Thyroid and Parathyroid Disease

Thyroid and Thyroid and Parathyroid DiseaseParathyroid Disease

Carson Agee, MD, FACSCarson Agee, MD, FACSGeneral SurgeonGeneral SurgeonBJC Medical GroupBJC Medical GroupProgress West Healthcare CenterProgress West Healthcare Center

Thyroid GlandThyroid Gland

Thyroid AnatomyThyroid Anatomy

Thyroid AnatomyThyroid Anatomy

Thyroid Scar 2 WeeksThyroid Scar 2 Weeks

Thyroid Scar 3 MonthsThyroid Scar 3 Months

Thyroid DiseasesThyroid Diseases

Graves’ Disease Graves’ Disease – ExophthalmosExophthalmos


Thyroid NodulesThyroid Nodules– Cancer or not cancer that is the Cancer or not cancer that is the

questionquestion– 15% of solitary nodules are cancer15% of solitary nodules are cancer– Multiple nodules less likely to have Multiple nodules less likely to have

cancer (less than 5%)cancer (less than 5%)


Thyroid NodulesThyroid Nodules– Risk factors for cancerRisk factors for cancer

Radiation exposureRadiation exposure Family historyFamily history Younger or olderYounger or older Rapid growthRapid growth Voice changesVoice changes


Thyroid NodulesThyroid Nodules– DiagnosisDiagnosis

Fine Needle Aspiration (FNA)Fine Needle Aspiration (FNA) UltrasoundUltrasound Thyroid scan (less common)Thyroid scan (less common)


Thyroid CancerThyroid Cancer– 40/1,000,000 per year incidence40/1,000,000 per year incidence– Fewer than 10% of patients die of Fewer than 10% of patients die of

their thyroid cancer their thyroid cancer – The Good, The Bad and The Ugly!The Good, The Bad and The Ugly!


Papillary Thyroid CancerPapillary Thyroid Cancer– Most common (80%)Most common (80%)– 2:1 F:M2:1 F:M– Age 30-40Age 30-40– Mortality 0.5%Mortality 0.5%– Prognosis worse with: older (45), Prognosis worse with: older (45),

larger size, disorganized tumor, larger size, disorganized tumor, metastasesmetastases

– The GoodThe Good


Follicular Thyroid CancerFollicular Thyroid Cancer– 3:1 F:M3:1 F:M– Age 50Age 50– Diagnosis FNA (20% follicular nodules are Diagnosis FNA (20% follicular nodules are

cancer)cancer)– Prognosis worse with: age over 50, larger, Prognosis worse with: age over 50, larger,

disorganized tumor, vascular invasion, disorganized tumor, vascular invasion, outside thyroidoutside thyroid

– Mortality 15% at 10 years, continues to Mortality 15% at 10 years, continues to riserise

– The BadThe Bad


Medullary Thyroid CancerMedullary Thyroid Cancer– UncommonUncommon– Can run in familiesCan run in families– Good cure rateGood cure rate– Intermediate Intermediate


Anaplastic Thyroid CarcinomaAnaplastic Thyroid Carcinoma– Rare (1% of thyroid cancers)Rare (1% of thyroid cancers)– Few survive 6 mosFew survive 6 mos– Age 60-70+Age 60-70+– Fast growingFast growing– The UglyThe Ugly

ParathyroidParathyroid

Four glandsFour glands Next to thyroidNext to thyroid Not related to thyroidNot related to thyroid Control calcium levels in bloodControl calcium levels in blood



HyperparathyroidismHyperparathyroidism– Overactive parathyroid(s)Overactive parathyroid(s)– Incidence 1/700Incidence 1/700– 3:1 F:M3:1 F:M– Up to 3% of post-menopausal Up to 3% of post-menopausal

womenwomen– Elevated calcium found on routine Elevated calcium found on routine

blood testsblood tests


Hyperparathyroidism SymptomsHyperparathyroidism Symptoms– ““Bones, stones, groans, psychic Bones, stones, groans, psychic

overtones”overtones”– Osteoporosis, bone painOsteoporosis, bone pain– Kidney stonesKidney stones– Ulcers, constipation, abdominal painUlcers, constipation, abdominal pain– Fatigue, depression, forgetfulness, Fatigue, depression, forgetfulness,

weaknessweakness


HyperparathyroidismHyperparathyroidism– Usually one overactive glandUsually one overactive gland


Hyperparathyroidism diagnosisHyperparathyroidism diagnosis– High calciumHigh calcium– High parathyroid hormoneHigh parathyroid hormone– Rare familial disordersRare familial disorders– Can be a complication of kidney Can be a complication of kidney

diseasedisease


Hyperparathyroidism TreatmentHyperparathyroidism Treatment– SurgerySurgery


Hyperparathyroidism TreatmentHyperparathyroidism Treatment


Hyperparathyroidism TreatmentHyperparathyroidism Treatment– Radio-guided minimal access Radio-guided minimal access

surgerysurgery


HypoparathyroidismHypoparathyroidism– RareRare– Usually post thyroid surgeryUsually post thyroid surgery– Occasionally geneticOccasionally genetic

Questions?Questions?

Carson Agee, MD, FACSCarson Agee, MD, FACS

Health & Medicine

Thyroid and Parathyroid Disease