Enlarged Glands, Too Many Hormones, and Nodules: When Surgery May be Needed for Thyroid, Adrenal, or Parathyroid Conditions

Enlarged Glands, Too Many Hormones, and Nodules: When Surgery May be Needed for Thyroid, Adrenal, or Parathyroid Conditions

A DocTalk video with Nicole Zern, MD, Endocrine Surgeon

The endocrine system is a complex network of glands and organs that produce hormones. Hormones control and coordinate your body’s metabolism, energy level, reproduction, growth, development, and responses to injury, stress and environment factors. When issues arise within the endocrine system, surgery is sometimes the best treatment option.

Endocrine surgery is an uncommon specialty. At Valley, we are fortunate to have Nicole Zern, MD, serving our community. She specializes in surgical care for benign and malignant disease of the thyroid, parathyroid and adrenal glands. In addition to her specialized fellowship training in endocrine surgery, she is a board-certified general surgeon and a Fellow of the American College of Surgeons.

Learn more about what conditions Dr. Zern helps treat, the minimally-invasive techniques she uses, and what to do if you think you may have a hormone problem or endocrine condition that needs attention. A transcript of the video follows.

1. What is the body’s endocrine system? (0:17)
The endocrine system refers to organs or glands that produce hormones. This includes glands from many locations in the body including the pituitary gland in the brain, the thyroid and parathyroid glands in the neck, the adrenal glands and pancreas in the abdomen and others.

2. What is endocrine surgery? (0:39)
Endocrine surgery focuses on the surgical care of diseases of the thyroid, parathyroid and adrenal glands. Endocrine surgeons are trained first in general surgery and then specialize in the care of patients with thyroid, parathyroid or adrenal disease.

3. What are some common endocrine conditions that require endocrine surgery, and how are they diagnosed? (1:03)
The thyroid can have several different problems that may need surgery. This includes when your body makes too many hormones, like in Graves’ disease; an enlarged thyroid known as a goiter, that can lead to symptoms because of its size; or growth of nodules that may be suspicious for cancer.

The parathyroid glands can become enlarged as well, leading to hyperparathyroidism which results in too many parathyroid hormones and high calcium levels in the body. This can lead to many different symptoms including osteoporosis and kidney stones among others.

The adrenal glands can grow nodules or masses that may produce excess hormones. Surgery can be helpful to remove the gland to improve the hormone levels or make sure there is no cancer.

Endocrine conditions that might need a surgeon are diagnosed in a few ways. This can include imaging, such as a CT scan. Sometimes when a patient gets imaging for other reasons, a nodule or other mass is found on the thyroid or an adrenal gland. This could lead to more tests that might result in a potential surgery. Also, for patients who have a long-standing condition like diabetes or high blood pressure, lab testing can diagnose whether some of these conditions have been caused by abnormal hormones.

4. What are other treatments that might be done for endocrine conditions in addition to surgery? (2:45)
Options to surgery for some thyroid diseases including radioactive iodine ablation and radiofrequency ablation. Many thyroid issues need medical therapy as well, typically coordinated by an endocrinologist or primary care provider.

Some diseases like primary hyperparathyroidism have no treatment other than surgery, so it’s important to spot and diagnose this condition to allow a surgeon to asses it in a timely way.

5. How is endocrine surgery performed? (3:18)
Thyroid and parathyroid surgery are performed through a small incision in the center of the neck. These are done under a general anesthetic, but can often still be outpatient procedures and patients can go home the same day after the operation. During parathyroid surgery, we check the parathyroid hormone level to make sure that we have fixed the problem before the procedure is over. Adrenal surgery is also done under general anesthesia and is usually minimally invasive with the use of either laparoscopy or robotic surgery.

6. Can endocrine surgery be done using minimally invasive techniques? (3:50)
Yes, most of the time adrenal surgery is done via minimally invasive techniques. This includes both laparoscopic surgery and robotic surgery. This operation is done with small incisions using a camera and small instruments, which often means less pain and a faster recovery.

7. What type of training do endocrine surgeons have, beyond general surgeons? (4:21)
After medical school, surgeons have five to seven years of residency training in general surgery. Then endocrine surgeons complete one year of additional training, known as a fellowship, specifically in endocrine surgery. During that year, an endocrine surgeon will usually perform 200 to 300 endocrine surgeries, gaining good experience to begin their practice and perform these operations safely.

8. What are the features of Valley Medical Center’s endocrine surgery services? (5:00)
As an endocrine surgeon, I perform operations including thyroidectomy, parathyroidectomy, and adrenal surgery. I also evaluate patients in my clinic, including the initial workup of these issues and a thyroid biopsy (or fine needle aspiration), if needed. I work closely with primary care providers and endocrinologists to diagnose patients with endocrine surgical issues and coordinate their follow-up care after surgery. I make sure every patient understands their diagnosis and treatment options, including surgery when appropriate.

9. If someone has, or suspects they have, an endocrine condition, where should they seek care? (5:50)
You should see your primary care provider first. Many endocrine issues will usually begin with lab tests order by the primary care provider, which may include both urine and blood tests. Imaging with an ultrasound or CT scan can also be done. If needed, your primary care provider can refer you to either an endocrine surgeon or an endocrinologist depending on what issue has been discovered.

Dr. Zern practices at Valley’s General & Specialty Surgery Clinic in Renton, WA. For an appointment call 425.690.3433.

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