Endocrine Surgery

What is endocrine surgery?

Endocrine surgery treats diseases of the endocrine glands. These glands are responsible for the release of hormones into the bloodstream which are then carried to various cells in the body. There are number of organs and glands that make up the endocrine system, but the most common glands that get operated on are the thyroid gland, the parathyroid gland, and the adrenal gland.

General surgeons work closely with endocrinologists, who are often responsible for the initial diagnosis and investigation of endocrine disorders.

When should I see a specialist for endocrine surgery?

There are many reasons why you may require endocrine surgery. Most of the symptoms associated with endocrine disease can overlap with a number of other conditions, which makes it difficult to accurately predict which symptoms are related.

Hyperthyroidism (thyroid overactivity) often requires surgical intervention when it associated with other factors such as age, calcium levels over a certain range, and when there is a decrease in kidney function. Your doctor will also take into account any other symptoms to determine if surgery is right for you. Hyperthyroidism can include symptoms such as:

● Appetite changes (decrease or increase)
● Frequent bowel movements
● Fatigue
● Difficulty sleeping (insomnia)
● Heart palpitations
● Heat intolerance
● Increased sweating
● Irritability

In many cases, surgery may be required to remove part of the thyroid gland to help control the amount of hormones being released.
Parathyroid disease (also referred to as hyperparathyroidism) is usually caused by a benign (non-cancerous) growth on one of the four parathyroid glands in your neck. This can lead to a variety of symptoms, and the only definitive treatment for this is surgery to remove the tumour. Its symptoms can include:

● Fatigue
● Joint and muscle pain
● Mood changes (such as loss of interest in usual activities or depression)
● Memory and concentration problems
● Kidney stones and frequent urination
● Abdominal cramps, ulcers, and changes in bowel habits
● Bone loss (osteopenia or osteoporosis)

One of the most common reasons is benign or malignant tumours that are present on the glands. If there is a tumour present on the adrenal gland, surgery is also the only way to treat the problem. It may sometimes involve only removing the tumour, but may also involve removing the entire gland. Your surgeon will advise you on the best course of treatment. Tumours or disease of the adrenal gland can result in the following symptoms:

● High blood pressure
● Palpitations or racing heart rate
● Pounding headache
● Anxiety and panic attacks
● Flushing and sweats
● Fatigue

Did you know?

According to a Singapore study done in 2012, local adults who have been diagnosed with asthma have a 31% increased risk of developing diabetes.¹

What are the risks of endocrine surgery?

Thyroid surgery (like all surgery) carries some risk. The more general complications include reactions to anaesthesia, bleeding or infection. You may also be at risk of other complications related to underlying health problems.

Despite these risks, thyroid surgery is considered safe, with low complication rates, especially when performed by an experienced surgeon.

There are additional complications that are specific to thyroid surgery:

● One of the most common complications relating to thyroid surgery is low calcium. This is because of the disruption to the parathyroid (calcium) glands that sit behind the thyroid. This problem is usually only temporary, and you may require extra calcium and/or a special form of vitamin D in the days or weeks after surgery.
● Swelling in the throat after surgery can cause problems with your vocal cords, the surrounding nerves, and the neck muscles. It can lead to temporary voice loss and/or hoarseness which will usually rectify itself as you recover from surgery.

Adrenal gland surgery can include complications such as:

● Changes to your blood pressure and/or heart rhythm.
● Hormone imbalances – this can have an adverse effect on wound healing, including blood pressure fluctuations.

How do I prepare for endocrine surgery?

Certain glands may be prone to the irregular release of of hormones that can be dangerous during surgery. Your surgeon may prescribe specific medication prior to your surgery to decrease the risk of complications.

You may need to stop taking certain medications, as some medicines might increase your risk of complications. Talk to your surgeon or anaesthesiologist about any medication you’re taking.

If you are currently taking anticoagulants (blood thinners), steroids, and/or insulin, you may need to adjust your dose or substitute these for another medication before surgery.

You will usually be expected to stop eating and drinking a few hours, or even a day, before surgery. Your surgeon will advise you on the specifics of this.

What can I expect during endocrine surgery?

Surgery on any of the endocrine glands will usually involve a general anaesthetic.

When the surgical team are ready, you will be taken into an operating theatre. The anaesthesiologist will then administer the anaesthesia or some form of sedation, depending on the operation you will be having.

You will be connected to an echocardiogram (ECG) machine as well as a blood pressure machine to monitor your heart rate and circulation. Once you’re asleep, you may also need a tube inserted into your airway to assist your breathing during your operation.

The surgical team will then proceed with the planned surgery. Because of the nature of anaesthetic medication, you will not have any memory of the procedure.

What happens after my endocrine surgery?

Recovery following endocrine surgery will depend on the type of surgery you have had. You may experience the following symptoms after your surgery:

Voice changes may be caused by damage to the surrounding nerves due to the location of the endocrine glands.

Numbness may occur around the incision immediately after surgery. This will likely resolve itself after a few days.

In addition to these symptoms, you will need to take care of your wound. Keeping it clean will decrease your risk of infection in the area.

Recovery from surgery will take one to two weeks, and you should be able to return to normal activities after this time. Your general surgeon will advise you on exactly when you can do this.

[1] Mueller, N., Koh, W., Odegaard, A., Gross, M., Yuan, J. and Pereira, M. (2013). Asthma and the risk of type 2 diabetes in the Singapore Chinese Health Study. Diabetes Research and Clinical Practice, 99(2), pp.192-199.