Thyroid and Parathyroid Disease

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Thyroid and Parathyroid Disease

  1. 1. Thyroid and Parathyroid Disease Carson Agee, MD, FACS General Surgeon BJC Medical Group Progress West Healthcare Center
  2. 2. Thyroid Gland
  3. 3. Thyroid Anatomy
  4. 4. Thyroid Anatomy
  5. 5. Thyroid Scar 2 Weeks
  6. 6. Thyroid Scar 3 Months
  7. 7. Thyroid Diseases <ul><li>Graves’ Disease </li></ul><ul><ul><li>Exophthalmos </li></ul></ul>
  8. 8. Thyroid Diseases <ul><li>Thyroid Nodules </li></ul><ul><ul><li>Cancer or not cancer that is the question </li></ul></ul><ul><ul><li>15% of solitary nodules are cancer </li></ul></ul><ul><ul><li>Multiple nodules less likely to have cancer (less than 5%) </li></ul></ul>
  9. 9. Thyroid Diseases <ul><li>Thyroid Nodules </li></ul><ul><ul><li>Risk factors for cancer </li></ul></ul><ul><ul><ul><li>Radiation exposure </li></ul></ul></ul><ul><ul><ul><li>Family history </li></ul></ul></ul><ul><ul><ul><li>Younger or older </li></ul></ul></ul><ul><ul><ul><li>Rapid growth </li></ul></ul></ul><ul><ul><ul><li>Voice changes </li></ul></ul></ul>
  10. 10. Thyroid Diseases <ul><li>Thyroid Nodules </li></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><ul><li>Fine Needle Aspiration (FNA) </li></ul></ul></ul><ul><ul><ul><li>Ultrasound </li></ul></ul></ul><ul><ul><ul><li>Thyroid scan (less common) </li></ul></ul></ul>
  11. 11. Thyroid Diseases <ul><li>Thyroid Cancer </li></ul><ul><ul><li>40/1,000,000 per year incidence </li></ul></ul><ul><ul><li>Fewer than 10% of patients die of their thyroid cancer </li></ul></ul><ul><ul><li>The Good, The Bad and The Ugly! </li></ul></ul>
  12. 12. Thyroid Diseases <ul><li>Papillary Thyroid Cancer </li></ul><ul><ul><li>Most common (80%) </li></ul></ul><ul><ul><li>2:1 F:M </li></ul></ul><ul><ul><li>Age 30-40 </li></ul></ul><ul><ul><li>Mortality 0.5% </li></ul></ul><ul><ul><li>Prognosis worse with: older (45), larger size, disorganized tumor, metastases </li></ul></ul><ul><ul><li>The Good </li></ul></ul>
  13. 13. Thyroid Diseases <ul><li>Follicular Thyroid Cancer </li></ul><ul><ul><li>3:1 F:M </li></ul></ul><ul><ul><li>Age 50 </li></ul></ul><ul><ul><li>Diagnosis FNA (20% follicular nodules are cancer) </li></ul></ul><ul><ul><li>Prognosis worse with: age over 50, larger, disorganized tumor, vascular invasion, outside thyroid </li></ul></ul><ul><ul><li>Mortality 15% at 10 years, continues to rise </li></ul></ul><ul><ul><li>The Bad </li></ul></ul>
  14. 14. Thyroid Diseases <ul><li>Medullary Thyroid Cancer </li></ul><ul><ul><li>Uncommon </li></ul></ul><ul><ul><li>Can run in families </li></ul></ul><ul><ul><li>Good cure rate </li></ul></ul><ul><ul><li>Intermediate </li></ul></ul>
  15. 15. Thyroid Diseases <ul><li>Anaplastic Thyroid Carcinoma </li></ul><ul><ul><li>Rare (1% of thyroid cancers) </li></ul></ul><ul><ul><li>Few survive 6 mos </li></ul></ul><ul><ul><li>Age 60-70+ </li></ul></ul><ul><ul><li>Fast growing </li></ul></ul><ul><ul><li>The Ugly </li></ul></ul>
  16. 16. Parathyroid <ul><li>Four glands </li></ul><ul><li>Next to thyroid </li></ul><ul><li>Not related to thyroid </li></ul><ul><li>Control calcium levels in blood </li></ul>
  17. 17. Parathyroid
  18. 18. Parathyroid <ul><li>Hyperparathyroidism </li></ul><ul><ul><li>Overactive parathyroid(s) </li></ul></ul><ul><ul><li>Incidence 1/700 </li></ul></ul><ul><ul><li>3:1 F:M </li></ul></ul><ul><ul><li>Up to 3% of post-menopausal women </li></ul></ul><ul><ul><li>Elevated calcium found on routine blood tests </li></ul></ul>
  19. 19. Parathyroid <ul><li>Hyperparathyroidism Symptoms </li></ul><ul><ul><li>“Bones, stones, groans, psychic overtones” </li></ul></ul><ul><ul><li>Osteoporosis, bone pain </li></ul></ul><ul><ul><li>Kidney stones </li></ul></ul><ul><ul><li>Ulcers, constipation, abdominal pain </li></ul></ul><ul><ul><li>Fatigue, depression, forgetfulness, weakness </li></ul></ul>
  20. 20. Parathyroid <ul><li>Hyperparathyroidism </li></ul><ul><ul><li>Usually one overactive gland </li></ul></ul>
  21. 21. Parathyroid <ul><li>Hyperparathyroidism diagnosis </li></ul><ul><ul><li>High calcium </li></ul></ul><ul><ul><li>High parathyroid hormone </li></ul></ul><ul><ul><li>Rare familial disorders </li></ul></ul><ul><ul><li>Can be a complication of kidney disease </li></ul></ul>
  22. 22. Parathyroid <ul><li>Hyperparathyroidism Treatment </li></ul><ul><ul><li>Surgery </li></ul></ul>
  23. 23. Parathyroid <ul><li>Hyperparathyroidism Treatment </li></ul>
  24. 24. Parathyroid <ul><li>Hyperparathyroidism Treatment </li></ul><ul><ul><li>Radio-guided minimal access surgery </li></ul></ul>
  25. 25. Parathyroid <ul><li>Hypoparathyroidism </li></ul><ul><ul><li>Rare </li></ul></ul><ul><ul><li>Usually post thyroid surgery </li></ul></ul><ul><ul><li>Occasionally genetic </li></ul></ul>
  26. 26. Questions? <ul><li>Carson Agee, MD, FACS </li></ul>

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