FHH
This is an interesting topic for anyone with parathyroid disease.
The interest in FHH comes from the fact that it is one of the causes of an elevated calcium level so should be considered by your doctor as part of the differential diagnosis.
The important point about it is that the parathyroid glands are normal... The elevated calcium of FHH does not for reasons that are unclear cause symptoms in the way that a similar level from parathyroid disease would. There is no cure for FHH and the elevated calcium is permanent and not in any way a problem.
If the diagnosis of FHH is missed and you end up having surgery nothing abnormal will found the surgery will achieve precisely nothing.
FHH is excluded by checking a 24 hour urine collection and measuring the amount of calcium excreted in the urine. This is a very important test.
FHH patients have a low level of urine calcium excretion - usually <100mg per 24 hours.
Other hints that this condition is present are:
1. Only mild elevation of calcium which has been stable over time
2. Young age
3. Patients with a family history of 'parathyroid disease'
Nowadays if there is doubt there is a genetic test to exclude FHH however this takes a long time to get done and in my view is generally not necessary.
www.bucksendocrine.com - Parathyroid and minimal access surgery by a UK specialist surgeon
Facebook Discussion Page on Parathyroid Disease
Wednesday 31 August 2011
Sunday 7 August 2011
Thyroid Operations - How many should a surgeon undertake per year?
There has long been a debate in the medical community about how many operations a surgeon should do each year.
Thyroid surgery is rapidly becoming a specialist operation - this is a good thing as data from the British Association of Endocrine and Thyroid surgeons has clearly demonstrated that outcomes are better from surgeons undertaking greater numbers of thyroid operations.
In particular - length of stay in hospital and risk of needing calcium tablets after surgery are both reduced.
The British Association held a landmark vote last year which said that surgeons should perform more than 25 thyroid operations a year in order to maintain skills and be considered for revalidation (relicensing) in the future.
There are however considerable numbers of surgeons in the UK who are not members of the Association and undertake few operations.
Your surgeon should be able to tell you:
1. How many operations they perform a year on thyroids
2. Figures relating to risk of hypocalcaemia post thyroidectomy (the best will be around 5-10%)
3. Risk of injury to the recurrent laryngeal nerve in their hands
4. Average length of stay and number of daycase operations they perform
Daycase surgery is a good marker in my view as if a patient is fit, alert, pain free and keen to leave the same day it is a good indicator of a successful operation. If surgeons are unable to achieve discharge on the same day you should question why not.
www.thyroidsurgeon.org.uk
www.bucksendocrine.com
Thyroid surgery is rapidly becoming a specialist operation - this is a good thing as data from the British Association of Endocrine and Thyroid surgeons has clearly demonstrated that outcomes are better from surgeons undertaking greater numbers of thyroid operations.
In particular - length of stay in hospital and risk of needing calcium tablets after surgery are both reduced.
The British Association held a landmark vote last year which said that surgeons should perform more than 25 thyroid operations a year in order to maintain skills and be considered for revalidation (relicensing) in the future.
There are however considerable numbers of surgeons in the UK who are not members of the Association and undertake few operations.
Your surgeon should be able to tell you:
1. How many operations they perform a year on thyroids
2. Figures relating to risk of hypocalcaemia post thyroidectomy (the best will be around 5-10%)
3. Risk of injury to the recurrent laryngeal nerve in their hands
4. Average length of stay and number of daycase operations they perform
Daycase surgery is a good marker in my view as if a patient is fit, alert, pain free and keen to leave the same day it is a good indicator of a successful operation. If surgeons are unable to achieve discharge on the same day you should question why not.
www.thyroidsurgeon.org.uk
www.bucksendocrine.com
Thursday 4 August 2011
Thyroid Nodules
Thyroid nodules (lumps) are very common.
