Thyroid and Parathyroid Surgery - Thyroidectomy and Parathyroidectomy

Thyroidectomy and parathyroidectomy are one of the most common procedures performed in the neck. These procedures are generally performed due to a mass in thyroid or abnormal function in the parathyroid glands.

Thyroid Anatomy and Function

The thyroid gland is located in the lower neck and its main function is the regulation of the thyroid hormone. It is also partly responsible for the regulation of the calcium in the body. The thyroid gland is affected by many disorders including working too much (hyperthyroid), working less than it should (hypothyroid), as well as benign and malignant (cancerous) tumors. Hyperthyroidism and hypothyroidism are generally treated by endocrinologists, whereas masses or tumors are treated by otolaryngologist-head and neck surgeons.

The parathyroid gland is located within the thyroid gland. Its function is to regulate the calcium in the blood stream. The most common problem

Robotic Thyroid and Parathyroid Surgery (more on Robotic thyroidectomy - click here)

The most recent and exciting minimally invasive approach is the robotic thyroidectomy. This technique was developed in South Korea. Dr. Jason Kim has spent time with the pioneed of this technique in South Korea to learn the intricacies of using the da Vinci robot for these procedures. The thyroidectomy is performed through an axillary (under arm) incision using the special 3-D endoscope and instruments. Excellent visualization and dexterity (controlled by the surgeon) is maintained to perform the operation safely and effectively.

Dr. Jason Kim recently performed the first successful series of surgeries to remove thyroid tumors in the West Coast of the U.S. at UC Irvine. Dr. Kim is one of the first surgeons in Orange County who performed an endoscopic minimally invasive thyroidectomy. He is now the first to perform a robotic thyroidectomy.

Anatomy

The thyroid gland is located low in the neck (pink area in picture to the right). It sits below the voice box. The parathyroid glands lie in close proximity to the gland (yellow areas in the picture on the right). The thyroid gland also lies very near the recurrent laryngeal nerves, which function to move the vocal cords. Normal movement of the vocal cords allows one to speak and swallow properly. (Picture courtesy of ADAM).

Growths on the thyroid are often called nodules. Most thyroid nodules (more than 90 percent) are benign (not cancer). Benign nodules are not as harmful as malignant nodule (cancer):

Benign nodules

• Are rarely a threat to life
• Don’t invade the tissues around them
• Don’t spread to other parts of the body
• Usually don’t need to be removed

Malignant nodules

• May sometimes be a threat to life
• Can invade nearby tissues and organs
• Can spread to other parts of the body
• Often can be removed or destroyed, but sometimes the cancer returns Cancer cells can spread by breaking away from the original tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells attach to other organs and grow to form new tumors that may damage those organs. The spread of cancer is called metastasis.

TYPES OF THYROID CANCER There are several types of thyroid cancer:

• Papillary thyroid cancer. In the United States, this type makes up about 80 percent of all thyroid cancers. It begins in follicular cells and grows slowly. If diagnosed early, most people with papillary thyroid cancer can be cured.
• Follicular thyroid cancer. This type makes up about 15 percent of all thyroid cancers. It begins in follicular cells and grows slowly. If diagnosed early, most people with follicular thyroid cancer can be treated successfully.
• Medullary thyroid cancer. This type makes up about 3 percent of all thyroid cancers. It begins in the C cells of the thyroid. Cancer that starts in the C cells can make abnormally high levels of calcitonin. Medullary thyroid cancer tends to grow slowly. It can be easier to control if it’s found and treated before it spreads to other parts of the body.
• Anaplastic thyroid cancer. This type makes up about 2 percent of all thyroid cancers. It begins in the follicular cells of all thyroid cancers. It begins in the follicular cells of the thyroid. The cancer cells tend to grow and spread very quickly. Anaplastic thyroid cancer is very hard to control.

RISK FACTORS Doctors often cannot explain why one person develops thyroid cancer and another does not. However, it is clear that no one can catch thyroid cancer from another person.

Research has shown that people with certain risk factors are more likely than others to develop thyroid cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for thyroid cancer:

Radiation: People exposed to high levels of radiation are much more likely than others to develop papillary of follicular thyroid cancer. One important source of radiation exposure is treatment with x-rays. Between the 1920s and the 1950s, doctors used high-dose x-rays to treat children who had enlarged tonsils, acne, and other problems affecting the head and neck. Later, scientists found that some people who had received this kind of treatment developed thyroid cancer.

(Routine diagnostic x-rays – such as dental x-rays or chest x-rays – use very low doses of radiation. Their benefits usually outweigh their risks. However, repeated exposure could be harmful, so it’s a good idea to talk with your dentist and doctor about the need for each x-ray and to ask about the use of shields to protect other parts of the body.)

Another source of radiation is radioactive fallout. This includes fallout from atomic weapons testing (such as the testing in the United States and elsewhere in the world, mainly in the 1950s and 1960s), nuclear power plant accidents (such as the Chornobyl [also called Chernobly] accident in 1986), and releases from atomic weapons production plants)such as the Hanford facility in Washington state in the late 1940s). Such radioactive fallout contains radioactive iodine (I-131) and other radioactive elements. People who were exposed to one or more sources of I-131, especially if they were children at the time of their exposure, may have an increased risk of thyroid diseases. For example, children exposed to radioactive iodine from the Chernobyl accident have an increased risk of thyroid cancer.

