Endocrine surgery

The specialist consultation treats benign and malignant diseases of the hormone-producing glands (thyroid, parathyroid, adrenal gland, pancreas, and NET/GEP tumors, genetically caused hormonal tumor syndromes).

Findings necessary for establishing an indication:
The following documents are required for the initial consultation:
Referral from a specialist or general practitioner with a clear question
Blood test: T3, T4, TSH, thyroglobulin AK (TAK), TPO AK (MAK), calcitonin, calcium, parathyroid hormone
Ultrasound findings (possibly images)
Scintigraphy findings (images)
Additional findings optional: Computed tomography, MRI for adrenal tumor

Benign thyroid disorders (benign goiter)

The thyroid gland (en.wikipedia.org/wiki/Thyroid_gland) is a butterfly-shaped organ, or rather a hormone-producing gland. It is located in front of the trachea in a horseshoe shape and is connected to it by a ligament (Gruber ligament, Berry ligament).
The thyroid gland produces thyroid hormones (T3, T4), which have a stimulating effect on all organ functions! Therefore, an excess of thyroid hormones stimulates all organ functions, while an underactive thyroid slows them down.
Pathological enlargement of the thyroid gland is called goiter (struma). The most common thyroid disorder requiring surgery is nodular goiter with suspected thyroid carcinoma. One of the known causes of nodular goiter is iodine deficiency in the diet, which has been successfully combated for decades by adding iodine to table salt. However, many patients suffered from relative iodine deficiency in childhood or grew up with iodine deficiency. Recent findings show that nodular goiter often has a familial (genetic) basis. By eliminating iodine deficiency, the growth of the nodules is no longer as pronounced.

Multinodular goiter (Struma multinodosa)

In this case, there are several nodules of varying sizes in the thyroid gland. They can grow to a diameter of up to 10 cm or more. When there are many nodules in the thyroid gland, it is difficult to examine each one to determine whether it is malignant. In addition, a nodular goiter can be cosmetically unsightly and can also constrict the windpipe and esophagus.

Cold nodule, suspected thyroid carcinoma

If you have been diagnosed with a cold nodule, this means that the nodule cannot produce thyroid hormone. In our part of the world, approximately 10 % of cold nodules are malignant. There is currently no method that can reliably determine malignancy prior to surgery. In the case of a cold nodule or if preliminary examinations indicate a suspicion of malignancy, the affected thyroid lobe is usually removed and a so-called “frozen section examination” is performed. While you are still under anesthesia, the removed thyroid tissue is sent to the Institute of Pathology, where it is examined histologically (fine tissue) for malignancy. In approximately 70%–80% of cases (i.e., not in all cases), the correct diagnosis can be made in the frozen section. All tissue examined in the frozen section procedure is, without exception, subjected to further tissue examination. If a malignant tumor of the thyroid gland is diagnosed either in the frozen section during the operation or, in a few cases, only after the detailed tissue examination that is always performed, complete removal of the thyroid gland and cervical lymph nodes is performed if necessary.

Hyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland produces excessive amounts of thyroid hormones. This dysfunction is also known as hyperthyroidism. It can cause various important bodily functions to become unbalanced, such as heart rate, blood pressure, and metabolism.

In certain cases of hyperthyroidism, surgery is performed. In a condition known as “multifocal autonomy,” the hyperfunction is caused by several hormone-producing nodules. In these cases, only surgery can achieve the desired result.
In autonomous adenoma, there is only one nodule that leads to hyperthyroidism. Radioiodine therapy is an alternative to surgery in this case.

Graves’ disease
Graves’ disease is an autoimmune disorder in which antibodies attack the thyroid gland, stimulating it to produce excessive amounts of hormones. Half of patients experience protrusion of the eyeballs (orbitopathy). In cases of very large goiters, intolerance to the necessary medication, women under 40, and children, surgery on the thyroid gland is recommended rather than radioiodine therapy.

