The Redmond Clinic

Endocrine Surgery

Endocrine surgery refers to operations on one or more of the endocrine glands. These glands secrete hormones into the bloodstream, and have an important influence over the functions of almost all cells in the body. Endocrine surgeons are surgeons with special expertise and training in operations on a number of the endocrine glands including the thyroid gland, the parathyroid glands, the adrenal glands, the endocrine pancreas, and some neuroendocrine glands.

Professor Redmond has 30 years experience in Endocrine Surgery and has pioneered minimally invasive techniques in Ireland including:

  • TOETVA (Trans-oral endoscopic thyroidectomy video assisted)
  • MIRP (Minimally invasive radioguided parathyroidectomy)
  • Retroperitoneoscopic Adrenalectomy

Thyroid

The thyroid gland is an endocrine gland located in the neck below the Adams apple consisting of two connected lobes joined by the isthmus.

It secretes hormones including Tri-iodothyronine (T3), Thyroxine (T4) and Calcitonin. These hormones regulate metabolism and protein synthesis.

Helpful websites include:

www.thyroid.org

www.baets.org.uk

Thyroid surgery (thyroidectomy) may be required if there is:

  • A lump that could be a malignant tumour (thyroid cancer). This is usually determined by a fine needle biopsy of the lump.
  • A goitre (enlargement of the thyroid) causing pressure on surrounding organs resulting in symptoms such as difficulty swallowing, difficulty breathing or a persistent cough.
  • Growth of your thyroid down into the chest cavity (a retrosternal goitre)
  • Excessive activity of the thyroid (hyperthyroidism or thyrotoxicosis)

There are various type of thyroid operations that can be done including:

  • Total thyroidectomy - removal of the whole thyroid
  • Bilateral subtotal thyroidectomy - removal of most of the thyroid leaving part of both lobes behind
  • Hemithyroidectomy - removal of half the thyroid
  • Excision of thyroid nodule - removal of a lump from the thyroid

If a total thyroidectomy is performed, you will need to take thyroxine tablets for the rest of your life. If less than a total thyroidectomy is performed, you will generally not need to take thyroxine although around 15% of people still require some thyroxine supplementation after just a hemithyroidectomy.

Thyroid surgery is generally performed under a general anaesthetic although it can be done under local anaesthesia in special circumstances if required. An incision is made in the front of the neck, 2 to 3 cm above the collarbone. The underlying muscles are opened or divided to expose the thyroid gland which the surgeon then removes either totally or in part. Great care is taken not to injure the nerves which control the voice box (laryngeal nerves) and every attempt is made to preserve the parathyroid glands which control the body's calcium levels. Sometimes the parathyroid glands may be autotransplanted into a nearby muscle to preserve their function. The muscles are then put together again and the skin incision is closed with sutures that will either absorb or be removed soon after your operation.

Minimally invasive thyroid surgery (either through a keyhole incision or using an endoscope) is still experimental and should only be performed as part of a recognised trial.

Most surgery nowadays is safe however any operation has general risks including reactions to the anaesthetic, chest infections, blood clots, heart and circulation problems, and wound infection. In addition there are specific risks associated with thyroid surgery as follows:

  • Post-operative bleeding may cause swelling in the throat and difficulty breathing due to pressure on the windpipe. It is usually fixed by a further operation to remove the blood clot „h Injury to the laryngeal nerves may cause hoarseness of the voice. This is usually temporary, but may be permanent in up to 1 to 2% of cases. It may improve with speech therapy or further surgery to the vocal cords. If you are a singer or public speaker, any surgery to the thyroid may cause subtle long-term changes to your performing voice.
  • If a total thyroidectomy is performed, injury to the parathyroid glands may cause the calcium level in the blood to drop. It is treated with calcium and vitamin D tablets and usually comes good in a few weeks, although up to 1 to 2% of cases will need lifelong calcium supplements.
  • A keloid, or overgrowth of scar tissue, may form in any surgical scar. It will result in a tender, pink raised scar but may able to be treated with silicone gel tape or steroid injections.

Parathyroid

Parathyroid glands (usually 4) are small endocrine glands located in the neck usually behind the thyroid gland. Their main function is to produce and secrete Parathyroid Hormone (PTH) in response to a low blood calcium level. Parathyroid Hormone (PTH) plays a key role in regulating the amount of calcium in the blood and within the bones.

Helpful sites: www.parathyroid.com

Parathyroid surgery (parathyroidectomy) is generally required if there is overactivity of the parathyroid glands, This is either due to a benign tumour of one or more of the glands (parathyroid adenoma), generalised overactivity and growth of all of the glands (parathyroid hyperplasia), or rarely a malignant tumour of one of the glands (parathyroid cancer). Parathyroid overactivity may be associated with loss of calcium from the bones (osteoporosis), generalised tiredness and lethargy, kidney stones, stomach ulcers, aches and pains in the joints, and constipation.

Parathyroid surgery can be done as an open procedure or as a minimally invasive (keyhole) procedure.