Family history of medullary thyroid cancer: Medullary thyroid cancer sometimes runs in families. A change in a gene called RET can be passed from parent to child. Nearly everyone with the changed RET gene develops medullary thyroid cancer. The disease occurs alone as familial medullary thyroid cancer or with other cancers as multiple endocrine neoplasia (MEN) syndrome.

A blood test can detect the changed RET gene. If it’s found in a person with medullary thyroid cancer, the doctor may suggest that family members be tested. For those who have the changed gene, the doctor may recommend frequent lab test or surgery to remove the thyroid before cancer develops.

Family history of goiters or colon growths: A small number of people with a family history of having goiter (swollen thyroids) with multiple thyroid nodules are at risk for developing papillary thyroid cancer. Also, a small number of people with a family history of having multiple growths on the inside of the colon or rectum (familial polyposis) are at risk for developing papillary thyroid cancer.

Personal history: People with a goiter or benign thyroid nodules have an increased risk of thyroid cancer.

Being female: In the United States, women are almost three times more likely than men to develop thyroid cancer.

Age over 45: Most people with thyroid cancer are more than 45 years old. Most people with anaplastic thyroid cancer are more than 60 years old.

Iodine: Iodine is a substance found in shellfish and iodized salt. Scientists are studying iodine as a possible risk factor for thyroid cancer. Too little iodine in the diet may increase the risk of follicular thyroid cancer. However, other studies show that too much iodine in the diet may increase the risk of follicular thyroid cancer. However, other studies show that too much iodine in the diet may increase the risk of papillary thyroid cancer. More studies are needed to know whether iodine is risk factor.

Having one or more risk factors does not mean that a person will get thyroid cancer. Most people who have risk factors never develop cancer.

SYMPTOMS Early thyroid cancer often does not have symptoms. But as the cancer grows, symptoms may includes:

• A lump in the front of the neck
• Hoarseness or voice changes
• Swollen lymph nodes in the neck
• Trouble swallowing or breathing

Pain in the throat or neck that does not go away Most often, these symptoms are not due to cancer. An infection, a benign goiter, or another health problem is usually the cause of these symptoms. Anyone with symptoms that do not go away in a couple of weeks should see a doctor to be diagnosed and treated as early as possible.

Evaluation of a Thyroid Mass

When a thyroid mass has been identified, imaging is obtained, most commonly using ultrasound. If the mass is very large,  other imaging using a CT scan or an MRI may be indicated. A biopsy is done using a very small needle (fine needle aspiration) is performed to evaluate the mass. Easily palpable masses can be sampled with a needle directly, while smaller masses or masses that are not palpable or are difficult to reach are biopsied with ultrasound guidance.

Traditional Thyroidectomy

If a mass is thought to be cancer or suspicious for cancer, the half of the thyroid containing the mass or the entire thyroid is removed. This older surgical technique required a large incision in the lower neck.

Minimally Invasive Thyroidectomy

The minimally invasive approach uses small incisions in the lower neck and endoscopes and special ultrasonic scalpels are used to remove the thyroid or parathyroid mass.

Using small cameras and instruments, the surgeons can avoid the long incisions and extensive dissection. The overall morbidity can be minimized leading to less post-operative pain, faster healing, and earlier return to work and social life. Even total thyroidectomy and paratracheal dissection for thyroid cancer may be amenable to the endoscopic, minimally invasive approach. Below you can see some examples of patients who have undergone endoscopic thyroidectomy or parathyroidectomy at UC Irvine by Dr. Kim.

Examples of the Appearance of Scar After Endoscopic Thyroidectomy or Parathyroidectomy Performed by Dr. Kim at 1 month after the surgery

Robotic Thyroid and Parathyroid Surgery

The most recent and exciting minimally invasive approach is the robotic thyroidectomy. This technique was developed by Dr. Chung, a surgeon at Yonsei University in South Korea. Dr. Jason Kim has spent time with Dr. Chung to learn the intricacies of using the da Vinci robot for these procedures. The thyroidectomy is performed through an axillary (under arm) incision using the special 3-D endoscope and instruments. Excellent visualization and dexterity (controlled by the surgeon) is maintained to perform the operation safely and effectively.

UC Irvine Head and Neck Endocrine (Thyroid and Parathyroid) Surgery

UC Irvine Head and neck surgeons have been performing minimally invasive thyroidectomy and parathyroidectomy for several years and are regional experts in this technique. Both Dr. Kim and Dr. Armstrong have taught courses and lectured on the minimally invasive techniques nationally and internationally. Dr. Armstrong is an international expert on the use of ultrasound for guiding the treatment of thyroid and parathyroid disorders.

To make an appointment with Dr. Kim or Dr. Armstrong for evaluation of your thyroid or parathyroid, please Call 714-456-7017 or click here to request an appointment via the web.