Approximately 50% of people will have a thyroid lump if the thyroid is scanned with an ultrasound machine
In the UK the only lumps that need to be assessed are:
1. Visible thyroid swellings
2. Palpable thyroid swellings
3. Thyroid nodules seen on scans >1cm in size
Thyroid nodules under 1cm in size do not require any action
In my view thyroid ultrasound is over used particularly outside hospitals and I generally recommend that patients should first see someone in a one-stop thyroid clinic where biopsies are undertaken after clinical assessment.
The only way to determine whether a thyroid nodule is benign or malignant is to perform a fine needle aspiration of some cells which are then assessed under a microscope by a cytology specialist.
The Fine Needle Aspiration (FNA) can either be done by the consultant in clinic - quick and straightforward using a blood test needle - or done by a radiology specialist with the aid of ultrasound.
The results from FNA are classified:
THY 1 Not enough cells to give a clear diagnosis - the test must be repeated to acheive a diagnosis
THY 2 Benign - repeated at 2-3 months as a second double check and if still benign
THY 3 Indeterminate - this should be reviewed in a thyroid multi-disciplinary team meeting
THY 4 Suspicious result which may represent a thyroid cancer
THY 5 Definite thyroid cancer according to cytology
The action following the biopsy is outlined below:
THY 1 Repeat to establish diagnosis if possible - if no clear answer needs surgery to remove
THY 2 Benign and can therefore safely leave alone or offer patient choice re excision
THY 3 Remove to acheive definite diagnosis as 20% plus are cancerous
THY 4 Repeat to acheive definite diagnosis if possible or remove with on-table frozen section
THY 5 Needs surgery - usually a total thyroidectomy
Benign nodules are still removed. The reasons for removing these are:
1. Symptoms - often uncomfortable in the neck, difficulty swallowing, choking feeling etc
2. Cosmetic issues
3. Cancer concerns
4. Family history of thyroid cancer
5. Radiation exposure - particularly as a child (increase cancer risk)
Bucksendocrine.com - Thyroid surgery by a UK specialist surgeon
Thyroid Surgery by a UK specialist surgeon
Approximately 50% of people will have a thyroid lump if the thyroid is scanned with an ultrasound machine
In the UK the only lumps that need to be assessed are:
1. Visible thyroid swellings
2. Palpable thyroid swellings
3. Thyroid nodules seen on scans >1cm in size
Thyroid nodules under 1cm in size do not require any action
In my view thyroid ultrasound is over used particularly outside hospitals and I generally recommend that patients should first see someone in a one-stop thyroid clinic where biopsies are undertaken after clinical assessment.
The only way to determine whether a thyroid nodule is benign or malignant is to perform a fine needle aspiration of some cells which are then assessed under a microscope by a cytology specialist.
The Fine Needle Aspiration (FNA) can either be done by the consultant in clinic - quick and straightforward using a blood test needle - or done by a radiology specialist with the aid of ultrasound.
The results from FNA are classified:
THY 1 Not enough cells to give a clear diagnosis - the test must be repeated to acheive a diagnosis
THY 2 Benign - repeated at 2-3 months as a second double check and if still benign
THY 3 Indeterminate - this should be reviewed in a thyroid multi-disciplinary team meeting
THY 4 Suspicious result which may represent a thyroid cancer
THY 5 Definite thyroid cancer according to cytology
The action following the biopsy is outlined below:
THY 1 Repeat to establish diagnosis if possible - if no clear answer needs surgery to remove
THY 2 Benign and can therefore safely leave alone or offer patient choice re excision
THY 3 Remove to acheive definite diagnosis as 20% plus are cancerous
THY 4 Repeat to acheive definite diagnosis if possible or remove with on-table frozen section
THY 5 Needs surgery - usually a total thyroidectomy
Benign nodules are still removed. The reasons for removing these are:
1. Symptoms - often uncomfortable in the neck, difficulty swallowing, choking feeling etc
2. Cosmetic issues
3. Cancer concerns
4. Family history of thyroid cancer
5. Radiation exposure - particularly as a child (increase cancer risk)
Bucksendocrine.com - Thyroid surgery by a UK specialist surgeon
Thyroid Surgery by a UK specialist surgeon
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