The thyroid gland is located in the front of the neck (just above the breastbone and below the Adam's apple). The small, two-inch gland consists of two lobes, one on each side of the windpipe, connected by a small bridge of thyroid tissue called the isthmus. An important part of the endocrine system, the thyroid is a hormone-producing gland that regulates metabolism—the rate at which the body produces energy from nutrients and oxygen—and affects body functions, such as heart rate and energy level.
If there is a problem with the thyroid, the level of thyroid hormone may change. This can lead to symptoms ranging from fatigue and weight gain/loss to sleeping problems and depression. Affecting 20 million Americans, thyroid problems are five to eight times more common in women than men. Most thyroid diseases are life-long conditions that can be managed with medical attention. Learn more about how the thyroid gland works.
The four parathyroid glands very precisely control the amount of calcium in the bloodstream. This is critical because calcium is a major electrical ion. When calcium levels get too high (hyperparathyroidism), electrical systems start to slow down, causing a host of symptoms including bone loss and muscle weakness. When calcium levels get too low (hypoparathyroidism), patients may experience tingling around the lips and twitching of muscles. Parathyroid glands are located on the backside of the thyroid, deep within the neck .
The endocrine surgeons at Brigham and Women's Hospital (BWH) offer a comprehensive, multidisciplinary approach to caring for patients with thyroid and parathyroid disorders. We specialize in minimally invasive surgery techniques such as thyroidectomy, parathyroidectomy and lobectomy for diagnosis and removal of suspicious thyroid nodules.
Typical thyroid conditions are: multinodular goiter (enlarged thyroid), hyperthyroidism (overactive thyroid), hypothyroidism (underactive thyroid), thyroid nodules and thyroid cancer. Disorders of the parathyroid glands include hypoparathyroidism, hyperparathyroidism, and parathyroid tumors.
Fine Needle Aspiration (FNA) biopsies of the thyroid are prepared for microscopic evaluation in the BWH Cytopathology Laboratory and examined by cytopathology members of the BWH Thyroid Center team, board certified pathologists with special certification in cytopathology.
The diagnosis of hyperparathyroidism is based on an elevated parathyroid hormone level for a given level of calcium in the blood. It is possible to have hyperparathyroidism with a normal blood calcium. Our expert surgeons personally ensure that the diagnosis and its intricacies are correct before any consideration of surgery. If you have symptoms of abnormal calcium levels or another test showed an abnormal calcium level, you may have a parathyroid hormone test. You may also have a bone densitometry exam to determine bone density and to reveal loss of bone tissue.
Thyroid diseases are life-long conditions but with careful surgical and medical management, people with thyroid disorders can lead healthy lives.
Surgery may be necessary if you have a large goiter or nodules, have cancerous nodules, or have hyperthyroidism that does not respond to hormone or radioactive iodine treatment. When thyroidectomy or lobectomy surgery is indicated, BWH’s endocrine surgeons offer extensive experience, performing thousands of minimally invasive procedures each year. BWH is renowned internationally for its surgical skill and safety; our Thyroid Center team has reduced the rate of surgical complications far below the national average. Patients typically return home the same day or the day following surgery.
If the goiter does not improve and is causing problems, such as pain or difficulty swallowing or speaking, thyroidectomy surgery may be required to remove it.
Use of beta-blocking agents, which block the action of thyroid hormone on the body, mostly to decrease rapid heart rate and palpitations.
Hashimoto's thyroiditis usually results in hypothyroidism which requires thyroid hormone replacement.
Treatment may include an injection of calcium to provide immediate relief and/or taking calcium and vitamin D tablets for the rest of your life.
The only treatment for hyperparathyroidism is surgical removal of the abnormal parathyroid gland. Parathyroid exploration was once considered one of the most formidable surgical operations due to the subtle appearance of these small glands within the neck. Today, the surgery is quite refined and highly successful. Before surgery, an imaging test such as an ultrasound or a sestamibi scan may be used to find out which parathyroid gland is abnormal.
Surgery consists of a brief anesthetic, while a small incision is made and only that abnormal parathyroid is removed. Many surgeons use a method during surgery that measures the levels of the parathyroid hormone in the blood. Provided the parathyroid hormone drops during surgery, the surgery can be considered curative with the removal of a single parathyroid. In the event the parathyroid hormone levels do not fall, the surgery is continued to examine the other three parathyroid glands in the neck. The recovery after parathyroid surgery is brief and comparable to thyroid surgery. The incisions are generally in the skin creases of the neck and slightly off to one side.
You will receive a thorough diagnostic examination to evaluate if you have a thyroid or parathyroid condition and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced endocrinologist or endocrine surgeon are important to the successful outcome for patients with thyroid conditions.
If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.
The day of surgery, you will be taken care of in the operating room by endocrine surgeons, anesthesiologists and nurses who specialize in surgery for patients with thyroid disease. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.
Brigham and Women's Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues in other medical specialties. The Thyroid Center team includes leading endocrinologists, endocrine surgeons, pathologists, radiologists and anesthesiologists. We also collaborate with endocrine specialists in the Division of Endocrine, Diabetes and Hypertension at BWH.
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