At Keck Medicine of USC, we are dedicated to treating patients with cancerous and non-cancerous thyroid and parathyroid disorders. Our experienced surgeons collaborate with a multidisciplinary team of endocrinologists, radiologists, geneticists and pathologists to determine the best treatment for your individual needs.
The thyroid is a butterfly-shaped gland in the central part of your neck that produces hormones that control metabolism — how your body uses energy. At times, it may produce too little hormone or too much hormone, or it may develop nodules and cancer.
The parathyroids are four pea-sized glands that are found next to the thyroid and produce parathyroid hormone, which controls your body’s calcium. The parathyroids should maintain a balance of normal calcium levels, but occasionally one or more of the glands can become overactive, resulting in elevated calcium.
Thyroid and parathyroid conditions our surgeons treat include:
- Graves’ disease
- Inherited endocrine syndromes (such as multiple endocrine neoplasia type 1 or type 2)
- Parathyroid cancer
- Thyroid cancer
Treatment modalities we offer include:
- Parathyroidectomy, including minimally invasive techniques and re-operative surgery
- Intraoperative parathyroid hormone monitoring
- Fine needle aspiration of thyroid nodules, including molecular testing
- Thyroid lobectomy
- Total thyroidectomy
- Central and lateral neck dissection for thyroid cancer
Our experienced surgeons have trained specifically in thyroid and parathyroid surgery and are part of a team of providers who work together to develop a treatment plan that is tailored to you. We work with expert radiologists to locate parathyroid and thyroid abnormalities using ultrasound, CT imaging and nuclear medicine imaging. Biopsies are reviewed closely with pathologists to determine if thyroid nodules may be observed or if surgery will be needed.
Our operating rooms are equipped with intraoperative parathyroid hormone monitoring, which is essential for minimally invasive parathyroid surgery. We collaborate closely with our endocrinologists for management of thyroid and parathyroid dysfunction as well as long-term treatment for thyroid cancer.
Our goal is to help coordinate your care as smoothly as possible. We navigate the management of thyroid and parathyroid disease with a treatment plan that addresses your individual needs.
What is a thyroid nodule?
A thyroid nodule is a growth within a thyroid gland. Thyroid nodules are very common: They occur in up to 70% of women over the age 60 and in 30%-40% of men. Nodules may be identified in several ways, including feeling or seeing a lump in your neck, by your physician on physical exam, or they may be found during other routine testing.
Once a thyroid nodule is identified, laboratory tests should be done to determine thyroid function (whether the thyroid is overactive or underactive). Thyroid nodules may affect thyroid function, although most often they do not. A thyroid ultrasound should be performed for a more thorough evaluation of the size and characteristics of a nodule. Based on the characteristics of the nodule, a biopsy may be recommended.
What is hyperthyroidism?
Hyperthyroidism is a condition in which the thyroid produces too much thyroid hormone. It may most commonly be caused by Graves’ disease, toxic adenoma (single overactive thyroid nodule) or toxic multinodular goiter (multiple overactive thyroid nodules). Diagnosis will include testing thyroid function, thyroid ultrasound and thyroid uptake scan.
Treatment for hyperthyroidism may include one, or a combination of, the following: medical therapy, surgery or radioactive iodine ablation.
What is Graves’ disease?
Graves’ disease is an autoimmune problem that results in the overproduction of thyroid hormones (hyperthyroidism). In addition to symptoms of hyperthyroidism, patients with Graves’ disease may develop eye bulging (Graves’ ophthalmopathy). Hyperthyroidism can be treated with medical therapy, surgery or radioactive iodine ablation, but for patients with significant ophthalmopathy, surgery may be the best option.
What is thyroid cancer?
Thyroid cancer is a malignant growth within the thyroid. The most common type (80%) is papillary thyroid cancer, which has an excellent cure rate. Other types include the next most common follicular thyroid cancer, then medullary and, rarely, anaplastic thyroid cancer. Thyroid cancer is most commonly treated with surgery, which may involve removal the thyroid gland (sometimes only half) and, if necessary, surrounding lymph nodes.
What is a goiter?
A goiter is a benign (noncancerous) enlargement of the thyroid gland that may cause breathing and swallowing difficulty. These may be surgically removed for symptoms.
What is hyperparathyroidism?
Hyperparathyroidism is an overproduction of parathyroid hormone (PTH) from one or more parathyroid glands. This causes elevated calcium levels (hypercalcemia), which can only be cured with surgery. Specialized imaging is used to identify abnormal parathyroid glands and to check PTH levels during surgery to ensure that all abnormal parathyroid tissue has been removed.
What are inherited endocrine syndromes?
Certain syndromes may be associated with endocrine abnormalities that require surgery. Multiple endocrine neoplasia 1 is strongly associated with hyperparathyroidism as well as other pituitary and pancreatic tumors. Multiple endocrine neoplasia 2 is associated with medullary thyroid cancer and hyperparathyroidism as well as adrenal tumors. Genetic testing may be beneficial for patients with a known family history of endocrine syndromes, patients who have been diagnosed at a young age or patients who have associated conditions. Treatment involves a multidisciplinary approach.
What is parathyroid cancer?
Parathyroid cancer is a rare cancer, accounting for less than 1% of cases of primary hyperparathyroidism. Patients usually have very high calcium levels. Treatment is removal of the parathyroid cancer, adjacent thyroid lobe and any other involved tissue or lymph nodes.
What is a fine needle aspiration (FNA) biopsy?
FNA biopsy may be used to evaluate thyroid nodules. A small needle, which is smaller than the type of needle usually used for a blood draw, is guided using ultrasound into the nodule to take a small sample of cells. The cells are then examined by a cytopathologist. FNA biopsy may be performed in a surgeon’s office or in radiology.
What does my FNA biopsy result mean?
An FNA biopsy may provide several different results, including:
- Nondiagnostic – This means there were not enough cells in the sample to give a diagnosis; a repeat biopsy will likely be recommended.
- Benign – This means no abnormal cells were identified, and the overall risk of cancer is less than 5%.
- Indeterminate – This may include atypia of undetermined significance and follicular neoplasm. Neoplasm refers to an abnormal growth that may be benign or cancer. These abnormal growths may increase your risk of cancer by 5%-30%. Surgery or additional testing may be recommended.
- Malignancy/cancer – Papillary thyroid cancer is the most common result, but this result may include other types of thyroid cancer.
- Treatment is surgical removal of part or all of the thyroid and possibly the surrounding lymph nodes. Additional treatment such as radioactive iodine may also be recommended. Occasionally, the biopsy results will include “suspicious for cancer,” which is associated with a 50%-80% risk of being cancerous.