Thyroid and parathyroid glands
Enlargements of the thyroid gland (goitre) or nodules (nodular goitre, multinodular goitre) are common and often incidental findings during other examinations (such as an ultrasound of the neck vessels or a CT scan of the lungs). Further evaluation aims to detect and treat potentially malignant thyroid nodules (thyroid cancer) or those that may cause complications (e.g., narrowing of the trachea or thyroid overactivity (hyperthyroidism), for example in a thyroid adenoma) in a timely manner. Both these evaluations, usually involving ultrasound and fine-needle aspiration, as well as thyroid surgery (thyroidectomy), are a specialized area of our practice HalsGesichtsChirurgie Zurich. Closely related is parathyroid surgery (parathyroidectomy), which is typically performed for hyperparathyroidism, a condition that leads to elevated calcium levels (hypercalcemia) in the blood, to remove the causative parathyroid adenoma.
Diagnostics
The main pillars of thyroid disease evaluation are blood tests to measure thyroid hormone levels and an ultrasound examination of the neck. In many cases, these steps are already carried out by your primary care physician or by an endocrinologist (hormone specialist). If the ultrasound shows thyroid nodules that require further evaluation, these are examined using an ultrasound-guided fine-needle aspiration biopsy (FNA). This FNA, which allows for cell sampling from the thyroid with minimal pain and complications, can be performed directly during your initial consultation. After standardized analysis in the cytology lab, results are usually available within a few working days to discuss the next steps. Typical preoperative assessment for thyroid and parathyroid surgery also includes laryngoscopy (endoscopy, examination of the larynx) to evaluate vocal cord mobility. Additional imaging (scintigraphy to assess thyroid autonomy or adenoma, MRI, etc.) is indicated for specific questions and is arranged with our collaboration partners.
Evaluation of hyperparathyroidism (primary hyperparathyroidism), which can lead to osteoporosis or kidney stones due to elevated calcium levels in the blood, is generally performed by endocrinologists. If surgery (parathyroidectomy) is indicated, a referral to us for surgical planning is usually made after so-called "localization diagnostics," in which specialized imaging methods are used to identify the overactive parathyroid gland (parathyroid adenoma).
Treatment
There are three types of thyroid surgeries: a hemithyroidectomy (removal of one thyroid lobe, lobectomy), a total thyroidectomy (complete removal of both thyroid lobes), and, in selected cases, an isthmectomy (removal of the middle part of the thyroid above the trachea). We perform all of these thyroidectomies, as well as parathyroid surgeries (parathyroidectomies), in a standardized, routine manner and always with so-called recurrent laryngeal nerve monitoring (intraoperative neuromonitoring to monitor the vocal nerves). This usually requires a hospital stay of 2 nights.
Typically, the procedure is performed through a small incision in a neck crease, which is often barely visible a few weeks after surgery. A unilateral weakness of the vocal nerve with hoarseness is fortunately very rare with standardized and routinely performed thyroid surgery and has a good chance of recovery within a few weeks. In the era of intraoperative neuromonitoring (recurrent nerve monitoring), bilateral vocal nerve paralysis with breathing difficulties almost never occurs anymore, as in a total thyroidectomy (removal of both lobes), the procedure on the second side is only carried out after the surgeon has verified the integrity of the nerve on the opposite side. The previously feared postoperative bleeding after thyroid surgery has lost its danger due to the use of modern devices for vessel sealing. Typically, thyroid and parathyroid surgeries are only mildly painful, and standard painkillers such as paracetamol or ibuprofen are entirely sufficient.
For certain types of thyroid cancer, depending on the stage, therapy with radioactive iodine (radioiodine therapy) may be necessary a few weeks after surgery. The indication for this is determined at the thyroid tumours board (multi-disciplinary meeting (MDM) with case discussion) together with nuclear medicine physicians, who also perform this radioiodine treatment, endocrinologists, and pathologists.
Surgeries for hyperparathyroidism (parathyroidectomy) are performed with intraoperative monitoring of parathyroid hormone (PTH). An adequate drop in this hormone during surgery serves as a success check, with PTH levels expected to return to the normal range by the end of the operation.
Follow-up
The recovery period after a thyroidectomy or parathyroidectomy typically requires 10–14 days, depending on the extent of the surgery. Until the wound has fully healed after a thyroid or parathyroid surgery, we will monitor you in our outpatient clinic. This also includes a follow-up laryngoscopy (endoscopy, examination of the larynx) to check the mobility of the vocal cords.
For benign thyroid conditions and after surgical treatment of thyroid or parathyroid hyperfunction, follow-up care is primarily carried out by your general practitioner or your endocrinologist. Not all thyroid surgeries require thyroid hormone replacement: after a hemithyroidectomy (removal of half of the thyroid), there is a good chance that the remaining side will produce sufficient hormones. However, after a total thyroidectomy, thyroid hormone replacement is always necessary.
Follow-up care after treatment for thyroid cancer is conducted in collaboration with nuclear medicine physicians, endocrinologists, and your general practitioner.
