Great catching up with endocrine friends at AACE meeting 2017 in Austin, Tx with Drs Lindsay Harrison and Tira Chaicha-BromRead more →
Review by Dr. Bridget Brady
The thyroid gland is a small, butterfly shaped organ in the lower neck which controls our metabolism by secreting thyroid hormone. A thyroid nodule is a lesion (adenoma, cyst, or tumor) within the thyroid gland. (The terms “thyroid lesion,“ “thyroid mass,” and “thyroid nodule” are used interchangeably.) These nodules are common, especially in women, and many patients have no symptoms. At times, patients can have symptoms of compression, such as difficulty breathing, swallowing or voice changes which can require surgery. Other nodules overproduce thyroid hormone, causing hyperthyroidism. The majority of thyroid nodules are benign (non-cancerous), but some are cancerous.
A goiter is simply an abnormally enlarged thyroid gland. It may contain multiple nodules and can produce too much hormone (hyperthyroid), too little hormone (hypothyroid) or normal amount of hormone (euthyroid).
Most common causes:
- Multi-nodular goiter
- Grave’s Disease (patients are typically hyperthyroid)
- Hashimoto’s Disease
As goiters enlarge with time, they can cause difficulty breathing, swallowing problems, or voice changes. At times, goiters need to be removed surgically.
The incidence of thyroid cancer is increasing in the United States. There are different types of thyroid cancer, including papillary, follicular, Hurthle cell, medullary, and anaplastic. Most thyroid cancers have an excellent prognosis and are not typically aggressive. Patients can be treated with minimally invasive surgery to remove these cancers and surrounding lymph nodes with smaller scars and easier recovery.
At times, patients will need therapy with radioactive iodine after surgery to treat their cancer. Long-term thyroid hormone replacement may also be necessary.
Graves’ disease is an autoimmune process that causes the thyroid to overproduce thyroid hormone. It is more common in young women and can cause enlargement of the thyroid gland. Possible triggers for Graves’ Disease are thought to be viral or bacterial infection as well as a genetic link.
Symptoms of Graves’ hyperthyroidism:
- Muscle Weakness
- Thinning hair or hair loss
- Increased appetite
- Emotional problems
- Difficulty concentrating
- Weight loss
- Problems sleeping
- Rapid heart rate
- Bulging eyes (exophthalmos)
How is it diagnosed?
- High free T3 or T4 (thyroxine) levels
- Low thyroid stimulating hormone (TSH) levels
- High levels of thyroid stimulating hormone (TSH) receptor antibodies
Graves’ disease can be treated with medications, radiation, or thyroid surgery.
Hashimoto’s thyroiditis is the most common inflammatory disease of the thyroid. It occurs when a patient’s own antibodies attack their thyroid gland. Hashimoto’s thyroiditis is more common in women ages 45-65, but can be seen in patients of any age. Hashimoto’s disease is also known as chronic lymphocytic thyroiditis.
Symptoms of Hashimoto’s Thyroiditis:
- Pale, dry skin
- Puffy face
- Increased sensitivity to cold
- Muscle aches
- Painful joints
- Prolonged menstrual bleeding
How is it diagnosed?
- Blood test for thyroid autoantibodies
- Elevated TSH (thyroid stimulating hormone)
- Firm, slightly enlarged, or even tender thyroid gland on exam
How is it treated?
- Thyroid replacement hormone for those with hypothyroidism
- Thyroid removal for patients with compressive symptoms or enlarging nodules
The parathyroid glands are four small glands, each about the size of a grain of rice, located behind the thyroid gland. Their function is to regulate calcium metabolism in the body. Primary hyperparathyroidism is the disease process in which one or more of these glands overproduces PTH (parathyroid hormone). When this occurs, the calcium level in the body becomes too high. Left untreated, this disease can lead to osteoporosis, kidney disease, heart problems, depression, and fatigue.
Parathyroid glands monitor our calcium levels in the blood and bones. Sometimes one of the parathyroid glands will develop into a tumor which is known as hyperparathyroidism. “Hyper” means abnormally increased or excessive. It happens in almost 1 out of 100 people, most commonly in women over the age of 50. These parathyroid tumors will pull calcium out of the bones and raise the blood level of calcium. They do this by breaking down the bones which can lead to osteopenia or osteoporosis. High levels of calcium in the blood then can lead to fatigue, problems concentrating, high blood pressure, reflux, kidney stones, depression or even stroke. If your doctor ordered a blood calcium level and told you it was high, you have parathyroid disease until proven otherwise. After you have been told that your calcium is high, please make an appointment with Dr Brady.
Primary hyperparathyroidism is caused usually by one gland that turns into a tumor or adenoma. It can happen in more than one of the parathyroid glands (15% of the time), this is why Dr Brady ALWAYS examines ALL four of your parathyroid glands in the operation. These tumors of the parathyroid are almost always BENIGN or not cancerous, but they can make patients feel awful. This is a list of common symptoms my patients complain of:
- Brain fog
- Problems with memory or concentration
- Weakness and generalized lack of energy
- Joint pain or muscle aches
- Kidney Stones
- Bone disease, osteoporosis or fractures
- High blood pressure
- Reflux or indigestion
- Depression, irritability or mood swings
- Problems sleeping
- Irregular heart beat or arrhythmias or atrial fibrillation
PTH or parathyroid hormone is what the parathyroid glands secrete into the body which makes the bones leak calcium and increase the blood levels of calcium. If someone’s blood calcium is HIGH, their PTH level should be LOW. When both the calcium and PTH are high or elevated, then that patient has hyperparathyroidism and is a candidate for minimally invasive parathyroidectomy or MIP.
Minimally invasive parathyroid surgery is easy and takes only about 15-20 minutes for Dr Brady to perform. All of her patients go home the same day with a small band-aid and a tiny incision (2cm or less than 1 inch) hidden in a natural skin crease on the neck. Some of her patients have told her that they felt better in the recovery room or on the way home from the surgery center.
The most common cause (85%) of primary hyperparathyroidism is a single benign tumor called an adenoma. Approximately 15% of patients have 2 adenomas and less than 1% of patients have 4 gland hyperplasia (all glands enlarged).
Many patients with this disease undergo “mini parathyroid surgery” which is minimally invasive and takes about 15-20 minutes to perform. The surgery is safe, relatively painless, leaves a tiny scar, and is typically performed on an outpatient basis (No overnight stay in the hospital is necessary).
Secondary Hyperparathyroidism is typically seen in chronic renal failure patients on dialysis. Failing kidneys are unable to convert vitamin D into its active form, which affects calcium levels. This, in turn, stimulates the parathyroid glands to overproduce PTH (parathyroid hormone).
Tertiary Hyperparathyroidism is a rare disease that is seen after kidney transplantation. The parathyroid glands continue to overproduce parathyroid hormone and patients sometimes require surgery to remove them.
The adrenal gland is a small organ located above both kidneys that release hormones, including those in response to stress. The medulla (core) of the adrenal gland secretes epinephrine and norepinephrine, which are the adrenaline hormones. The cortex (outer portion) produces cortisol, aldosterone, and androgen hormones. Adrenal tumors can cause an over or underproduction of any of these hormones, which can cause a variety of symptoms for patients.
Examples of tumors of the adrenal gland
These lesions can be removed with a minimally invasive laparoscopic surgery using 3 small incisions and typically require only a one night stay in the hospital.