Thyroid and parathyroid

Why see an ENT surgeon for the thyroid

The thyroid and parathyroid glands sit at the base of the neck, a region that the otolaryngologist and head and neck surgeon assesses and operates on. People are most often referred for a neck mass, a nodule found incidentally on imaging done for another reason, an enlarging goitre, difficulty swallowing or a change in voice associated with a thyroid mass, or a high blood calcium level suggesting hyperparathyroidism.

How the assessment works

It begins with examination and palpation of the neck and the gland. Three investigations complete it as needed: blood tests (TSH, sometimes calcium and parathyroid hormone) to measure how the gland is working; an ultrasound, which defines the size and appearance of any nodule; and, when the ultrasound features warrant it, a fine-needle aspiration biopsy. This sampling is done in the clinic, without general anaesthesia, and it is what guides the decision.

What the results mean

Thyroid nodules are common and the great majority are benign. The whole process therefore aims to identify the minority that require surgery, without operating unnecessarily on the rest. A benign nodule is most often simply monitored with ultrasound.

Surgery, when it is indicated

Depending on the diagnosis, the operation removes one lobe of the thyroid or the entire gland. For primary hyperparathyroidism, the affected parathyroid gland or glands are removed. The two main points discussed before surgery are protection of the nerve that controls the vocal cord and, for a total thyroidectomy, monitoring of calcium and lifelong thyroid hormone replacement afterwards. These are reviewed in detail at the consultation.