Thyroid gland surgery
and parathyroid gland surgery
Professor José SANTINI (MD-PhD)
Thyroid and Head and Neck Surgery Unit, Saint George Hospital, Nice, France
Corresponding Member of the American Thyroid Association
Langue / Language
Francais FR / English EN
Patient information website on the surgery of thyroid and parathyroid glands
Updated April 4, 2024
Hyperthyroidism
Hyperthyroidism (there are in fact different hyperthyroidisms) is a disease caused by an excess of thyroid hormones significantly disrupting the functioning of the body and more particularly of certain organs (the heart, the muscles, etc.).
Hyperthyroidism is much more common in women and often occurs in a family context of thyroid disease.
Common symptoms include: general fatigue, weight loss, nervousness, excessive sweating, tremors, diarrhea, palpitations and muscle fatigue.
Some patients experience ocular signs with abnormal eye protrusion (exophthalmos), eye redness, and eyelid swelling.
Graves' disease is the main cause of hyperthyroidism. It affects women more often than men and it frequently has a genetic component. Graves' disease is an autoimmune disease with the presence in the blood of thyroid-stimulating antibodies (anti-TSH receptor antibodies or TRAK) which will lead to excessive and uncontrolled production of thyroid hormones.
The proposed treatments consist of blocking hormone production with antithyroid drugs or destroying the cells using radioactive iodine or surgically removing the thyroid (total thyroidectomy).
Other causes of hyperthyroidism are: certain multinodular goiters, certain nodules called hot nodules or even inflammation of the gland (thyroiditis).
The treatments of the different hyperthyroidism depends on its cause;
1 - Diagnosis hyperthyroidism is evoked on clinical symptoms (palpitations, nervousness, sweating, weight loss, fatigue). This diagnosis suspected on clinical signs will be confirmed by a blood test which shows the collapse of TSH and a elevated peripheral thyroid hormones
(T3 and T4L).
2 - The causes
If the diagnosis of hyperthyroidism is confirmed by the blood test , the cause will need to be investigated. the 3 most common are:
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- Graves' disease , autoimmune disease with the presence in the blood of antibodies directed against the thyroid (anti-TSH receptor autoantibodies). We can find a clinical goiter (large thyroid palpable and sometimes visible at the base of the neck and inconsistently a protrusion of the eyes (exophthalmos). It most often affects women between 20 andt 40 years old. It is often familial and can be associated with other autoimmune diseases.
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- Toxic multinodular goiter linked to the presence of functional nodules which produce thyroid hormones autonomously (and not in response to TSH stimulation). We often find in the same gland the association of functional nodules (hot nodules) and non-functional nodules (cold nodules). The assessment of nodules developed in a goiter is the same as that of isolated nodules.
- The hot nodule or toxic nodule due to hypersecretion of hormones by a nodule which functions autonomously. Hot nodules are very rarely cancerous.
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Hot nodules and multinodular goiters represent the main cause of hyperthyroidism after age 55.
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3 -Treatments hyperthyroidism There are 3 of them:
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-Taking medications that will block the production of hormones by the gland; these medications are called synthetic anti-thyroid drugs (Neomercazole, Thyrozol, Propylex); they are effective but their use requires rigorous monitoring of blood counts and liver functions; This monitoring is carried out by a specialist endocrinologist and the duration of this treatment is usually 18 months. It is not recommended for pregnant women.
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-Administration of a dose of radioactive iodine which allows hyperthyroidism to be controlled in approximately 70% of patients; it is contraindicated in pregnant women, in cases of large goiter, or if there is a suspicion of associated cancer; it exposes you to the risk of post-therapeutic hypothyroidism.
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-Surgery (partial or total thyroidectomy) is a radical treatment; she preferably indicated in young subjects, in cases of goiter, in the presence of nodules at risk of cancer, if the drugs are poorly tolerated.
In the event of total thyroidectomy (Graves' disease and multinodular goiter), hormone replacement therapy of the thyroid gland will be necessary and for life. In the event of a functional nodule ("hot" nodule), conservative treatment of the normal tissue is carried out, which will most often allow it to heal without treatment.
