As part of his comprehensive General Surgical practice Dr. Smith has developed one of the largest surgical practices involving diseases of the parathyroid and thyroid glands in this area of the country. The thyroid is a butterfly-shaped gland in the front portion of the neck that acts as the body's thermostat. As the body's thermostat, it influences all bodily functions.

Surgical diseases of the thyroid gland can typically be divided into two categories those that are benign and those that are malignant.

Dr. Smith performs between 80 and 100 thyroid procedures each year and works very closely with many of the endocrinologist in this area of the country. One of the most important criteria of thyroid surgery is to be in the hands of an experienced surgeon who has a long and proven track record of doing this type of tedious and very exacting surgery.

Benign diseases of the thyroid that would require surgical intervention would be;

Non-Toxic Multi-Nodular Goiters,

Toxic Multi-Nodular Goiters,

and Nodules of the thyroid.

Malignant surgical diseases of the thyroid gland represent the most common of all endocrine malignancies.

Approximately 2% of all human cancers are associated with thyroid carcinomas. Approximately 21 to 23 thousand cases of thyroid cancer are reported each year in the United States.  Thankfully, only about 6% of these newly diagnosed cases will die as a result of their carcinoma. Most patients diagnosed with thyroid carcinoma are either cured of their cancer, or can live for many years with their disease held in check and will eventually die from other causes. In general, there are five recognized types of thyroid carcinoma. The least aggressive to the most aggressive forms of cancer are as listed:

Papillary Carcinoma,  

Follicular Carcinoma,  

Hurthle Cell Carcinoma,  

Medullary Carcinoma,  

Anaplastic or Undifferentiated Carcinoma.

Benign diseases of the thyroid:

Non-Toxic Multi-Nodular Goiters

These are benign enlargements of the thyroid that are associated with either normal or low thyroid function. Surgical resection is required because of “compression symptoms” that make it difficult for the patient to breathe or swallow their food.  [back]

Toxic Multi-Nodular Goiters

These are enlargements of the thyroid associated with over production of thyroid hormone. Some of these patients can successfully be treated with radio active iodine therapy and or thyroid suppressing medications such as PTU or Tapazole. It is always vitally important that the toxic goiter be “cooled down” prior to any surgical intervention so as to avoid intra operative “thyroid storm”.   [back]

Nodules of the thyroid

Solitary or multiple growths involving part of the thyroid lobe sometimes require removal to guarantee that they are not malignant and also because they continue to rapidly enlarge and may eventually cause “compression symptoms”. Some of the more common benign nodules of the thyroid gland are; follicular adenomas, colloid adenomas, benign hurthle cell tumors, and the most common benign adenomatous nodule.   [back] 

Malignant surgical diseases of the thyroid gland:

Papillary Carcinoma

Papillary carcinoma is responsible for 78% of all thyroid malignancies. It is not only the most common malignancy but also the least aggressive. Its spread is usually limited to local disease occurring in the lymph nodes of the neck and it very rarely metastases to other areas of the body. Surgical resection followed by administration of radio-active iodine almost always results in either cure or long time disease free intervals of life.   [back] [top]

Follicular Carcinoma

Follicular carcinoma represents approximately 14% of all thyroid malignancies. There is a higher incidence of follicular thyroid cancer in older females and in patients with a low iodine intake. Most follicular carcinomas present as a solitary nodule and do not have the high rate of cervical lymph node involvement that is found in papillary carcinoma. Follicular carcinoma, on the other hand, has a much higher rate of metastatic disease than does papillary carcinoma. Some patients with follicular carcinoma may present with bony metastases as their initial presenting symptom. Poor prognostic factors associated with follicular carcinoma would include an age more than 50 years old, a tumor larger than 4cms in diameter and distant metastases. Treatment of follicular carcinoma again requires total thyroidectomy with follow up radio active iodine administration. Distant metastases may be treated with radiation therapy or if possible with surgical resection.   [back] [top]

 Hurthle Cell Carcinoma

Hurthle cell carcinoma compromises approximately 3% of all thyroid malignancies. Again total thyroidectomy followed by radio-active iodine administration is the treatment of choice. The size of the Hurthle cell tumor directly affects the possibility of the tumor becoming malignant. Hurthle cell tumors over 5cms in diameter have a much greater incidence of being malignant than those tumors less than 5cm in diameter. Lymph node metastasis from this tumor does not occur as readily as it does in papillary carcinoma but slightly more readily than it does in follicular carcinoma. Hurthle cell carcinoma can be associated with distant metastasis.   [back] [top]

Medullary Carcinoma

Medullary carcinoma of the thyroid comprises approximately 3% of almost all thyroid malignancies. Typically patients will present with a solitary thyroid nodule and metastases to cervical lymph nodes are often present at the time of diagnosis. Medullary carcinoma will also be associated with an increased level of calcitonin in the blood stream. Medullary thyroid carcinoma may also be part of the multiple endocrine neoplasia type 2 syndromes. (EN-2) In this syndrome medullary carcinoma is associated with pheochromocytoma of the adrenal gland and primary hyperparathyroidism of the parathyroid glands. Again surgical resection with total thyroidectomy and complete central cervical lymph node dissection is the treatment of choice.   [back] [top]

Anaplastic or Undifferentiated Carcinoma

 Anaplastic or undifferentiated carcinoma is a deadly disease of the thyroid gland that usually results in less than one year of survival after it has been diagnosed. Most of the time the tumor is densely adherent to surrounding structures and is not able to be surgically resected. The patient usually presents with a rapidly enlarging rock hard mass in the neck that can frequently involve both the trachea and esophageal tissues. Although the outlook of Anaplastic carcinoma is very grim, thyroid lymphoma has a much brighter outlook. One must be careful that the diagnosis of thyroid lymphoma is not interpreted as Anaplastic carcinoma. Thyroid lymphoma can be cured with total thyroidectomy and external beam radiation if the disease is limited to the neck. Often times, needle biopsy is not adequate enough for this differentiation to be made and open biopsy is indicated.   [back]  [top]                      

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