eyes to look like they’re bulging (exophthalmos). A nodule in your thyroid gland can cause hyperthyroidism if the cells in the nodule produce more hormone than the rest of the gland.

Common Symptoms

Shaking, nervousness, irritability
Feeling hot
A rapid, irregular heartbeat
Muscle weakness, fatigue
More frequent bowel movements
Shorter, lighter menstrual periods
Weight loss
Hair loss

Nodules

Nodules are lumps of tissue in the thyroid gland. Usually, the cause of nodules isn’t known, but they may be more common in people who’ve had therapeutic radiation to the head or neck. Most of the time, nodules don’t affect the production of thyroid hormone and cause no symptoms. Sometimes they can be felt on the outside. Most nodules are benign (noncancerous), but occasionally a nodule may be cancerous.

What Is a Goiter?

A goiter is the enlargement of the thyroid gland. When the gland enlarges, you may see or feel a swelling on your neck. A goiter may develop in a person with hypothyroidism.

Evaluating Thyroid Problems

Your doctor suspects that you have a thyroid problem. Thyroid problems can be fairly easy to diagnose. Your doctor is likely to take a medical history, do a physical exam, and order blood tests. You may also have further testing. Based on the results, your doctor may refer you to an endocrinologist (thyroid specialist) or a surgeon.

Medical History

Your doctor will ask about symptoms you’ve noticed, such as changes in body temperature, weight, and energy level. Tell your doctor about all medications you’re taking and if you’ve ever had thyroid surgery. And mention if you have a family history of thyroid problems, or if you are pregnant or plan to become pregnant. Also tell your doctor if you’ve ever been treated with radiation to the head or neck.

Physical Exam

After the medical history, your doctor will examine you. He or she will feel your neck to check your thyroid gland for changes in size or shape. Your doctor may also look for changes in heart rate, reflexes, muscle strength, or skin texture.

Blood Tests

Your doctor will order blood tests. They may include the following:

A TSH test helps determine how much TSH is being produced by the pituitary gland. This test is used to help diagnose or evaluate most thyroid problems.
A T4 test helps determine how much thyroid hormone (T4) is available in the blood. This test is most often used to help diagnose hyperthyroidism (too little TSH).

Other Diagnostic Tests

Ultrasound

Based on the results of your exam and blood tests, you may have other diagnostic tests. They may include the following:

Thyroid antibody tests are blood tests that look for problems with the immune system. These tests are most often used if hypothyroidism or hyperthyroidism is suspected.
An ultrasound uses sound waves to create an image showing the size and shape of the thyroid gland. It is most often used if a nodule (a lump in the thyroid) or goiter (enlarged thyroid) is suspected.
A radioactive iodine uptake test measures how much iodine the thyroid gland takes in. It is most often used if hyperthyroidism is suspected.
A thyroid scan is an imaging test that can show if the thyroid gland is making too much thyroid hormone. It is most often used if hyperthyroidism is suspected.

Fine Needle Aspiration (FNA)

Fine needle aspiration (FNA)

If you have a nodule, you may have a fine needle aspiration done. This is a biopsy, which is a procedure to remove a sample of cells. An FNA is the best test to find out if thyroid cells are cancerous. The procedure can be done in a doctor’s office. The doctor uses a needle to take cells from the thyroid. The cells are then analyzed under a microscope. If cancer is suspected, other tests may also be done to help determine the type of cancer.

Risks and complications of FNA: These are rare but include mild discomfort, bleeding, and skin infection.

Thyroid Surgery

Surgery can be done to remove a very large goiter or nodule, a hyperthyroid gland that can’t be controlled with medications, or a thyroid gland that may be cancerous.

Preparing for Surgery

Ask your surgeon whether you need to stop taking aspirin, other medications, supplements, or herbal remedies before your procedure. Unless instructed otherwise, don’t eat or drink anything for 12 hours before the procedure. You’ll probably be admitted to the hospital or surgery center on the day of surgery. You usually need to be monitored after surgery, so prepare to spend one or more days in the hospital.

The Surgical Procedure

The incision is made at the base of your neck.

