Endocrine Organ Surgery
The endocrine system is composed of organs that produce special hormones to obtain homeostasis. Under the scope of general surgery, thyroid glands, parathyroid glands, and adrenal (suprarenal) glands are evaluated and treated. The surgical treatment of these organs may be either open surgery (thyroid, parathyroid) or closed surgery (laparoscopic - adrenal gland).
Thyroid Gland
The thyroid gland is a highly vascularized endocrine organ and is responsible for the production of thyroxin (T4) and triiodothyronine (T3) hormones. These hormones are vital for all cells and moreover, they determine metabolic (matter and energy transformation in the body) rate. Therefore, the functions of the thyroid gland may be affected in two ways. Underactive thyroid (hypothyroidism) causes low metabolic rate, which may lead to some conditions, such as constipation, somnolence, forgetfulness, edema on the legs or all body, unintentional weight gain, depression, and heart diseases. Overactive thyroid (hyperthyroidism) causes a high metabolic rate, which may lead to unintentional weight loss, sweating, nervousness, tremor in hands, and mood changes, and it may be linked to infertility or miscarriage. Normal thyroid hormone synthesis is known as euthyroidism.
Goiter is the enlargement of the thyroid gland, either partially or as a whole. Partial formation of nodes in the thyroid gland is known as nodular goiter whereas enlargement of the whole thyroid gland is known as diffuse goiter. Most goiters are benign and functional, goiter may be with hypothyroidism, euthyroidism, or hyperthyroidism.
Thyroid tumors may be either benign or malignant. The most common benign thyroid tumor is thyroid adenoma. In thyroid adenoma, one node is formed in the thyroid gland, and it synthesizes quite more thyroid hormone in comparison to the other parts of the thyroid gland. Therefore, the patients are usually present due to hyperthyroidism.
Malignant thyroid gland tumors may be classified as thyroid glands tumor or tumors that spread from other organs (metastasis). The most common thyroid gland tumor is papillary thyroid cancer (80%). The course of papillary thyroid cancer is relatively slow and in case of timely diagnosis and correct treatment, it is a benign disease. Follicular, Hurthle cell, medullary and anaplastic thyroid cancers are rare and more serious diseases, which require serious treatment and follow-up.
Surgical treatments for benign (nodular, nodular goiter, goiter associated with the production of an excessive amount of hormone) and malignant (thyroid tumors, cancer) diseases of the thyroid gland are as follows:
- Nodulectomy (removal of the diseased node) - a rare surgery that may be performed in special cases.
- Thyroid lobectomy (removal of one half of thyroid gland) - in cases of thyroid adenoma, and unilateral micropapillary thyroid carcinoma.
- Total (bilateral) thyroidectomy (removal of the entire thyroid gland) - in cases of papillary carcinoma, functional and non-functional goiter.
- Complementary thyroidectomy (removal of the residual thyroid gland, which was partially removed priorly, for various reasons).
- Other - Procedures known as neck dissection may be added to total thyroidectomy pursuant to lymph node involvement (central neck dissection, radical neck dissection).
Aside from General follow-up and care after the operation, definitely consult your physician in case of any symptoms that may occur for early diagnosis and treatment of these complications.
Parathyroid Glands
Parathyroid glands are 3 to 5 glands responsible for the synthesis of one of the hormones (parathyroid hormone - PTH) that regulate calcium metabolism. Hyperparathyroidism develops when the parathyroid glands create high amounts of parathyroid hormone. The reason for overproduction (parathyroid hyperplasia, adenoma) should be searched, and the necessary procedure may be chosen. Regardless of whether the parathyroid gland is functioning properly or not, surgery is inevitable for cases with parathyroid cancer.
Parathyroid gland surgery is performed in the following cases:
- Parathyroid gland hyperplasia
- Parathyroid gland adenoma
- Parathyroid gland cancer
Aside from General follow-up and care after the operation, symptoms of low calcium level - numbness and cramps on face and lips, hands, palpitation, and malaise, should be followed up carefully.
Adrenal Glands
Adrenal glands (suprarenal glands) are glands that are located over the kidneys in the abdomen and produce various hormones (cortisol, adrenalin, aldosterone, etc.). Active and inactive conditions for hormone release or tumors may be present.
Tumors releasing adrenaline (a hormone among catecholamines) are known as pheochromocytoma and they may be benign or malignant.
Tumors releasing cortisol are generally known as a cortical adenoma. They are specifically known as Cushing’s syndrome.
The specific name of the cortical adenoma that releases aldosterone is Conn's syndrome.
A significant amount of benign adrenal gland tumors is detected incidentally. If an adrenal gland tumor is detected during investigations performed for another reason, this tumor is known as an adrenal incidentaloma. Most of the time, they do not release hormones and are inactive. Surgery may be planned depending on its size and functioning status.
Of adrenal cancers, 40% are not active for hormone release. For active adrenal cancers, surgery may be performed after certain treatments for the regulation of hormone effects.
One of the options for adrenal gland pathology is surgery.
Laparoscopic adrenalectomy (removal of the adrenal gland) - usually unilateral.
Investigations and treatment regulations may be required before the surgery (since medications you are using, or other diseases may affect it).
Aside from general follow-up, you should be aware of a condition known as adrenal insufficiency after the surgery. Non-specific signs and symptoms, such as malaise, dizziness, loss of consciousness, and loss of appetite may be observed. Consult your doctor before the operation.