Open parathyroidectomy

Open parathyroidectomy is generally performed under a general anaesthetic although it can be done under local anaesthesia in special circumstances if required. An incision is made in the front of the neck, 2 to 3 cm above the collarbone. The underlying muscles are opened or divided to expose the thyroid and the parathyroid glands. The surgeon then removes the parathyroid gland or glands that are enlarged. Great care is taken not to injure the nerves which control the voice box (laryngeal nerves). The muscles are then put together again and the skin incision is closed with sutures that will either absorb or be removed soon after your operation.

Minimally invasive parathyroidectomy

Minimally invasive parathyroid thyroid surgery is performed through a small (2 to 3 cm) keyhole incision directly over the tumour and can be performed under a general or local anaesthetic. It is only suitable for patients where pre-operative scans and tests have been able to identify the exact location of a single parathyroid tumour. Through the small incision the surgeon removes only the enlarged parathyroid, taking great care not to injure the nearby nerves. The skin incision is closed and many patients can go home the same day. In up to 5% of cases, a minimally invasive parathyroidectomy may have to be converted to an open parathyroidectomy if the surgeon cannot locate an enlarged parathyroid gland.

Most surgery nowadays is safe however any operation has general risks including reactions to the anaesthetic, chest infections, blood clots, heart and circulation problems, and wound infection. In addition there are specific risks associated with parathyroid surgery as follows:

  • Post-operative bleeding may cause swelling in the throat and difficulty breathing due to pressure on the windpipe. It is usually fixed by a further operation to remove the blood clot
  • Injury to the laryngeal nerves may cause hoarseness of the voice. This is usually temporary, but may be permanent in up to 1 to 2% of cases. It may improve with speech therapy or further surgery to the vocal cords. If you are a singer or public speaker, any surgery to the thyroid may cause subtle long-term changes to your performing voice.
  • Injury to the other parathyroid glands may cause the calcium level in the blood to drop. It is treated with calcium and vitamin D tablets and usually comes good in a few weeks.
  • A keloid, or overgrowth of scar tissue, may form in any surgical scar. It will result in a tender, pink raised scar but may able to be treated with silicone gel tapes or steroid injections
  • Even in the most expert hands, up to 5% of parathyroid tumours cannot be found at operation and the calcium will remain raised (persistent hyperparathyroidism). Sometimes after successful surgery, one of the other parathyroid glands may also then become overactive and cause the calcium to be raised again (recurrent hyperparathyroidism)

Adrenal

The Adrenal Glands are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. They are located on the top of the kidneys. 

Their main functions are to produce a handful of hormones that help maintain salt balance in our blood and tissues, maintain blood pressure and produce some sex hormones. Some of these hormones are responsible for the well known “Fight or Flight” response.

Helpful websites: www.adrenal.com

Adrenal surgery (adrenalectomy) may be recommended where:

  • There is a tumour of the gland. This is usually detected when a scan is performed for non-specific symptoms and an incidental tumour (adrenal incidentaloma) is detected. Most of these are benign but a small percentage turn out to be malignant (adrenal cancer) Surgery may be recommended if the tumour is large or causing symptoms.
  • There is overproduction of hormones causing one of a number of clinical syndromes: Cushing's Syndrome is caused by excess secretion of cortisol, causing obesity and osteoporosis; Conn's Syndrome is caused by excess secretion of aldosterone which may cause problems with high blood pressure and blood potassium levels; Phaeochromocytoma leads to excess secretion of adrenaline and noradrenaline causing problems such as high blood pressure, excess sweating, tremor, and anxiety.

Adrenalectomy can be done as an open procedure or as a laparoscopic (keyhole) procedure.

Open adrenalectomy

This is usually performed if the adrenal tumour is very large or is likely to be a cancer. Open adrenalectomy is generally performed under a general anaesthetic. Open operations may be performed through the back, the flank, or the abdomen. In all cases a skin incision is made and the underlying muscles divided. The adrenal gland is located and removed with great care being taken not to injure nearby structures such as the major veins in the abdomen. The muscles are then put together again and the skin incision is closed with sutures that will either absorb or be removed soon after your operation.

Laproscopic adrenalectomy

This can be performed where the tumour is smaller and unlikely to be a cancer. It is also performed under general anaesthetic. Laparoscopic procedures use small telescopes and instruments to remove the adrenal gland through a number of small incisions. The adrenal gland is located and removed with video guidance and, as with open surgery, with great care being taken not to injure nearby structures such as the major veins in the abdomen. Typically, patients having laparoscopic procedures have less pain and a more rapid recovery.

Most surgery nowadays is safe however any operation has general risks including reactions to the anaesthetic, chest infections, blood clots, heart and circulation problems, and wound infection. In addition there are specific risks associated with adrenal surgery as follows:

  • Bleeding may occur during the operation as the adrenal glands are near large arteries and veins. This may lead to the need for a blood transfusion.
  • Abnormally high or low blood pressure is a risk following removal of some adrenal tumours. This can usually be prevented or treated with medicine.
  • Any open surgical incision in the abdomen may be at risk of developing a hernia long after the operation.
  • Depending on the type of adrenal disorder leading to your adrenalectomy, you may require oral steroid medication to replace those steroids formerely made by the adrenal gland. In some cases, these steroids are essential for life.

The Redmond Clinic

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