Endocrine surgery

Overview

Endocrine surgeries address conditions impacting the glands within your endocrine system. These procedures primarily target issues related to the thyroid, parathyroid, and adrenal glands. Glands are specialized organs that release hormones directly into the bloodstream, which then deliver instructions to various tissues, ensuring the body’s proper functioning and health. You might require endocrine surgery if a gland malfunctions, either producing an excess of hormones or not enough.

Glands in your endocrine system release hormones used by your body for:

• Metabolism
• Breathing
• Movement
• Sensory perception
• Pregnancy and reproduction
• Body growth and sexual development

Endocrine surgery targets:

• Adrenal glands: The adrenal glands produce androgens, which are sex hormones that influence reproductive health and body development. They also produce cortisol, a hormone released during stress. Additionally, the adrenal glands secrete aldosterone, which plays a role in regulating blood pressure.
• Parathyroid glands: This cluster of four small glands located behind the thyroid gland is responsible for managing calcium and phosphorus levels in the body, essential for bone health.
• Thyroid gland: The thyroid, a butterfly-shaped gland at the front of the neck, regulates metabolism. It influences how the body generates heat, utilizes energy, and consumes oxygen.

Types of endocrine surgery

Endocrine surgeons carry out many surgeries, such as:

• Adrenalectomy: The surgical removal of one or both adrenal glands.
• Parathyroidectomy: The surgical removal of one or more of the four parathyroid glands.
• Thyroidectomy: The surgical removal of the thyroid gland or one of its lobes (thyroid lobectomy).
• Pancreatectomy: The surgical removal of a portion or all of the pancreas.

Reasons for undergoing the procedure

Various conditions can impact the health of the glands within your endocrine system. Endocrine surgery may be necessary to address issues affecting your:

Adrenal glands

• Cushing’s syndrome
• Primary aldosteronism (Conn’s syndrome)
• Pheochromocytoma
• Adrenal tumors
• Adrenocortical carcinoma

Parathyroid glands

• Hyperparathyroidism
• Parathyroid adenomas
• Parathyroid cancer

Thyroid gland

• Goiter
• Graves’ disease
• Hyperthyroidism.
• Thyroid nodules
• Toxic (hyperfunctioning) thyroid nodules
• Thyroid cancer
• PTEN hamartoma tumor syndrome (Cowden syndrome)

Other parts of your endocrine system

• Neuroendocrine tumors
• Multiple Endocrine Neoplasia (MEN) syndromes

Risks

Endocrine surgery has a risk of complications, much like any other surgery. These include:

• Fluctuations in blood pressure.
• Infections.
• Bruising.
• Blood clots, blood loss, and internal bleeding.
• Injury to blood vessels, nerves, glands, or organs nearby.
• Nerve injury in your larynx, which may cause vocal changes, such as hoarseness or a weak voice, which can be either temporary or permanent.
• Respiratory issues such as dyspnea or pneumonia.
• Low calcium levels (hypoparathyroidism).

Before the procedure

It’s important to follow your surgeon’s preoperative instructions carefully. This may include fasting for a specified period before the surgery. Your surgeon might also advise you to stop taking certain medications, including vitamins and herbal supplements, and to quit smoking.

Additionally, you may need to undergo specific tests, such as:

• Blood testing for gland function evaluation.
• Imaging tests to ascertain the location and size of the tumor or gland, such as a Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scan, or ultrasound.
• Bronchoscopy to see if your windpipe (trachea) is affected by a gland tumor.
• Laryngoscopy to evaluate the condition of your larynx, or vocal cords
• An examination of your esophagus using upper endoscopy or barium swallow (gastrointestinal (GI) X-ray examination).
• To check for cancer cells, perform a needle biopsy.

During the procedure

Hospitals or surgical centers are the settings for endocrine surgeries. You are given general anesthetic, so the process doesn’t keep you awake.

The type of surgical surgery your surgeon does will depend on the endocrine system condition.

• Laparoscopic surgery: The surgeon makes several small incisions and uses a laparoscope, a thin tube equipped with a light and video camera, to remove the gland. This minimally invasive approach often results in quicker recovery with less pain and scarring.
• Robotic surgery: Utilizing robotic and laparoscopic technology, the surgeon removes the diseased gland through small incisions. This method is also minimally invasive.
• Open surgery: The surgeon makes a direct incision over the gland to remove it, which may be necessary for larger or cancerous tumors.

The endocrine problem and procedure complexity determine how long the surgery will take. For example, it can take an hour or so to remove a portion of your thyroid gland. However, a comprehensive thyroidectomy could take up to three hours to remove a malignant thyroid gland together with any surrounding lymph nodes. You will receive an estimated time of surgery from your surgeon.

After the procedure

Your surgeon can send tissue samples for a biopsy from the gland to a laboratory. An expert looks for indications of malignancy in the tissue. The results might suggest that more treatments are required. For instance, following thyroid surgery, patients with thyroid cancer may require radioiodine (radioactive iodine) therapy.

You might need to take specific medications for a short time or potentially for the rest of your life, depending on the type of operation. For example, you might require:

• Steroids following an adrenalectomy. 
• Thyroid hormone levels following thyroid removal.
• Vitamin D and calcium following a parathyroidectomy.

Outcome

After endocrine surgery, the majority of patients require at least one night in the hospital. You can feel a slight sore throat and discomfort. 

Adhering closely to your discharge instructions is important for your recovery and to minimize the risk of complications. Your outlook will depend on the particular endocrine disorder, your overall health, and the effectiveness of the treatment. Your endocrine surgeon or endocrinologist can provide a prognosis based on your specific diagnosis.