Endocrine (Thyroid, Parathyroid, Adrenal)
The thyroid gland is a butterfly shaped organ located in the neck, wrapped around the front of the windpipe, just below the voicebox. It makes hormones that help to control the body’s metabolism. The thyroid gland may need to be removed for a number of reasons:
- This is when the thyroid enlarges because of the presence of multiple benign nodules. When sufficiently large, the thyroid becomes visible as a swelling at the front of the neck. Typical symptoms may include difficulty swallowing, shortness of breath on exertion, or a choking sensation, particularly when lying flat.
- Overactive thyroid (Grave’s disease)
- Symptoms of an overactive thyroid may include anxiety, weakness, tremor, palpitations, heat intolerance, increased sweating, and weight loss despite a normal or increased appetite. The diagnosis is confirmed with a blood test and a nuclear medicine thyroid scan. Treatment options may include antithyroid medication, radioactive iodine, or surgery.
- Thyroid cysts
- Cysts may form in the thyroid gland. These are usually benign and treated by needle aspiration, however if they recur then surgery may be required.
- Thyroid cancer
- Occasionally, cancer can develop in the thyroid gland. This is usually diagnosed with a needle biopsy. Treatment usually involves removal of the entire thyroid gland and some of the nearby lymph glands. Additional treatment with radioactive iodine may be recommended after your surgery. Thyroid cancer is generally curable with appropriate treatment.
Removal of the thyroid gland (thyroidectomy) is performed under general anaesthetic and requires one to two nights stay in hospital. Patients are started on a thyroid hormone replacement tablet (“thyroxine”) which needs to be continued for life. GPs will periodically check the thyroid hormone levels with a blood test and adjust the dose as necessary. Patients usually also require calcium tablets for a few weeks after the surgery.
The left and right adrenal glands sit atop the kidneys. They produce many hormones – including adrenaline, steroids and others that regulate blood pressure and salt levels.
Tumours in the adrenal glands may cause symptoms from excessive hormone production, or they may be silent. Most are detected incidentally on imaging studies such as a CT scan or ultrasound.
Diagnosis is confirmed with blood and urine tests, and a dedicated adrenal CT scan.
Surgical removal is necessary if the tumour is large, cancerous, or is producing hormones. This is usually performed as a keyhole operation, with a 1-2 day stay in hospital.
These small lentil-sized glands (usually four) are located immediately behind the thyroid gland. They are responsible for regulating the calcium levels in the blood, by producing varying amounts of a hormone called parathyroid hormone (PTH). Surgery to remove one or more parathyroid glands is most commonly recommended in these two conditions:
- Primary hyperparathyroidism
- Patients have high levels of calcium in their blood, due to an enlarged, overactive parathyroid gland (parathyroid adenoma). The diagnosis is confirmed with a blood test and nuclear medicine scan of the neck. Occasionally a urine test is also required. This condition is often asymptomatic, but patients may experience kidney stones, osteoporosis, fatigue, anorexia, mild depression or irritability, and muscle pain or weakness.
- Secondary hyperparathyroidism
- This is a more complex situation that arises in patients with advanced kidney failure, usually on dialysis. Your specific circumstances will be discussed between Dr Williams and your kidney specialist. Surgery entails removal of all or nearly all of the parathyroid glands.
Surgery on the parathyroids can usually be performed through a small incision as day surgery. Blood tests will be checked afterwards to ensure the calcium levels have returned to normal.
Stomach and Oesophagus
Liver and Pancreas