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Babak Larian, M.D.
9401 Wilshire Blvd #650
Beverly Hills, CA 90212
Phone: (310) 776-6913
Fax: (310) 461-0310

 


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Thyroid Surgery

The thyroid is a butterfly-shaped gland that is located in the front lower area of the neck. It is responsible for releasing hormones that regulate growth, metabolism, and heart rate. Problems with the thyroid can trigger unpleasant symptoms and, if untreated, result in serious damage to multiple systems in the body. Likewise, the parathyroid glands, a set of smaller structures located on the back of the thyroid, are essential to normal functioning of the body's key systems. The job of a parathyroid is to closely regulate the body's calcium level, keeping the muscles, nerves and other organs working properly. When problems arise, thyroid surgery, performed at our Beverly Hills practice, serving Los Angeles and all of Southern California, may be necessary to restore the body's natural balance.

Thyroid Problems and Treatments
Minimally Invasive Thyroidectomy (MIT)
Minimally Invasive Parathyroidectomy (MIP)

Thyroid Problems and Treatments

Problems with the thyroid typically trigger symptoms of either hyperthyroidism or hypothyroidism, as the production of hormones normally secreted by the thyroid is either increased or decreased. Symptoms of hyperthyroidism, or overactive thyroid, include sudden and unexplained weight loss, fatigue, insomnia, shaking, and rapid or irregular heartbeat. Decreased thyroid hormone levels, known as hypothyroidism, can trigger such symptoms as unexplained weight gain, constipation, pain and stiffness in the muscles, and increased sensitivity to cold.

In most cases, these conditions that affect the thyroid hormone production are treated with medications and are best managed by internists and endocrinologists.

Fig. 2 Thyroid Gland

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Thyroid Nodule

A thyroid nodule is a lump or growth that develops in the thyroid. In the majority of cases, a thyroid nodule is so small that it will go unnoticed unless discovered by a physician during a routine examination or while having a radiologic study of the Fig 3 neck for other problems. Thyroid nodules are very common; research studies have shown that upto 50% of population have nodules in their thyroid gland. The difficulty comes from the fact it is impossible to tell the difference between a benign (non-cancerous) nodule and a thyroid cancer which also looks exactly the same on ultrasound, CT, and MRI studies. A fine needle aspirate (FNA) biopsy is the only reliable way to get an answer to this problem.

Fig. 2 Thyroid Nodule

Goiter

Unlike a thyroid nodule, which is a growth within the thyroid, a goiter is an enlargement of the thyroid itself. When the thyroid becomes enlarged, pressure on the trachea and esophagus make swallowing and breathing uncomfortable or difficult. Larger goiters are visible from the exterior, as a lump or swelling of the neck. A goiter can develop due to a deficiency of iodine (this is now rare in developed countries, due to the prevalence of iodized table salt) or as a symptom of certain autoimmune diseases. Treatment depends on the size of the goiter, and if it is putting pressure on the structures inside and causing symptoms. A goiter that is not visibly enlarged, does not have a suspicious nodule within it, and is not causing symptoms does not require surgical removal.

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Thyroid Cancer

Although the majority of thyroid nodules and growths are benign, a small percentage of them turn out to be malignant. Close to 40,000 new cases of thyroid cancer are diagnosed each year in the United States. Thyroid cancer is similar to skin cancer in that the most common forms are the most easily treated, especially when detected early. The only effective treatment for thyroid cancer is thyroid surgery. In our practice, serving Los Angeles and all of Southern California, we have been highly successful in treating thyroid cancer.

Type of Cancer

Incidence

Papillary

65-70%

Follicular

15-20%

Medullary

5-10%

Anaplastic

1-2%

Papillary and Follicular Thyroid Carcinomas

Papillary and follicular thyroid carcinomas are categorized as well-differentiated thyroid cancer and account for 80–90% of all thyroid cancers, with papillary being the most predominant. These types of thyroid cancer tend to be slow growing and when diagnosed early (a majority of cases) have a high cure rate. More aggressive variants of well-differentiated thyroid cancer include tall cell, schirrous, insular, Hurthle cell, etc. Their treatment and management are similar, despite the fact that they tend to be more aggressive. The risk group categories are described in the table and help us determine how aggressively the tumor needs to be treated and if radioactive iodine or other adjunctive measures need to be taken.

