Thursday 23 June 2011

Graves Disease and Thyroid Surgery

Graves disease is caused by an antibody made by the body's own immune system which attacks the eyes and thyroid gland.

In the thyroid gland the result is overproduction of thyroid hormone.

The treatment is to bring the thyroid under control with anti-thyroid medication. These drugs have significant side effects and there is a risk of agranulocytosis (loss of all white blood cells) which means patients cant fight infection and can become very ill.

Drugs usually work well and after a year if all is controlled they can be stopped and many patients will be cured. For those where the disease relapses it is essential to restart the drugs and seek a definitive treatment.

There are two definitive treatments:

1. Radioactive iodine

2. Total thyroidectomy

I wont discuss radio-iodine here but it is good for small thyroids and patients without eye problems.

Surgery should always be a total thyroidectomy. Some surgeons still offer a sub-total thyroidectomy which is a poor operation.

Sub-total surgery leaves bits of the thyroid behind and this means the tissue can regrow and the disease come back - a crazy situation when it could all be taken away at the first operation.

Surgery is a good option for many people and is offered along the lines of minimal access thyroid surgery.




www.bucksendocrine.com

www.thyroidsurgeon.org.uk

Wednesday 8 June 2011

Vitamin D and Parathyroid Disease

This topic discusses the importance of vitamin D and its link with primary parathyroid disease.

Vitamin D is required by the body to allow us to absorb calcium from the foods we eat. It is for this reason that many calcium supplements are made with vitamin D added to them as without it the intestines cannot absorb the calcium in the pill.

Vitamin D is made in the skin when the skin is exposed to sunlight.

There is some evidence that when someone starts developing parathyroid disease and the calcium levels rise the body uses vitamin D as a protective mechanism. The basic concept is that as the calcium starts to go up the body limits the amount of vitamin D made which reduces the amount of calcium the body can absorb from the diet.

The end result is that vitamin D levels go lower than normal.

A large study looking at this in nearly 1600 patients with parathyroid disease found that 67% of all patients with parathyroid disease have low levels of vitamin D. There also appeared to be a trend to vitamin D being lower the higher the level of calcium went.

This is an observational study and we do not know the mechanism for this however it does illustrate that vitamin D levels are likely to be low with parathyroid disease.

Occasionally endocrinologists recommend taking extra vitamin D in this situation. Generally this does nothing but it can have the paradoxical effect of increasing blood calcium levels - presumably as the absorption of calcium from the intestine improves.

So correcting the vitamin D level is not the answer for the calcium levels. Calcium levels are only very rarely high due to low vitamin D. What is usually needed is consideration of parathyroid surgery to cure the problem. Vitamin D levels can be corrected easily after surgery.






www.bucksendocrine.com

www.thyroidsurgeon.org.uk
The article linked to below represents some of the features of parathyroid disease.

Firstly, it can be difficult to diagnose but the key feature is a high calcium and a PTH level that is normal or high.

Secondly, scans must not be used to diagnose the disease.  They are only of use in planning surgery so by extension the diagnosis should have been made first.  Scans do NOT always show where the offending parathyroid gland is - this is an important point which many doctors forget.


Difficult Parathyroid Case

www.bucksendocrine.com
www.thyroidsurgeon.org.uk

Mr Andrew McLaren, Consultant Surgeon in the UK with a special interest in minimal access thyroid and parathyroid surgery

Monday 6 June 2011

Graves Disease and Thyroid Surgery

Read an article on Graves Disease by Mr Andrew Mclaren, Consultant Surgeon.  Graves disease can be treated by minimal access thyroid surgery...


Article on Graves Disease

Thursday 2 June 2011

Minimal Access Parathyroid Surgery

Minimal access parathyroid surgery using a 2cm incision.

UK consultant surgeon describes the use of this surgery in practice. Read our paper on the subject

http://tinyurl.com/3ranv97

Daycase Thyroid Surgery

Read our paper on daycase thyroid surgery and how we successfully introduced this into a UK hospital

Daycase thyroid surgery is now routine practice in my hospital.

http://tinyurl.com/3k7rdgo