Dr. Surendra K. Varma, MD

One kind of parathyroid surgery is called bilateral neck exploration. The surgeon finds and looks at all of the parathyroid glands on both sides of the neck, visually identifying any that are diseased and removing them. Minimally invasive, or focused, parathyroidectomy is done to remove a single diseased gland. The gland causing problems is identified before surgery using localization techniques such as hormonal or radiology testing. Since in most cases only one gland is causing problems, focused parathyroidectomy is a common alternative to bilateral neck exploration. Both procedures are safe and effective.

In the rare case that all four glands are diseased, the surgeon will either remove three and a half glands and leave one half in place, or all four will be removed and part of one gland will be transplanted into the forearm. This is done to keep calcium levels where they should be.

After surgery, patients will have a bandage on their neck and a sore throat. Patients may only want liquids or very soft food for the first day, and thy may be asked to take calcium supplements for a while until their remaining parathyroid glands begin functioning well again. Recovery is fairly quick, and within a few days patients should be feeling like themselves again.

Despite the name, not everyone with polycystic ovarian syndrome develops cysts on their ovaries. It is also possible to have ovarian cysts without having PCOS. The symptoms of polycystic ovarian syndrome are actually related to insulin resistance, a condition where the insulin made by the body is not effectively recognized by the cells. This causes the pancreas to release higher levels of insulin in order to keep blood sugar levels stable, and the excess insulin interferes with hormone production in the pituitary and ovaries, causing the PCOS symptoms.

The symptoms of PCOS include:

• Weight gain
• Acne
• Facial or body hair
• Thinning head hair
• Missing or irregular periods
• Infertility

PCOS is a syndrome, which means that if patients have PCOS, they might not have each and every symptom. Even a few of them might be enough to have physicians check for polycystic ovarian syndrome. A doctor might perform an exam and order blood tests to measure hormone levels.

Treatment for PCOS may include:

• Insulin sensitizers, which help the body use insulin more effectively, lowering hormone levels. The most commonly used insulin sensitizer is metformin.
• Weight loss. Being overweight does not cause PCOS, and PCOS can make losing weight difficult. Still, weight loss can improve symptoms for many women.
• Birth control pills to regulate menstruation and sometimes reduce symptoms such as acne.
• Fertility medications, especially medications to stimulate ovulation such as clomiphene.
• Anti-androgen medications, which work to treat symptoms such as acne and facial hair.
• Low-carb diets, which work similarly to insulin sensitizers to lower hormone levels and help reduce weight.
• Ovarian drilling or resectioning, surgical procedures sometimes performed if infertility is a persistent problem. These procedures open up the wall of the ovary to temporarily make ovulation more likely.

Polycystic ovarian syndrome is one of the most common endocrine disorders affecting women. Left untreated, it can increase the risk of diabetes, heart disease, and certain cancers. Fortunately there are many good treatment options available.

Hashimoto's is the leading cause of hypothyroidism, which is when the thyroid does not produce enough hormones to stimulate adequate metabolism. The condition is diagnosed by blood tests that measure TSH (thyroid stimulating hormone) and detect Hashimoto's antibodies. Symptoms of hypothyroidism include sluggish metabolism, inflammation, fatigue, weight gain, brittle hair, dry skin, and sensitivity to cold. To supplement impaired thyroid function, patients with Hashimoto's are typically prescribed synthetic thyroid hormone pills. Such patients may need to consume synthetic thyroids for the rest of their lives. Other treatments may include dietary changes, such as the avoidance of certain foods and medication to reduce inflammation. Frequent blood tests can inform patients if their TSH levels are within a normal range.

Grave's disease is most frequently the cause of hyperthyroidism, which is when the thyroid produces too many hormones, overstimulating one's metabolism. The condition is also diagnosed by blood tests that measure TSH and detect Grave's antibodies. Elevated heart rate, high blood pressure, sweating, bulging eyes, and weight loss are common symptoms of hyperthyroidism. Treatments for hyperthyroidism include oral radioactive iodine, which slowly shrinks the thyroid, slowing the production of excess thyroid hormone. Other anti-thyroid medications such as methimazole (Tapazole) also reduce the production of thyroid hormones. Blood pressure medications known as beta blockers can ease the increased heart rate caused by hyperthyroidism. If treatments are unsuccessful, patients may be prescribed a thyroidectomy, or surgery to remove part or all of the thyroid. Some patients with hyperthyroidism may require ophthalmological (eye medicine) treatments such as eye drops, prednisone, and surgery to reduce eye swelling and bulging.

Untreated thyroid disorders frequently lead to goiters or thyroid nodules. A thyroid goiter is a large lump that can be felt near the base of the neck and is made of swollen thyroid tissue or nodules (excess cell growth). Nodules and goiters are diagnosed by CT scan or ultrasound. Obstructive goiters can cause pain, coughing, and abnormal breathing. The most common cause of goiters is hyperthyroidism (overactive thyroid). However, Hashimoto's is also known to cause goiters or nodules. Goiters develop from continued damage from antibodies to the thyroid over time. At times, a goiter can result from a cancerous thyroid tumor. Most goiters and nodules are themselves benign.

The exact causes of thyroid cancer are unknown. People who develop thyroid cancer may or may not have another thyroid problem such as Hashimoto's or Grave's disease. Symptoms of thyroid cancer include a nodule that can be felt on the neck, hoarseness, difficulty swallowing, swelling in the neck, and neck and throat pain. CT and MRI scans are used to diagnose thyroid cancer. There are four types of thyroid cancer which vary in intensity. Thyroidectomy (thyroid removal surgery) is usually prescribed to treat thyroid cancer.

Thyroid problems are often long-term conditions that require some form of treatment. With regular monitoring and medication, many people with thyroid problems are able to lead active and fulfilling lives.