thyroid cancer treatment - salem oregonThree of our surgeons specialize in surgery of the thyroid and parathyroid glands. Their five years of postgraduate training concentrated specifically on disorders of the head and neck, including these glands.

Specialized anatomic training, as well as the frequent surgical treatment of many diseases involving the neck, makes these Otolaryngologists especially qualified to perform minimally invasive, outpatient surgeries on the parathyroid and thyroid glands.

Both benign and malignant conditions can be diagnosed and treated, whether limited to these glands or involving adjacent lymph nodes or other structures in the neck.

During your consultation, your surgeon will carefully examine your neck and thyroid gland. The surgeon will view your larynx and vocal cords, looking for any evidence of early weakness that sometimes results from thyroid disease. We offer on-site thyroid ultrasound to allow detailed imaging of your thyroid gland and/or parathyroid glands.

If a suspicious lump is seen, ultrasound-guided fine needle aspiration biopsy can help determine whether a lump can be safely observed or should be removed.

Ultrasound is the preferred method to image the thyroid because it does not use radiation, it is much cheaper than a CT or MRI scan, a “real time” discussion with the patient can be performed on whether to perform an ultrasound guided needle biopsy that very day. The pathology report on this biopsy will take a few business days.

We will cooperate closely with your primary care physician or endocrinologist to achieve the best possible outcome for you.

Thyroid Glands

The thyroid gland is a butterfly shaped endocrine gland in the lower front part of the neck over your voicebox/thyroid. It secretes hormones that are necessary for the proper functioning of nearly every tissue in your body. The gland has a right lobe connected to the left lobe by a thinner isthmus.

Thyroid Nodules

Thyroid nodules are very common; only 7-15 percent of them are cancerous. Experts estimate that 50 percent of women over 50 years of age will have a nodule larger than one cm. Most nodules smaller than two cm are found on neck imaging studies ordered for other reasons, such as neck pain/arthritis or carotid artery atherosclerosis. Your doctor may order a fine needle biopsy (FNB) to determine if the nodules are benign or malignant. Willamette Ear, Nose, Throat and Facial Plastic Surgery has been performing ultrasounds guided FNB for almost two decades.

Thyroid Cysts

Some thyroid cysts are large enough to be noticeable on your neck. Some of these large cysts can cause discomfort with swallowing or turning one’s neck side to side. Our doctors can withdraw the fluid from your cyst and install a small amount of ethanol to gradually shrink the cyst to be less noticeable.

Thyroid Cancer

There are approximately 64,000 new cases of thyroid carcinoma annually in America; less than 2000 patients die from this cancer per year. Most patients are either cured with surgery (with or without radioactive iodine) or live with small amount cancer in their neck lymph nodes. Newer chemotherapy agents can treat advanced disease.

Papillary carcinoma account for 70-80 percent of all thyroid cancers. This type of cancer grows slowly and often spreads to the neck lymph nodes. The survival rate of papillary carcinoma is more than 90 percent.

Follicular carcinoma accounts for 10-15 percent of all thyroid cancers. It sometimes spreads to lungs and bones.

Medullary thyroid carcinoma accounts for only two percent of all carcinomas. 25 percent of these carcinomas run in families

Anaplastic thyroid carcinomas account for one to two percent of all thyroid carcinomas. They grow very quickly and are difficult to treat.

Surgery

The thyroid gland has a robust supply of blood and it is not feasible to remove just a nodule. Surgery will almost always require the removal of one lobe, called a partial thyroidectomy or lobectomy, or both lobes, called a total/complete thyroidectomy.

Your surgeon will make a horizontal incision in the lower neck. They will separate the muscles involved in swallowing, find the nerve to your voicebox and separate your parathyroid glands from the thyroid.

Sometimes your neck lymph nodes must also be removed through a neck dissection. A paratracheal involves removing the nodes near the trachea/windpipe. A lateral neck involves removing the nodes on the side of neck, near the internal jugular vein.

Most thyroidectomies are done as an outpatient procedure. Patients with lateral neck dissections will typically require an overnight stay in the hospital.

Parathyroid Glands

There are four small glands on the back/posterior side of the thyroid gland. The parathyroid glands control the calcium level in your blood stream by secreting parathyroid hormone (PTH). PTH causes your body to absorb calcium from your small intestine, absorb calcium from your urine and steal calcium from your bones. Sometimes one or more parathyroid glands are overactive and secrete excessive levels of PTH. This leads to kidney stones, thinning of your bones (osteoporosis) with a higher risk of bone fracture, unexplained muscle aches and declines in cognition and memory.

Hyperparathyroidism

Hyperparathyroidism is the excessive secretion of PTH despite adequate or high blood calcium levels. Most cases are caused by a single enlarged gland. In the past, a surgeon would have to dissect both sides of your neck to localize the enlarged gland. These surgeries could take more than three hours and put both nerves to your voicebox at risk for injury. Surgeons are now able to localize the enlarged gland to one side (left or right) with preoperative imaging studies, including: high resolution ultrasound (no radiation involved, relatively inexpensive), nuclear medicine parathyroid scans and CT scans of your neck.

If the studies localize the enlarged gland to one side, the surgeon can perform a minimally invasive or focused parathyroidectomy. This has the advantage of a smaller incision, a shorter surgery and exposing only one voicebox nerve to possible injury. The surgeons at Willamette Ear, Nose, Throat and Facial Plastic Surgery have been performing minimally invasive parathyroidectomies for almost two decades.