Endocrine Surgery

Female doctor examining her patient.

Providing comprehensive surgical treatment of endocrine disorders in the Mid-Hudson Valley and northwestern Connecticut

Specializing in diagnosis and endocrine surgery for conditions involving the thyroid, parathyroid and adrenal glands

Endocrine surgery is a distinct surgical specialty that focuses on the endocrine glands and combines endocrinology, oncology and surgery. Health Quest Medical Practice (HQMP) offers clinical expertise in the diagnosis and surgical treatment of imbalances and tumors within the body’s complex and essential endocrine system.

What is the endocrine system?
Endocrine glands are a group of glands that secrete hormones. The hormones are secreted into the bloodstream to send chemical signals to other cells in your body which may be located far from the gland. For example, the thyroid gland is located in your neck and secretes thyroid hormone to regulate your body’s overall metabolism.

Your endocrinologist or primary care physician may refer you to an endocrine surgeon for diagnosis and potential surgical treatment of different parts of the endocrine system, including the thyroid, parathyroid, thymus and adrenal glands. Endocrine disorders are complicated and require special training, experience and expertise.

Why Choose Us?

  • You and your family can receive the specialized diagnosis and surgical treatment that endocrine gland disorders require, conveniently close to home.
  • Endocrine glands are complex and interconnected. We use advanced testing technologies to thoroughly assess the nature and pathology of cysts, tumors, nodules or other abnormalities of the endocrine glands.
  • Should surgery be required, a highly qualified, specialist endocrine surgeon will perform the surgery, frequently using the latest minimally invasive or robotic procedures that leave minimal visible scarring.
  • Our team will partner seamlessly with your endocrinologist, primary care physician or oncologist to ensure that post-surgery you will receive:
    • The appropriate level of medication or hormone to correct imbalances, or
    • Chemotherapy for those who have cancer of an endocrine gland.

Diagnosis and Testing

A number of different diagnostic tests are used to determine what type of surgical procedure would be most effective. Many of these tests can be performed in our office and include the following:

  • Ultrasound
    A comprehensive neck ultrasound uses sound waves to detect masses or fluid in soft tissues. It is especially useful in evaluating thyroid nodules and lymph nodes in the neck and can identify enlarged parathyroid glands.
  • Fine needle aspiration (FNA)
    An FNA biopsy is a simple procedure that involves passing a thin needle through the skin to sample fluid or tissue from a cyst or solid mass. The sample of cellular material taken during an FNA is placed on a slide which is then sent to a pathology laboratory for analysis. This process may be repeated a number of times and sometimes is performed with ultrasound guidance.

Conditions We Treat

Thyroid gland
The thyroid gland is a butterfly-shaped organ located in the base of your neck. It releases hormones that control metabolism—the way your body uses energy.

Thyroid cancers
We perform diagnoses of thyroid nodules, adenomas, cysts and toxic nodules using
ultrasound and/or FNA biopsy.

  • Goiter
    • A goiter is an enlargement of your thyroid gland. It is commonly the result of an iodine deficiency or an inflammation of the thyroid gland. A goiter may be relatively simple to treat and respond to dietary changes to increase your iodine intake.
    • A multinodular goiter can be either toxic (i.e., it makes too much thyroid hormone and causes hyperthyroidism) or non-toxic (i.e., it does not make too much thyroid hormone).
    • Large multinodular goiters may cause difficulty in breathing or swallowing or cause coughing. A thyroid ultrasound will be performed and frequently, an FNA biopsy, especially if you have a family history of thyroid cancer.
    • Diagnostic testing will establish if there is cancer and to what stage it has developed.
    • Your endocrine surgeon will help you understand your options regarding whether surgery is required. If your symptoms are not too uncomfortable, or development is not too advanced, a period of surveillance may be the prudent choice.
  • Refractory Graves’ disease
    • There are several treatment options for Graves’ disease—an immune system disorder that results in the overproduction of thyroid hormones, known as hyperthyroidism.
    • Although the needs of each patient are different, removing the thyroid, known as a thyroidectomy, often relieves symptoms of Graves’ disease, although it requires life-long use of thyroid medication.
  • Hashimoto’s thyroiditis with persistently elevated antibodies
    • Hashimoto’s disease is a condition in which your immune system attacks your thyroid which often leads to an underactive thyroid gland, known as hypothyroidism.
    • Symptoms progress slowly, but people with a family history of thyroid or autoimmune disease are more likely to develop it. It is particularly common in women.
    • A total thyroidectomy can successfully reduce symptoms of pain and fatigue in Hashimoto’s thyroiditis with persistently elevated antibodies.

