Transcript
Thyroid and Thyroid and Parathyroid DiseaseParathyroid Disease
Carson Agee, MD, FACSCarson Agee, MD, FACSGeneral SurgeonGeneral SurgeonBJC Medical GroupBJC Medical GroupProgress West Healthcare CenterProgress West Healthcare Center
Thyroid GlandThyroid Gland
Thyroid AnatomyThyroid Anatomy
Thyroid AnatomyThyroid Anatomy
Thyroid Scar 2 WeeksThyroid Scar 2 Weeks
Thyroid Scar 3 MonthsThyroid Scar 3 Months
Thyroid DiseasesThyroid Diseases
Graves’ Disease Graves’ Disease – ExophthalmosExophthalmos
Thyroid DiseasesThyroid Diseases
Thyroid NodulesThyroid Nodules– Cancer or not cancer that is the Cancer or not cancer that is the
questionquestion– 15% of solitary nodules are cancer15% of solitary nodules are cancer– Multiple nodules less likely to have Multiple nodules less likely to have
cancer (less than 5%)cancer (less than 5%)
Thyroid DiseasesThyroid Diseases
Thyroid NodulesThyroid Nodules– Risk factors for cancerRisk factors for cancer
Radiation exposureRadiation exposure Family historyFamily history Younger or olderYounger or older Rapid growthRapid growth Voice changesVoice changes
Thyroid DiseasesThyroid Diseases
Thyroid NodulesThyroid Nodules– DiagnosisDiagnosis
Fine Needle Aspiration (FNA)Fine Needle Aspiration (FNA) UltrasoundUltrasound Thyroid scan (less common)Thyroid scan (less common)
Thyroid DiseasesThyroid Diseases
Thyroid CancerThyroid Cancer– 40/1,000,000 per year incidence40/1,000,000 per year incidence– Fewer than 10% of patients die of Fewer than 10% of patients die of
their thyroid cancer their thyroid cancer – The Good, The Bad and The Ugly!The Good, The Bad and The Ugly!
Thyroid DiseasesThyroid Diseases
Papillary Thyroid CancerPapillary Thyroid Cancer– Most common (80%)Most common (80%)– 2:1 F:M2:1 F:M– Age 30-40Age 30-40– Mortality 0.5%Mortality 0.5%– Prognosis worse with: older (45), Prognosis worse with: older (45),
larger size, disorganized tumor, larger size, disorganized tumor, metastasesmetastases
– The GoodThe Good
Thyroid DiseasesThyroid Diseases
Follicular Thyroid CancerFollicular Thyroid Cancer– 3:1 F:M3:1 F:M– Age 50Age 50– Diagnosis FNA (20% follicular nodules are Diagnosis FNA (20% follicular nodules are
cancer)cancer)– Prognosis worse with: age over 50, larger, Prognosis worse with: age over 50, larger,
disorganized tumor, vascular invasion, disorganized tumor, vascular invasion, outside thyroidoutside thyroid
– Mortality 15% at 10 years, continues to Mortality 15% at 10 years, continues to riserise
– The BadThe Bad
Thyroid DiseasesThyroid Diseases
Medullary Thyroid CancerMedullary Thyroid Cancer– UncommonUncommon– Can run in familiesCan run in families– Good cure rateGood cure rate– Intermediate Intermediate
Thyroid DiseasesThyroid Diseases
Anaplastic Thyroid CarcinomaAnaplastic Thyroid Carcinoma– Rare (1% of thyroid cancers)Rare (1% of thyroid cancers)– Few survive 6 mosFew survive 6 mos– Age 60-70+Age 60-70+– Fast growingFast growing– The UglyThe Ugly
ParathyroidParathyroid
Four glandsFour glands Next to thyroidNext to thyroid Not related to thyroidNot related to thyroid Control calcium levels in bloodControl calcium levels in blood
ParathyroidParathyroid
ParathyroidParathyroid
HyperparathyroidismHyperparathyroidism– Overactive parathyroid(s)Overactive parathyroid(s)– Incidence 1/700Incidence 1/700– 3:1 F:M3:1 F:M– Up to 3% of post-menopausal Up to 3% of post-menopausal
womenwomen– Elevated calcium found on routine Elevated calcium found on routine
blood testsblood tests
ParathyroidParathyroid
Hyperparathyroidism SymptomsHyperparathyroidism Symptoms– ““Bones, stones, groans, psychic Bones, stones, groans, psychic
overtones”overtones”– Osteoporosis, bone painOsteoporosis, bone pain– Kidney stonesKidney stones– Ulcers, constipation, abdominal painUlcers, constipation, abdominal pain– Fatigue, depression, forgetfulness, Fatigue, depression, forgetfulness,
weaknessweakness
ParathyroidParathyroid
HyperparathyroidismHyperparathyroidism– Usually one overactive glandUsually one overactive gland
ParathyroidParathyroid
Hyperparathyroidism diagnosisHyperparathyroidism diagnosis– High calciumHigh calcium– High parathyroid hormoneHigh parathyroid hormone– Rare familial disordersRare familial disorders– Can be a complication of kidney Can be a complication of kidney
diseasedisease
ParathyroidParathyroid
Hyperparathyroidism TreatmentHyperparathyroidism Treatment– SurgerySurgery
ParathyroidParathyroid
Hyperparathyroidism TreatmentHyperparathyroidism Treatment
ParathyroidParathyroid
Hyperparathyroidism TreatmentHyperparathyroidism Treatment– Radio-guided minimal access Radio-guided minimal access
surgerysurgery
ParathyroidParathyroid
HypoparathyroidismHypoparathyroidism– RareRare– Usually post thyroid surgeryUsually post thyroid surgery– Occasionally geneticOccasionally genetic
Questions?Questions?
Carson Agee, MD, FACSCarson Agee, MD, FACS
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