For the head and neck surgeon, endocrine surgery focuses solely on problems affecting the thyroid gland and the parathyroid glands.
The thyroid gland is a structure low in the neck that produces a hormone (thyroid hormone) that affects the entire body. Patients can have an over-performing thyroid gland (hyperthyroidism, where too much thyroid hormone is produced) or an under-performing gland (hypothyroidism, where too little thyroid hormone is produced). Symptoms of hyperthyroidism include nervousness, irritability, skin and hair changes, palpitations, heat intolerance, weight loss, gastrointestinal changes, and other symptoms. Symptoms of hypothyroidism include fatigue, cold intolerance, skin and hair changes, weight gain, hoarseness, muscle weakness, and other symptoms. There are also a number of growths that can affect the thyroid gland. See some of the specific thyroid problems listed below.
The parathyroid glands are small glands that are just beneath and adjacent to the thyroid gland. They secrete a hormone (parathyroid hormone) that is essential to keeping a normal level of calcium in the body. An over-active parathyroid gland (or multiple over-active glands) can produce too much parathyroid hormone. This can lead to high calcium levels, which can cause symptoms (fatigue, muscle soreness, gastrointestinal problems, memory problems etc). High calcium can also lead to kidney stones, bone loss (osteopenia and osteoporosis), and heart problems. Aside from problems with the parathyroid gland, high calcium can be caused by other disorders, which need to be assessed for and ruled out to determine if it is a problem with the parathyroid glands or not. See some specific parathyroid problems below.
Through partnerships at Indiana University Health, Dr. Parker works with endocrinologists, radiologists, oncologists, and other surgeons as a multi-disciplinary team designed to optimize the surgical treatment of thyroid and parathyroid disorders. Dr. Parker devotes a significant portion of his practice to surgery of the thyroid and parathyroid glands.
The midline neck includes the larynx, trachea, thyroid gland, and parathyroid glands.
Thyroid nodules are solid or fluid-filled growths that can develop in in the thyroid gland. Most do not cause symptoms and are not serious; in fact, many people have nodules and do not realize it. Some nodules can produce too much thyroid hormone and cause symptoms of hyperthyroidism (hair and skin changes, nervousness, sweating, etc), while others can become large enough to cause swallowing or breathing trouble. Only a very small percentage of nodules are cancerous. Nodules should be evaluated with a thyroid ultrasound and labs, and some might require additional imaging studies or a biopsy. Treatments depend on what underlying issues are found on evaluation, but can include observation, medication, radio-active iodine, and/or surgery.
A goiter is a thyroid gland that has enlarged to an abnormal extent, typically with multiple nodules within the gland. Goiters are usually painless and often asymptomatic, but can be large enough to be visible as a lump or mass in the lower neck and can cause difficulty swallowing or breathing. Other symptoms can occur if nodules secrete too much thyroid hormone and cause hyperthyroidism (see "Toxic Thyroid Nodules"). Goiters should be evaluated with a thyroid ultrasound and labs, and some might require additional imaging studies or a biopsy. Similar to nodules, treatments depend on what underlying issues are found on evaluation and symptoms, but can include observation, medication, radio-active iodine, or surgery.
Graves' disease is a disorder of thyroid hormone over-production leading to symptoms of hyperthyroidism (hair and skin changes, nervousness, sweating, etc) that can also include significant eye changes as well. Grave’s disease is caused by a problem with the body’s immune system, where antibodies are produced that lead to this overproduction of hormone. In addition to a visit with a specialist to discuss symptoms, thyroid ultrasound and labs are utilized to make a diagnosis and assess severity. The primary goals of treatment are to limit the effects of overproduced thyroid hormones and to reduce symptom severity. Treatment options include medications, radio-active iodine, or surgery for gland removal. Significant eye symptoms may require specialized treatment.
Thyroid nodules are solid or fluid-filled growths that can develop in in the thyroid gland. Most do not cause symptoms and are not serious, but some nodules can produce too much thyroid hormone, which can cause symptoms of hyperthyroidism (hair and skin changes, nervousness, sweating, etc), while others can become large enough to cause swallowing or breathing trouble. "Toxic" nodules are those nodules that over-secrete thyroid hormone and cause hyperthyroid symptoms. These nodules should be evaluated with a thyroid ultrasound and labs, and often an iodine study to see if it is an over-active nodule. Sometimes a biopsy is necessary. Treatments depend on what underlying issues are found on evaluation, but can include observation, medication, radio-active iodine, and/or surgery.
The thyroid gland is made of cells that play various roles in thyroid function. Sometimes, those cells can become abnormal and start to rapidly divide and grow. Thyroid cancers are growths in the thyroid gland of one of these cell types that can enlarge, invade, and spread. Most thyroid cancers are relatively slow growing, but some types can be aggressive. This is why any nodule or growth of the thyroid gland requires appropriate imaging, labs, and sometimes biopsies. If thyroid cancer is suspected or proven, then additional evaluations are sometimes performed. Treatment typically begins with surgery to remove the thyroid gland and sometimes lymph nodes. Additional treatments can include radio-active iodine and, more rarely, radiation or chemotherapy.
Primary hyperparathyroidism is a condition where one or more of the parathyroid glands produces too much parathyroid hormone (PTH). This can lead to a high level of calcium, which causes a number of symptoms (fatigue, muscle weakness, nausea, vomiting, GI discomfort, kidney stones and memory problems) and can have other more dangerous complications, including bone loss leading to osteoporosis and an abnormal heart beat. After diagnosis is made based on lab values, imaging is performed to help locate the abnormal glands. While medications can be used to lower blood calcium or protect bones, surgery is typically the treatment of choice for primary hyperparathyroidism.
Secondary hyperparathyroidism is a condition where the parathyroid glands are responding to another problem in the body by over-secreting parathyroid hormone (PTH). In this case, the response can be an appropriate one because it is compensating for the other condition, often vitamin D deficiency, kidney failure, and stomach or other gastro-intestinal issues leading to poor resorption of calcium. The primary treatment for secondary hyperparathyroidism is to identify the underlying cause and treat it appropriately so that the parathyroid glands can resume a normal level of PTH. Rarely, surgery can be a strategy.
Tertiary hyperparathyroidism is a condition where the parathyroid glands have been over-secreting parathyroid hormone (PTH) for a long time from one of the conditions causing secondary hyperparathyroidism, typically renal failure. Whereas in secondary hyperparathyroidism, correction of the underlying problem can lead to a normal PTH level, in tertiary hyperparathyroidism, these corrections do not correct the high levels of parathyroid hormone. Because the glands are over-secreting PTH, high blood calcium and associated symptoms and potential complications can occur. Typically, medical therapy is employed, but if levels get sufficiently high, then surgery can be a strategy.
The parathyroid gland is made of cells that play various roles in parathyroid function. Sometimes, those cells can become abnormal and start to rapidly divide and grow. Parathyroid cancers are growths in one of the parathyroid glands that can enlarge, invade, and spread. They also typically secrete high levels of parathyroid hormone (PTH). Lab values assessed during the evaluation of primary hyperparathyroidism can point to a possible parathyroid cancer (very high PTH levels), but this cancer is very rare. If a parathyroid cancer is suspected or proven, then additional evaluations are sometimes performed. Treatment typically begins with surgery to remove the abnormal gland and surrounding lymph nodes. Additional treatments can be utilized, such as radiation therapy.