During the procedure, an intravenous (IV) line provides you with fluids and medications. You’ll be given general anesthesia, so you’ll be asleep during the procedure. An incision is made in your neck, along a crease in your skin. The surgeon may remove one half of the thyroid gland (lobectomy), most of the gland (subtotal thyroidectomy), or the entire gland (total thyroidectomy). Sometimes, the decision about how much of the thyroid to remove can’t be made until the surgeon makes the incision and can see the area around the thyroid. Once the procedure is completed, the incision is closed with surgical strips, surgical clips, or sutures. Occasionally, a drain may be left in the incision to remove fluid that can build up.

Risks and Complications

Bleeding
Infection
Damage to nerves in your voice box leading to temporary or permanent hoarseness
Permanent damage to the parathyroid glands, making them underactive (hypoparathyroidism)

Because these glands control the amount of calcium in your bloodstream, permanent calcium supplements may then be necessary.

After the Procedure

You can usually begin to eat and drink normally the evening after the procedure, but you may still be a little queasy from the anesthesia. Once the anesthesia has worn off and you’re feeling up to it, you’ll be able to get up and walk around. You may be given oral medication for pain the first day or so, but discomfort is usually minimal. A sore throat and hoarseness are common and may last for a week or so after surgery. During your hospital stay, you’ll be monitored for bleeding and to make sure your parathyroid glands are working normally. The stress of surgery may stun these glands for a short time, so you may be given calcium supplements for a few days.

After Thyroidectomy

Your doctor will monitor your recovery to be sure you’re healing correctly and that your thyroid problem is under control.

Once your thyroid problems are under control, you can get back to doing the things you like to do. To keep feeling good, follow your doctor’s instructions closely. Take your medications or hormone pills every day. And see your doctor for regular checkups.

While You’re Healing

Your surgeon may ask you not to get your incision area wet for a few days after your surgery.
Avoid strenuous physical activity for a few weeks, and don’t return to work until your doctor says it’s okay.
Within a week or so, you’ll visit the surgeon to have your incision checked. If you still have surgical staples or sutures, they may be removed then. Your incision will be red and raised at first, but it will probably flatten out and fade in about six months.
After your surgery, you may need to take thyroid hormone pills. These pills replace the hormone that your thyroid used to make.

In the Years to Come

If you’ve been given thyroid hormone or other medications, take your pills regularly to help keep your thyroid hormones at the right levels and your body running smoothly.
See your doctor as directed for regular blood tests. These tests confirm that your hormone pills or medications arestill at a dose that’s right for you.
If you have a nodule, monitoring may be necessary to check for changes in its size or for the appearance of additional nodules.
If you’ve had treatment for cancer, regular exams help catch it early if it returns.

Call your doctor if you notice any of these signs, or any other problems:

Swelling or bleeding at the incision site
Fever or tenderness
A sore throat that continues beyond 3 weeks
Tingling or cramps in the hands, feet or lips

Understanding the Parathyroid Glands

Normal parathyroid glands

The parathyroid glands are usually no bigger than grains of rice. Their main job is to keep the level of calcium in the blood within a certain range. This helps the muscles and nerves work properly and also keeps bones strong. When there is a problem with the parathyroid glands, the blood calcium level may get too high. This has effects throughout the body.

The Parathyroid Glands

The parathyroid glands are most often found behind the thyroid gland in the neck. The parathyroid glands control the level of calcium in the blood by making parathyroid hormone (PTH). This is a chemical messenger that tells the body how to control calcium.

How The Parathyroid Glands Work

When the blood calcium level is low, the glands make more PTH. This tells the body to increase the amount of calcium in the blood. To increase the blood calcium level, the body may absorb more calcium from food in the intestines. It may also take calcium from the bones. When the blood calcium level is high, the glands make less PTH. This tells the body to decrease the amount of calcium in the blood. To decrease the blood calcium level, calcium is filtered out of the blood by the kidneys.

Understanding Hyperparathyroidism

The parathyroid glands are four tiny glands located in the neck. These glands control the level of calcium in the blood. If one or more of the glands is too active, it can cause a high blood calcium level. This is called hyperparathyroidism. Hyperparathyroidism can lead to serious health problems throughout the body, but it can be treated.

What Causes Hyperparathyroidism?

