Surgical Options

Thyroidectomy

Thyroidectomy is surgical removal of part or all of the thyroid gland. A thyroid lobectomy is removal of half of the thyroid gland. Doctors may recommend thyroidectomy for patients that have goiters, thyroid nodules, hyperthyroidism, or thyroid cancer. A standard thyroidectomy is a good option for patients that have large goiters, nodules, or thyroid cancer. Dr. Brady makes safe and effective thyroid surgery a priority. While performing thyroid surgery, the laryngeal nerves, parathyroid glands, and vessels must be protected and preserved. Her expertise and ten year experience in practice guarantees that the chance of complications is minimized. Drains are not typically used for these cases.

Minimally Invasive Video Assisted Thyroidectomy

Minimally Invasive Video Assisted Thyroidectomy (MIVAT) or endoscopic thyroidectomy uses a high definition camera in surgery through a very small incision. It is an excellent choice for patients with small thyroid cancers or nodules. This type of surgery enables thyroidectomy through smaller incisions while being safe and effective allowing for faster recovery and less discomfort for patients.

Minimally Invasive Thyroidectomy

Minimally invasive thyroidectomy is thyroid surgery performed through an incision that is 1.5 inches or less. Patients typically have less pain and recover faster than traditional thyroidectomy incisions. Most patients can be sent home several hours after surgery, avoiding an overnight stay in the hospital.

Re-operative Thyroidectomy

Re-operative thyroidectomy is typically performed on patients with recurrent thyroid cancer or thyroid goiters. When thyroid cancer comes back after treatment, re-operative surgery to remove new disease can be required. Scar tissue is a normal response to any trauma from previous surgery, which increases the risks of a second thyroid surgery. Since re-operative surgery is more difficult, these types of cases are best performed by surgeons, such as Dr. Brady with specialized training and years of experience.

Neck Dissections for Thyroid Cancer

A neck dissection for thyroid cancer is a surgery that includes removal of lymph nodes involved in thyroid cancer. Typically, these nodes are found on thyroid ultrasound and biopsied by FNA (fine needle aspiration) if suspicious to prove whether or not they are cancerous. There are two main types of lymph node dissections for thyroid cancer as described below:

Central Neck Dissection

The central neck dissection involves removing lymph nodes closest to the thyroid gland. Dr. Brady performs this surgery on EVERY patient diagnosed with thyroid cancer. It is the removal of lymph nodes in the region of the voice box and the windpipe down to the upper part of the chest cavity. This surgery is also called a level VI (six) lymph node dissection. Once the pathologist examines the lymph nodes for cancer, we use this information to help in deciding if a patient needs radioactive iodine treatment.

Lateral Neck Dissection

A lateral neck dissection is removal of lymph nodes on the side of the neck. The lymph nodes of the neck are divided into levels and named by roman numerals (Levels I-VI). This surgery is removal of levels II, III, IV, and V. There are many nerves in the neck that are at risk for injury during this type of surgery and this type of surgery is only recommended if thyroid cancer has been proven to be in these lymph nodes. Proof of lymph node involvement is confirmed with a biopsy using neck ultrasound.

As with any surgery, there are risks involved with the lateral neck dissection. In the hands of an experienced surgeon, these risks are low. The nerves that are at risk for a lateral neck dissection include the recurrent laryngeal nerve, the phrenic nerve, the spinal accessory nerve and cervical nerves. The recurrent laryngeal nerve, a branch of the vagus nerve, innervates the vocal cord and injury can affect the voice. The phrenic nerve controls breathing by innervating the diaphragm and injury can to it can cause breathing problems. The spinal accessory nerve controls the trapezius muscle and helps with shoulder movement. Injury to it can cause shoulder weakness. The cutaneous cervical nerves that innervate the skin in this region are at risk and if injured cause numbness. Large blood vessels that are also at risk include the carotid artery and the internal jugular vein. The thoracic duct that drains lymphatics is also at risk during this type of surgery and injury can require drainage.

Parathyroidectomy

Parathyroidectomy is removal or one or more of the parathyroid glands, which lie behind the thyroid gland. Patients may need parathyroid surgery for primary, secondary, or tertiary hyperparathyroidism. A standard parathyroid exploration involves identification of all four parathyroid glands. During this procedure, only abnormal glands should be removed while protecting the laryngeal nerves. It is essential to preserve normal glands for future calcium metabolism. Drains or clips are not used for this type of surgery.

Minimally Invasive Parathyroidectomy (MIP)

Minimally invasive parathyroidectomy is a focused parathyroid operation through a very small incision, typically less than 1 inch. This operation is less painful and performed on an outpatient basis with a shorter recovery period. While in the operation, blood tests for parathyroid hormone are utilized to ensure adequate surgery. After parathyroid surgery, patients often feel more energetic and less tired.

Minimally Invasive Radioguided Parathyroidectomy (MIRP)

Minimally Invasive Radioguided Parathyroidectomy (MIRP) involves an injection with a radioactive substance called sestamibi (radioisotope technetium-99m) by the radiology department before surgery. The sestamibi tracer will be taken up quickly by the thyroid and parathyroid glands. Over time, the thyroid loses or clears the tracer before the parathyroid glands. If a patient has an enlarged parathyroid gland, it will hold onto the sestamibi even longer and therefore can be picked up by a probe in the operating room. Once the enlarged parathyroid is removed, Dr. Brady can get a count (or level) of radioactivity compared to background tissue. It can help thyroid surgeons detect locations of parathyroid lesions that may be hard to find. For example, if a patient requires a reoperation for a failed parathyroid surgery or if the parathyroid gland is found to be ectopic (not in its normal anatomic location), this type of procedure is extremely helpful. Dr. Brady, who specializes in thyroid and parathyroid operations, uses this type of injection selectively as it is may not be needed in straightforward cases where the adenoma is seen well on parathyroid scan prior to surgery. It can carry an added cost to the patient and their procedure.

Minimally Invasive Video Assisted Parathyroidectomy

Minimally Invasive Video Assisted parathyroidectomy or endoscopic parathyroidectomy uses a high definition camera in surgery through a very small incision, usually less than 1 inch placed in a natural skin crease on the neck. It is an excellent choice for patients with primary hyperparathyroidism. This type of surgery enables parathyroid removal through smaller incisions while being safe and effective allowing for faster recovery and less discomfort for patients. During her fellowship, Dr. Brady worked alongside the french endocrine surgeon that first described and popularized this technique.

Re-operative Parathyroidectomy

Re-operative parathyroidectomy is when a second surgery is needed in patients that have had parathyroid surgery in the past. These patients might have their hyperparathyroidism recur or experience persistent hyperparathyroidism wherein the first surgery did not result in a cure of their disease. It is a challenging operation that should only be performed by experienced surgeons with specialized training. Risk of complications are higher in this type of surgery and therefore require localization tests to properly identify the abnormal parathyroid gland. Dr. Brady has been performing these types of operations for years in her practice and always uses the nerve monitoring device to ensure the safety of the recurrent laryngeal nerve.

Laproscopic Adrenalectomy

Laproscopic Adrenalectomy is a surgery in which a few small incisions, less than 1 inch are made on the abdomen through which long graspers and the aid of carbon dioxide are used to remove the adrenal gland while the patient is under general anesthesia. It is considered minimally invasive surgery and patients experience very little discomfort. After laproscopic adrenal surgery, patients typically are observed in the hospital for 24 hours and return to work in 7-10 days.