Parathyroid glands
The body has four parathyroid glands which are about the size of a grain of rice and are
located in your neck. The parathyroid glands produce parathyroid hormone (PTH), which
helps maintain an appropriate balance of calcium in your bloodstream and in tissues that depend on calcium to function properly.

In referring you to an endocrine surgeon, your primary care doctor is looking for diagnostic help in determining the type of hyperparathyroidism that you may have:

  • Primary hyperparathyroidism: One or more of the parathyroid glands becomes overactive and secretes excess amounts of PTH. As a result, your blood calcium rises to a level that is higher than normal (called hypercalcemia).
  • Normocalcemic hyperparathyroidism: This type of primary hyperparathyroidism does not have high calcium levels, but the parathyroid hormone levels are too high.
  • Secondary hyperparathyroidism from ESRD: Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease or end-stage renal disease (ESRD) that results in elevated levels of PTH, and may result in bone disease, neuromuscular disorders and soft tissue problems.
  • Parathyroid carcinoma: Parathyroid cancer is a rare disease in which malignant (cancer) cells form in the tissues of a parathyroid gland.

Adrenal glands
Adrenal glands are small, triangular-shaped glands located on top of both kidneys. Adrenal glands produce hormones that help regulate your metabolism, immune system, blood pressure, response to stress and other essential functions. Your endocrine surgeon can diagnose and test disorders of the adrenal glands, including the following:
Adrenal nodules and cysts, both functional: Benign adrenal tumors are noncancerous masses that form in the adrenal glands.

Surgical procedures
These procedures are performed in the operating room by a highly qualified endocrine surgeon.

  • Thyroid lobectomy: A thyroid lobectomy is used to remove one of your two thyroid lobes, leaving the other intact. This type of surgery may be performed if there are nodules that cause symptoms or could be cancerous. It is also used to treat excessive hormone production like that associated with hyperthyroidism.
  • Total thyroidectomy, including substernal resections: When a goiter extends far into the chest, this surgery removes the thyroid gland and the substernal goiter.
  • Central neck dissection: This procedure is recommended for the removal of thyroid and suspected cancerous lymph nodes.
  • Lateral neck dissection: This procedure is frequently performed to remove a papillary thyroid carcinoma.
  • Minimally invasive parathyroidectomy: This procedure is often selected when there is evidence of lymph node metastasis from thyroid cancer.
  • Subtotal parathyroidectomy: Unlike total thyroidectomy, a benefit to patients who have a subtotal parathyroidectomy can be that you do not need additional long-term calcium supplements.
  • Autotransplantation of parathyroid: When all of the parathyroid gland must be removed, it is possible to grow new tissue for a subsequent transplant, restoring parathyroid function.
  • Thymectomy: The surgical removal of the thymus gland, which is located just under the breast bone. This treatment is effective for people who have myasthenia gravis (a neuromuscular disorder) or thymoma (a tumor of the thymus gland).
  • Open, laparoscopic and robotic adrenalectomy: Adrenalectomy is the surgical removal of one or both adrenal glands. It is usually advised for patients with tumors of the adrenal glands. The procedure can be performed using an open incision or laparoscopic technique, as well as a da Vinci robotic procedure.