Thyroid cancer (thyroid carcinomas)

In cases of differentiated thyroid carcinoma (papillary and follicular thyroid carcinoma), total thyroidectomy with central and lateral functional lymphadenectomy is performed due to its many advantages for the outcome. The most important advantage of thyroidectomy in thyroid carcinoma is the improved effectiveness of subsequent radioiodine therapy. Further advantages include the possible removal of additional tumor foci, as papillary carcinoma occurs in up to 50% of cases as multicentric (multiple tumor foci in the thyroid gland); thyroglobulin is only useful as a tumor marker if a complete thyroidectomy has been performed (benign thyroid tissue also secretes thyroglobulin), etc. Only in the case of occult microcarcinoma (not diagnosed intraoperatively by frozen section) (definition:Tumor diameter less than 1 cm, no extension beyond the thyroid capsule, tumor completely removed) no subsequent complete thyroidectomy (removal of thyroid remnants) or radioiodine therapy is required. However, if microcarcinoma is diagnosed intraoperatively by means of frozen section analysis, a total thyroidectomy with central lymphadenectomy is recommended (this allows for subsequent radioiodine therapy in any case, but this is only considered for high-risk microcarcinomas).

Preliminary examinations for thyroid surgery
– Nuclear medicine preliminary examination (thyroid outpatient clinic)
– Internal medicine preliminary examination (for patients over 40 years of age)
– Laryngological examination (vocal cord function) by an ENT doctor

Hyperparathyroidism (overactive parathyroid glands)

Hyperparathyroidism is characterized by elevated blood levels of parathyroid hormone and calcium.
Parathyroid hormone is produced by the parathyroid glands. As the name suggests, these are located in the thyroid gland area. Normally, there are four parathyroid glands. Parathyroid hormone causes an increase in blood calcium levels via several mechanisms. The most important mechanism is the release of calcium from the large calcium depot in the skeleton. In healthy individuals, parathyroid hormone is released into the bloodstream when blood calcium levels are low in order to normalize them. If the parathyroid glands are overactive, parathyroid hormone is constantly released inappropriately from one or more parathyroid glands.
Primary hyperparathyroidism (overactive parathyroid glands) is one of the most common hormonal disorders alongside diabetes. With the exception of a few hereditary forms of primary hyperparathyroidism, the cause is unknown. The symptoms are sometimes relatively uncharacteristic, especially in the early stages of hyperparathyroidism (bone pain, fatigue, exhaustion), so that hyperparathyroidism is not considered. Only after prolonged existence can more severe bone changes (10% of patients suffer bone fractures even with minor injuries), kidney stones, but also diffuse calcifications of the kidney or functional impairments of the kidney without calcifications occur. The development of stomach and duodenal ulcers is promoted by the constantly elevated calcium level in the blood. Furthermore, adequate calcium levels in the blood are important for the function of nerve and muscle cells. Constantly elevated blood calcium levels can therefore impair the function of nerve cells and muscles. Many patients complain of fatigue and poor performance or have psychological problems such as depression, etc. (endocrine psychosyndrome). In recent years, studies have shown that patients with hyperparathyroidism are more likely to develop cardiovascular problems (heart attack, stroke, circulatory disorders of the extremities, etc.).

Prostate disease
Since there is a 90 – 95% probability that only one of the four parathyroid glands is diseased, in the vast majority of cases only this one diseased parathyroid gland needs to be removed.

Adrenal tumors and diseases

The adrenal glands are among the body’s hormone-producing glands. They produce several vital hormones. Tumors of the adrenal gland can produce excess hormones (hormone-active tumors), leading to clinical symptoms. However, the vast majority of tumors are asymptomatic (hormone-inactive) and are discovered incidentally during abdominal ultrasound, computed tomography, or magnetic resonance imaging (incidentaloma).
A tumor does not automatically mean cancer; the majority of tumors in the adrenal glands are benign. Most are so-called adenomas (i.e., a growth of glandular tissue).
Malignant tumors are rare in the adrenal glands. A distinction is made between metastases, i.e., tumors that have spread from other organs, and malignant tumors of the adrenal glands themselves. The latter are usually a type of cancer called adrenocortical carcinoma; it occurs in about one to two people per million inhabitants.

Intraoperative recurrent nerve visualization (stimulation, neuromonitoring), surgery with magnifying glasses, minimally invasive video-assisted thyroidectomy (MinVA-T)
Intraoperative frozen section diagnosis
Short postoperative stay (2 to 3 days), drains always removed on the first day
Quality control through postoperative examination of vocal cord function
Alcohol instillation for autonomic adenomas