Thyroid and Parathyroid Disease

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