Thyroid Disease

by Marc Levine, M.D. & Sergey Koyfman, D.O., F.A.A.O.A.

Thyroid Nodules: The thyroid gland is a butterfly-shaped gland located in the low anterior neck.  It produces thyroid hormone, which helps to regulate the body’s metabolism.  The functional capacity of the thyroid is measured by blood tests.  Excessive production of thyroid hormone (hyperthyroidism) can cause palpitations, tremors, weight loss, and heat intolerance.  Conversely, an under-active thyroid gland (hypothyroidism) can result in fatigue, weight gain, and cold intolerance.

Fine Needle Aspiration Biopsy of Thyroid Nodules: One of the major advances in the treatment of thyroid nodules over the past 25 years has been the adoption of fine needle aspiration (FNA) as a screening tool to help determine when thyroidectomy is required. Thyroid nodules are extremely common but only approximately 10% of all nodules are cancerous.  While advanced malignancies are usually readily apparent, most benign and malignant nodules cannot be differentiated on the basis of examination alone.

Hyperparathyroidism: The parathyroid glands are tiny glands in the neck that help to regulate the level of serum calcium.  When the blood calcium level drops, the parathyroid glands release parathyroid hormone (PTH), which helps to raise the level of serum calcium.  Once the serum calcium level returns to normal, PTH production usually stops.  In hyperparathyroidism one or more parathyroid glands become independent and continue to produce PTH.  As a result, the serum calcium climbs.  The resulting hypercalcemia can result in metabolic complications such as kidney stones, osteoporosis, brittle bones that can easily fracture, and abdominal pain.  The most common symptom of hyperparathyroidism is probably fatigue, however, since there are so many other potential causes for fatigue, you can never be certain if it is parathyroid-related until after surgery.  Some patients with hyperparathyroidism are completely asymptomatic.

In-Office Ultrasound: Office-based ultrasound is fast becoming an essential tool in the management of neck disease. It enables the clinician to more fully answer questions pertaining to head and neck anatomy, progression of disease, pathology and preoperative mapping. It provides the patient one-stop service with more accurate, higher yielding guided biopsies, all without the need to expose the patient to radiation

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