Thyroid and Salivary Surgery

Your thyroid gland is one of the endocrine glands that make hormones to regulate physiological functions in your body, like metabolism (heart rate, sweating, energy consumed). Other endocrine glands include the pituitary, adrenal, and parathyroid glands and specialized cells within the pancreas.

The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and wraps around the front half of the trachea (windpipe). It is shaped like a bow tie, just above the collarbones, having two halves (lobes) joined by a small tissue bar (isthmus.). You can’t always feel a normal thyroid gland.

Diseases of the thyroid gland are very common, affecting millions of Americans. The most common thyroid problems are:

• An overactive gland, called hyperthyroidism (e.g., Graves’ disease, toxic adenoma or toxic nodular goiter).
• An underactive gland, called hypothyroidism (e.g., Hashimoto’s thyroiditis).
• Thyroid enlargement due to over activity (as in Graves’ disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a “goiter.”

Patients with a family history of thyroid cancer or who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy.

Hypothyroidism is generally treated with thyroid hormone replacement medication.

Hyperthyroidism can be treated with:

• Medication to block the effects of excessive production of thyroid hormone
• Radioactive iodine to destroy the thyroid gland or
• Surgical removal of the thyroid gland

Goiters (lumps) require additional imaging studies to determine size, location and characteristics. These can include CT, ultrasound or MRIs. A fine-needle aspiration biopsy may also be ordered in order to take a sample of the cells within the nodule. This can help differentiate between benign and malignant (or cancerous) masses.

Thyroid surgery may be required when the fine needle aspiration is reported as indeterminate, suspicious or suggestive of cancer, imaging shows that nodules have worrisome characteristics or that nodules are getting bigger and/or the trachea (windpipe) or esophagus are compressed because one or both lobes are very large.

Historically, some thyroid nodules, including some that are malignant, have shown a reduction in size with the administration of thyroid hormone. However, this treatment, known as medical “suppression” therapy, has proven to be an unreliable treatment method.

The salivary glands are found in and around your mouth and throat. We call the major salivary glands the parotid, sub-mandibular, and sublingual glands. They all secrete saliva into your mouth, the parotid through tubes that drain saliva, called salivary ducts, near your upper teeth, sub-mandibular under your tongue, and the sublingual through many ducts in the floor of your mouth. Besides these glands, there are many tiny glands called minor salivary glands located in your lips, inner cheek area (buccal mucosa), and extensively in other linings of your mouth and throat. Salivary glands produce the saliva used to moisten your mouth, initiate digestion, and help protect your teeth from decay.

Salivary gland problems that cause clinical symptoms include:

• Obstruction to the flow of saliva which most commonly occurs in the parotid and sub-mandibular glands, usually because stones have formed. Symptoms typically occur when eating. Saliva production starts to flow, but cannot exit the ductal system, leading to swelling of the involved gland and significant pain, sometimes with an infection. Unless stones totally obstruct saliva flow, the major glands will swell during eating and then gradually subside after eating, only to enlarge again at the next meal. Infection can develop in the pool of blocked saliva, leading to more severe pain and swelling in the glands. If untreated for a long time, the glands may become abscessed.
• Infections which occur because of ductal obstruction or sluggish flow of saliva because the mouth has abundant bacteria.
• Tumors which rarely involve more than one gland and are detected as a growth in the parotid, sub-mandibular area, on the palate, floor of mouth, cheeks, or lips. Primary benign and malignant salivary gland tumors usually show up as painless enlargements of these glands. An otolaryngologist-head and neck surgeon should check these enlargements. If a mass is found in the salivary gland, it is helpful to obtain a CT scan or a MRI.

Treatment of salivary diseases falls into two categories: medical and surgical. Selection of treatment depends on the nature of the problem.