Enlarged parathyroid gland

Hyperparathyroidism most often occurs when one parathyroid gland becomes enlarged. This is almost always because of a benign (noncancerous) growth called an adenoma. In some cases, more than one parathyroid gland becomes enlarged.

Risk Factors for Hyperparathyroidism

The risk of hyperparathyroidism increases with age. It is also more common in women than men. Other risk factors for hyperparathyroidism include:

Having parents or siblings with hyperparathyroidism
Getting too little vitamin D in the diet
Having certain kidney problems
Taking certain medications
Having had radiation to the head or neck

When You Have Hyperparathyroidism

With hyperparathyroidism, your glands make too much parathyroid hormone (PTH). This is a chemical that tells the body how to control calcium. Too much PTH means the body increases the level of calcium in the blood. This causes a condition called hypercalcemia (an above-normal level of blood calcium). Hypercalcemia can lead to problems throughout the body.

Symptoms of Hyperparathyroidism

Muscle weakness
Depression
Tiredness
Poor memory
Nausea and vomiting
Pain in the stomach area (abdomen)
Hard stools (constipation)
Stomach ulcers
Needing to urinate often
Kidney stones
Joint or bone pain
Bone disease (osteopenia or osteoporosis)

What You Can Do

If hyperparathyroidism is not treated, it may get worse over time. Treatment is surgery to remove any enlarged parathyroid glands. This helps restore the level of calcium in the blood to normal. Your doctor will discuss your condition with you and explain the risks and benefits of surgery.

Parathyroid Surgery

Your doctor has discovered that one of your parathyroid glands is enlarged (hyperparathyroidism). These glands control the calcium in your blood. Hyperparathyroidism causes increased levels of blood calcium (hypercalcemia). This can lead to a number of problems throughout your body. To treat hyperparathyroidism, the enlarged glands are removed with surgery.

Preparing for Surgery

After your surgery is scheduled, you’ll be told how to prepare. Follow all instructions, and be sure to ask any questions you have. To prepare for surgery, you may need to:

Tell your doctor of any medications you’re taking, including vitamins and supplements. You may need to stop taking certain medications, such as aspirin or ibuprofen, a week or two before surgery.
Have nothing to eat or drink for 6–8 hours before surgery. The doctor will give you specific instructions in advance.
Arrange for an adult family member or friend to give you a ride home after surgery.

The Day of Surgery

Arrive for surgery on time. Before going to surgery:

You’ll need to register. This may be done ahead of time during an earlier visit, online, or over the phone. Have identification and insurance information ready.
An IV (intravenous) line will be placed in a vein in your arm or hand. This is used to give fluids and medications.
A doctor or nurse will discuss with you what type of pain medication (anesthesia) you will receive during surgery.

During Surgery

You may need one or more parathyroid glands removed. The decision about how many glands to remove is often made during surgery. Be sure to ask your doctor for more information.

Removing the Glands

An incision is made in the neck.
The enlarged parathyroid gland or glands are found and removed.
In some cases, all four glands are enlarged. When this happens, three and a half of the glands may be removed. The remaining half gland often makes enough hormone to replace four normal glands. In rare cases, all of the glands are removed. Parts of one gland are then placed in another location in the body, usually in the neck or arm. This is called a parathyroid autotransplantation. The moved gland continues to work from this new location.
When surgery is complete, the incision is closed with sutures (stitches), strips of surgical tape, or surgical glue.

Risk and Complications

Your doctor will discuss the risks and possible complications of surgery with you. These include:

Injury to laryngeal nerves
Failure to locate the enlarged gland or glands, requiring more surgery
Bleeding
Infection
Reaction to anesthesia
Thyroid gland complications

Your Recovery

Recovery from parathyroid surgery is usually quick. You may go home on the day of surgery or you may need to stay overnight. Once you’re ready to go home, you’ll be given instructions for how to care for yourself. Follow these instructions carefully.

When to Call Your Doctor

Call your doctor if you notice any of the following during your recovery:

Numbness or tingling in the fingertips or around the mouth
Muscle cramping or spasms
Neck swelling
Fever over 100.4° F
Increasing redness, swelling, or drainage at the incision site
Nausea or vomiting
Hoarse voice that worsens
Trouble breathing
Trouble swallowing
Irregular heartbeat