   

Risk Group

   
 

Low

Intermediate

Intermediate

High

Age

<45

<45

>45

>45

Distant Metastases

None

yes

None

yes

Tumor Size

<4cm

>4cm

<4cm

>4cm

Histology

Papillary

Follicular or High Grade

Papillary

Follicular or High Grade

5 year Survival (%)

100

96

96

72

20 year Survival (%)

99

85

85

57

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Medullary Thyroid Carcinoma

Medullary thyroid carcinoma (MTC) is a relatively uncommon form of thyroid cancer. When diagnosed early (before it has spread), the cure rates can be high. Once diagnosed the patient must undergo the necessary testing ASAP so that you may begin treatment (surgery) right away. MTC can run in families in 20% of cases. So genetic testing (of the RET proto-oncogene) should be done on all patients with MTC to check to see whether they have the familial form, in which case their family members must also be checked to see if they carry the gene. The familial forms of MTC are often times associated with other types of tumors (MEN 2A & 2B) and hormonal problems that need to be accurately diagnosed before treatment is started.

 

MEN

Syndromes

 

MEN 2A

MTC

Pheochromocytoma

Hyper-Parathyroidism

MEN 2B

MTC

Pheochromocytoma

Mucosal Neuromas Marfanoid Habitus

Anaplastic Thyroid Carcinoma

Anaplastic thyroid carcinoma is, fortunately, the least common type of thyroid cancer. This is a very aggressive cancer that rapidly grows and spreads. In most cases the tumor has already spread and is involving the adjacent organs making it very difficult to control and treat.

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Thyroid Ultrasound

The simplest method to visually examine the thyroid is an ultrasound. Using high-frequency sound waves, we are able to create an image of the thyroid that can reveal any abnormal growth or nodules. Ultrasound cannot be used to determine whether a particular growth is cancerous, however, it can identify the presence, size, and location of the growth, making it possible to access it for a needle biopsy or to use for long-term monitoring of a nodule. There are no risks or side effects associated with ultrasound and it is completely non-invasive. The ultrasound is a very valuable tool in close monitoring after thyroid cancer is removed.

Fine Needle Aspiration

In order to determine whether a thyroid growth is cancerous or not, a sample must be taken and examined for signs of abnormal cells. This can be done by fine needle Fig 4 aspiration, which involves the insertion of a very thin needle through the skin and into the thyroid growth. Ultrasound technology is often used to visualize the internal structures and guide the placement of the needle. Then, cells are collected with the needle so that they can be examined. The physician will generally take multiple samples to ensure an accurate analysis.

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Minimally Invasive Thyroidectomy (MIT)

A thyroidectomy is the surgical removal of all (Total thyroidectomy) or part (Hemi-Thyroidectomy) of the thyroid gland. Thyroid surgery may be necessary to treat thyroid cancer, large goiters that are casusing symptoms, or certain types of hyperthyroidism. Thyroid surgery is made safer by using larngeal (voice box) nerve monitoring device; this is specially useful in patients that have previously had surgery in this area of the neck, or when the risk of injury to the recurrent laryngeal nerve (RLN) is high due to the location of the cancer.

  Fig. 6 - Recurrent Laryngeal Nerve (RLN) behind the thyroid gland

Fortunately, endoscopic surgical techniques allow us to perform the procedure through an incision approximately one inch long, which when closed using a plastic surgery technique, leaves an almost invisible scar. The endoscope not only minimizes the scar and trauma to the tissue, it also magnifies the tissue so that the laryngeal nerve and parathyroid glands are well visualized. The hospital stay and recovery time following endoscopic thyroid surgery is significantly shorter than that of traditional methods as well.

If only part of the thyroid is removed, the remaining section is capable of producing the necessary hormones on its own. If the entire thyroid is removed, hormone replacement therapy will be needed to maintain normal body functioning.

Fig. 7 - Inferior and Superior Parathyroid Gland (IFG & SPG)

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Neck Dissection for Thyroid Cancer

Unfortunately, removal of the thyroid alone is not always sufficient to eliminate thyroid cancer. If cancerous cells are present present in the lymph nodes or if the lymph nodes have become enlarged, or if the patient is at high risk for cancer regrowth, the lymph nodes in one or both sides of the neck will be removed. This procedure is known as a modified neck dissection. In most patients who have been diagnosed with thyroid cancer at the time of surgery a central compartment neck dissection is performed, that is the removal of a small group of lymph nodes just below the thyroid gland (this is done through the same small incision) The lymph system can function normally after a neck dissection, but this is a complex procedure due to the close association of the nerves in this area, there is a possibility of nerve damage, which may result in numbness or weakness, as such these procedures must be performed by expert surgeons to make sure a complication is unlikely. We perform neck dissections routinely for thyroid and other types of cancer in the neck area.

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Thyroid pamphlet Thyroid post op

 

Contact Our Practice

To learn more about parathyroid & thyroid surgery, contact our Beverly Hills practice, serving Los Angeles and all of Southern California.

Request your consultation with Dr. Larian today.
Call us at 310.776.6913 to schedule an appointment or

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