Thyroid and parathyroid conditions
The thyroid and parathyroid glands are located close together in the neck, but they have different functions and different types of disease.
The thyroid produces hormones involved in regulating metabolism. The parathyroid glands are much smaller and regulate calcium levels through parathyroid hormone.
Assessment is therefore different depending on whether a problem involves the thyroid or the parathyroid glands.
Thyroid nodules
Thyroid nodules are common and most are benign.
A nodule may be discovered because of a visible or palpable lump in the neck, during examination for another problem, or incidentally on imaging.
Assessment may include thyroid blood tests and ultrasound. The ultrasound appearance helps determine whether a nodule requires monitoring, needle biopsy or further investigation.
Not every thyroid nodule requires surgery.
Goitre
A goitre is an enlarged thyroid gland. Enlargement may involve the whole gland or result from multiple thyroid nodules.
Some people have no symptoms, while a larger goitre may cause visible neck swelling, pressure or difficulty swallowing. A thyroid that extends lower into the chest can occasionally cause additional pressure symptoms.
Thyroid function may be normal, overactive or underactive, so blood tests form an important part of the assessment.
Thyroid cancer
A small proportion of thyroid nodules are cancerous.
Investigation usually involves ultrasound and, where indicated, ultrasound-guided fine-needle aspiration. The results are considered together with the size and ultrasound characteristics of the nodule and other clinical factors.
Thyroid cancer is not a single disease, and treatment varies according to the type, size, location and extent of the tumour.
Depending on the diagnosis, management may include surveillance in selected cases, removal of one thyroid lobe, total thyroidectomy or lymph-node surgery when indicated.
Parathyroid disease
The parathyroid glands are usually four small glands situated behind or close to the thyroid.
Primary hyperparathyroidism occurs when one or more parathyroid glands produce excessive parathyroid hormone. This can result in an elevated blood calcium level.
The condition may be identified on routine blood tests or during investigation of problems such as kidney stones or reduced bone density.
How is hyperparathyroidism diagnosed?
The diagnosis of primary hyperparathyroidism is principally made from blood-test results, particularly calcium and parathyroid hormone levels.
Other investigations may include vitamin D levels, kidney function, urine calcium measurements and bone-density assessment depending on the circumstances.
Imaging does not establish the diagnosis of hyperparathyroidism. Once a biochemical diagnosis has been made and surgery is being considered, imaging may be used to help locate the abnormal parathyroid gland or glands.
How are thyroid and parathyroid conditions assessed?
Assessment depends on the suspected condition and may include:
• Examination of the neck
• Thyroid function blood tests
• Calcium, parathyroid hormone and vitamin D measurements
• High-quality ultrasound
• Ultrasound-guided fine-needle aspiration of selected thyroid nodules
• CT or other imaging in selected cases
• Parathyroid localisation imaging when appropriate
Examination of vocal-fold movement may also be recommended before some thyroid or parathyroid operations.
When might thyroid surgery be considered?
Thyroid surgery may be recommended for some thyroid cancers, selected indeterminate or concerning nodules, significant enlargement or pressure symptoms, and certain conditions causing excessive thyroid hormone production.
The extent of surgery depends on the diagnosis. Some patients require removal of one thyroid lobe, while others may require total thyroidectomy.
Parathyroid surgery
When surgery is appropriate for primary hyperparathyroidism, the aim is to identify and remove the abnormal parathyroid gland or glands while preserving normally functioning parathyroid tissue.
The operative approach depends on the biochemical findings, imaging and whether disease appears to involve one or several glands.
Thyroid and parathyroid surgery at Hawthorn ENT
Dr Depak Patel is an ENT and head and neck surgeon with advanced fellowship training in head and neck surgery.
His practice includes the assessment and surgical management of thyroid nodules, goitre, thyroid cancer and parathyroid disease.
Investigation and treatment are tailored to the diagnosis and individual patient, with multidisciplinary involvement where appropriate.
Appointments for thyroid and parathyroid conditions
If you have been referred with a thyroid nodule, enlarged thyroid, abnormal thyroid investigation or parathyroid condition, specialist assessment can help determine whether further investigation, surveillance or surgery is appropriate.