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14.03.2016
In most people with thyroid nodules, the gland produces a normal level of thyroid hormone (euthyroid state). The most important tests to evaluate a thyroid nodule are a TSH level (a blood test that evaluates the function of the gland) and a fine needle aspiration (FNA) biopsy to evaluate the nodule for malignancy. The patient is usually admitted on the morning of surgery, and the operation is done under general anesthesia. The superior laryngeal nerve tenses the vocal cord, and is statistically injured more often than the recurrent nerve. Despite all the afore-mentioned complications, thyroidectomy is a very safe operation and most patients do not experience any permanent complications. The parathyroid glands are tiny glands in the neck that help to regulate the level of serum calcium. The diagnosis of hyperparathyroidism is made by repeated measurements of both serum calcium and PTH levels.
80-90% of hyperparathyroidism is due to a benign tumor, or adenoma, in one parathyroid gland. Unfortunately every operation entails some risk, and parathyroid exploration is no exception. The major risk of parathyroid surgery is the risk of a negative exploration, that is, failure to remove all abnormal parathyroid glands.
Despite the afore-mentioned risks, parathyroid exploration is among the most successful of all surgical operations, and most patients do not experience any significant perioperative complications. Head and Neck Surgery Associates is a group of 10 board certified otolaryngologists devoted to the treatment of ENT diseases in both pediatric and adult patients. The Medical practice, which would evolve into Head and Neck Surgery Associates, began in July, 1977 when Dr.
All of our physicians are Board Certified Otolaryngologists accredited by the American Association of Otolaryngology-Head & Neck Surgery.
The doctors of HNSA always do our own surgeries, and we do not use medical students, residents, or fellows to do surgery or provide care for our patients. At the present time Head and Neck Surgery Associates accepts all major health insurance providers. Because the Center for Surgical Care specializes in outpatient surgery, the cost of surgery is significantly less than in other facilities. The physicians of Head and Neck Surgery Associates perform many of our surgeries at our own surgery center. Our staff is highly trained and carries many years of peri-operative experience in the care of the adult and pediatric patient. Our surgery center patients prefer our competent, convenient, patient oriented approach as opposed to the hospital setting. The Center for Surgical Care’s board-certified surgeons, anesthesiologists and nurse anesthetists have passed rigorous exams that affirm their mastery of their specialty. AAAHC sets standards, measures performance and awards accreditation only to organizations that meet its criteria.
Focus and expertise performing pediatric ENT surgeries, We have privileges at all Northern Kentucky Hospitals, our own outpatient Surgery Center and Children’s Medical Center. For those patients who are not controlled with avoidance or medications, allergy testing and immunotherapy are available.
Head and Neck Surgery Associates is a group of 10 board certified otolaryngologists devoted to the treatment of Adult ENT diseases. Head and Neck Surgery Associates have received specialized training in the medical and surgical management of Sinus and Nasal Disorders. Certified Hearing Aid Consultants is staffed by fully licensed, certified and dedicated audiologists. Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Head and Neck Surgery Associates is a group of 10 board certified otolaryngologists devoted to the treatment of ENT diseases in both pediatric and adult patients.
At Head and Neck Surgery Associates, our doctors, nurses, audiologists, allergy staff, and other personnel are specially trained and qualified to offer the finest patient care. South Florida ENT Associates consists of 45 board certified ear, nose, and throat physicians located throughout Miami-Dade, Broward, and Palm Beach Counties.
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Thyroid nodules are extremely common, and may be solitary or multiple (multinodular goiter). The primary indications for thyroidectomy are suspicion of cancer, large size, substernal location (nodules that grow inferiorly into the chest), or symptoms (throat pressure, difficulty swallowing, respiratory distress, or cosmetic disfigurement from a visible goiter).
The most common indications for this operation are suspicion of malignancy, large nodules, substernal nodules (nodules that grow inferiorly into the chest), and nodules that cause symptoms (throat pressure, difficulty swallowing or breathing, or nodules so large they cause cosmetic disfigurement).
It generally takes about 1- 2 hours to perform, and is done through a horizontal incision (usually placed within a skin crease) in the low, anterior neck.
The recurrent laryngeal nerve supplies the vocal cord, and this nerve must be identified and protected during thyroidectomy. These nodules can almost always be removed through the neck, but rarely a sternotomy (division of the breastbone) is required. When the blood calcium level drops, the parathyroid glands release parathyroid hormone (PTH), which helps to raise the level of serum calcium. Unfortunately the only treatment option is surgery; there is no effective medication, and a calcium-restricted diet will only cause the parathyroid glands to pull calcium out of the bones, where the body stores calcium.
This risk is approximately 2-5%, meaning there is a better than 95% chance that the operation will be successful. The Center for Surgical Care (CSC) is a state of the art facility that opened its doors in 1988. Ambulatory health care centers such as ours value accreditation as the measure of professional achievement and quality care. Our Center for Surgical Care has been active since 1992 and many of our surgical procedures are done here. Problem snoring is more frequent in males and overweight persons, and it usually grows worse with age. Our expertise is in the diagnosis and treatment of ear, nose and sinus disorders, hearing and hearing rehabilitation, nasal allergies, throat and thyroid problems. Allergy ENT doctors in Miami, South Florida, and in Miami-Dade, Broward, and Palm Beach counties. ENT voice and vocal treatment care in Miami, South Florida, and in Miami-Dade, Broward, and Palm Beach counties. The best ENT physicians in Miami, South Florida, and in Miami-Dade, Broward, and Palm Beach counties.
ENT physician care in Miami, South Florida, and in Miami-Dade, Broward, and Palm Beach counties.
It is estimated that approximately 5-10% of the population has a palpable thyroid nodule, and between 30-85% have tiny thyroid nodules that are too small to palpate. FNA is usually performed in our office, but for smaller nodules and others that are difficult to palpate, the biopsy is done by the radiologists under ultrasound guidance. Recovery is usually rapid- most patients are ambulatory the day of surgery, and most experience little or no pain after the first 24 hours. Injury to one recurrent nerve causes a unilateral vocal cord paralysis which results in a breathy voice. Although they are usually identified and protected during thyroidectomy, they often do not function properly after the surgery.
Since it is easy to measure the level of thyroid hormone in the bloodstream, it is usually easy to determine the necessary dose of thyroid hormone for each patient. In addition, surgery for substernal nodules rarely results in pneumothorax, or collapse of the lung, a condition that is treated by inserting a chest tube to re-expand the lung.
The operation is performed under general anesthesia through an incision in the low anterior neck, identical to the incision used during thyroid surgery. 10-20% is due to parathyroid hyperplasia, where all glands are slightly enlarged and abnormal.
To minimize the risk of a negative exploration, localization studies are sometimes done before surgery to try to identify which gland or glands are abnormal. The Center is licensed by the State of Kentucky and is accredited by Medicare and the Accreditation Association for Ambulatory Health Care (AAAHC), a national organization that reviews outpatient surgical facilities.
The staff of the Center for Surgical Care is proud to have achieved this level of recognition. Pediatricians in Miami, South Florida, and in Miami-Dade, Broward, and Palm Beach counties. Excessive production of thyroid hormone (hyperthyroidism) can cause palpitations, tremors, weight loss, and heat intolerance.
A history of exposure to ionizing radiation to the neck is such a risk factor, as is a family history of thyroid cancer.


There are some types of thyroid nodules (follicular tumors) where FNA cannot distinguish benign from malignant nodules- these nodules are usually best managed by thyroidectomy.
The three most common types of thyroidectomy are total, subtotal (removes most of the gland), and hemi (removes one lobe of the thyroid).
A preoperative visit with your internist or cardiologist may be beneficial for those in this situation.
Although this in jury is rare and usually temporary, it can be permanent in about 1% of patients. It is thought that only 1 or 2 functioning parathyroid glands are needed to maintain a safe level of blood calcium.
In hyperparathyroidism one or more parathyroid glands become independent and continue to produce PTH. Since most individuals have 4 parathyroid glands, removing 3.5 hyperplastic glands is usually curative. Conversely, an under-active thyroid gland (hypothyroidism) can result in fatigue, weight gain, and cold intolerance. Hoarseness, lymph node enlargement, and fixation of the nodule can also increase the risk of malignancy.
The risk of needing a blood transfusion is extremely small, but all patients should avoid blood-thinning agents before surgery. If both recurrent nerves are injured (possible only in a bilateral thyroidectomy), the result is catastrophic because the vocal cords do not open during breathing. Since most people have 4 parathyroids (2 behind each lobe of the thyroid), patients having only a hemithyroidectomy are at no significant risk for hypoparathyroidism and are therefore usually discharged from the hospital the morning after surgery. These include aspirin, Advil, Motrin, Naprosyn, ibuprofen, and other non-steroidal anti-inflammatory drugs. Although these scans are often quite useful, no test can approach the accuracy of surgical exploration. Fortunately, the vast majority of thyroid cancers are treatable and carry an excellent prognosis. These include aspirin, Advil, Motrin, ibuprofen, naprosyn, and other non-steroidal anti-inflammatory agents. This bilateral vocal cord paralysis usually requires a tracheotomy followed by a reconstructive operation on the voicebox. Our results at Otolaryngology show that hypoparathyroidism develops in about a third of patients following total thyroidectomy.
The resulting hypercalcemia can result in metabolic complications such as kidney stones, osteoporosis, brittle bones that can easily fracture, and abdominal pain.
Most are ambulatory on the day of surgery, and most are discharged from the hospital the morning after surgery. Vitamin E and ginkgo biloboa are also blood thinners that should be avoided prior to surgery. Therefore all patients who undergo total thyroidectomy have a serum calcium checked twice daily after surgery- if the calcium does not drop, the patients are discharged on post-op day 1 or 2. 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.
The incision will be noticeable immediately after surgery but usually becomes much less visible with time. Those that develop hypocalcemia are started on oral calcium and Vitamin D, which aids in the absorption of oral calcium. The incision will be noticeable immediately after surgery, but will usually become less visible with time. Since it often takes several days to start absorbing this calcium, these patients must remain hospitalized while they receive intravenous calcium until they begin to absorb it orally. Although there will be a permanent scar, it will usually not be a very visible scar after it heals.
Fortunately, the hypocalcemia is almost always temporary- the risk of permanent hypoparathyroidism is about 1%.



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