If you are coming for a PARATHYROID consultation, please bring the following laboratory data and tests results:

1. serum Ca (2-3 test results preferred to establish history)

2. serum PTH (2-3 test results preferred to establish history)

3. serum electrolytes

4. serum Vitamin D level

5. Bone density study

6. 24-hour urine calcium

7. Sestamibi scan, (Please bring the films as well as the report from the radiologist)

8. Neck / Thyroid ultrasound (Please bring the films as well as the report from the radiologist)

If you are coming for a THYROID consultation, please bring the following laboratory data and tests results:

1. Serum electrolytes

2. Thyroid Function Tests  (TFT’s): TSH, free T4, T3

3. Neck / Thyroid Ultrasound (Please bring the films as well as the report)

4. Any neck imaging studies (CT or MRI) (bring the films and report)

5. Thyroid biopsy results if any

6. Thyroid Iodine Uptake Studies (nuclear medicine study) if any

For the patients coming in for a THYROID BIOPSY

1. The biopsy is done under ultrasound guidance in our office.

2. There will be a cytologist present in the room to prepare and evaluate the biopsy samples

3. The average procedure time is approximately 30 minutes

4. We utilize local anesthesia (Lidocaine)

5. Patients usually experience little too no pain during the procedure. If patient is on Coumadin, it needs to be stopped for 5 days before the biopsy.

6. You do not need any preparation:  no fasting, no restrictions after the biopsy.

Biopsy under ultrasound guidance:

Ultrasound guidance:

Slides preparation by cytologist:

 

Follow up for the patients AFTER THYROID BIOPSY

1. You can apply an ice pack for 10-20 min two or three times if needed

2. Tylenol may be used for pain.

3. Call the office immediately if you develop neck edema - swollen neck (large hematoma), difficulty breathing, fever or chills

4. The result is available within 2 to 4 business days

Minimally invasive thyroid surgery

Anesthesia

Length of hospital stay

Pain

Most patients have little or no pain. The neck block last for about 8 hours. Some patients may feel discomfort or pressure after the surgery. Some patients may feel discomfort or pain with swallowing after the surgery. It normally resolves within couple of days. Some patients might feel shoulder/arm weakness after the neck block, which also resolves within 4-8 hours after the surgery

Postoperatively most of the patients have no pain at all. If you do develop mild pain at home, you can take either Tylenol or Motrin.

Drain: there will be no drains.

Stitch and Scar:

Low calcium level:

With current technique the incidence of bleeding is close to zero.

Wound infection:

With current technique the incidence of wound infection is close to zero. You do not need any antibiotics for the surgery, unless you have condition which requires you to take antibiotics with every procedure.

POSTOPERATIVE CARE: 

Incision site:

The skin glue will peel off on its own in 6-8 days. After that you can apply moisturizer to the wound. Try not to have sun exposure to the wound for about 1-2 months (especially during summer months), such as it will cause skin discoloration in the wound area and it will look different from the other skin areas.

Physical restrictions:

There are no physical restrictions. Most of the patients resume their normal physical activities within day after the surgery.

Shower:

You can take shower in 2 days. Do not scratch or peel off the skin glue, just wipe it with the towel.

Pathology report:

Usually available within 5-7 days after the surgery

Problem calls:

Please immediately call doctor if you develop significant neck swelling or shortness of breath shortly after surgery, or you develop cramps in your hands or legs after the surgery.

Postoperative visit:

2-3 weeks after the surgery: for wound check and pathology report.

Minimally invasive parathyroid surgery  

Minimally invasive parathyroid surgery is the removal of one or several parathyroid adenomas through a small mid neck incision. The incision is placed in the natural skin crease.  It includes video-assisted or endoscopic parathyroidectomy, when surgeon uses camera to magnify the view. This technique makes the healing process faster and with minimum scar formation. In order to do minimally invasive approach we utilize intra-operative parathyroid hormone (PTH) monitoring to determine the cure after the removal of parathyroid adenoma.  About 85 % of the patients with primary hyperparathyroidism will have just one parathyroid adenoma.

Scar 2 weeks after video-assisted parathyroidectomy:

SURGERY:

Anesthesia  

The procedure is done either under general or local/regional anesthesia with general sedation. The later one helps surgeon to use voice monitoring and avoid injury to important nerves which go to your vocal cords

Length of hospital stay

Surgery is performed as outpatient procedure. The average stay after the surgery is about 3 hours. Most patients do not require overnight stay.

Pain

Most patients have little or no pain. The neck block last for about 8 hours. Some patients may feel discomfort or pressure after the surgery. It normally resolves within couple of days. Some patients might feel shoulder/arm weakness after the neck block, which also resolves within 4-8 hours after the surgery.

Postoperatively most of the patients have no pain at all. If you do develop mild pain at home, you can take either Tylenol or Motrin.

Drain: there will be no drains.

Stitches and Scars:

The stitches will be removed the day of the surgery, right before you go home. You will have just a strip of skin glue on the skin. It will peel off on its own in 6-8 days. Because the incision will be small and the stitch will be removed the same day of the procedure the size of the scar will be much less than that with traditional parathyroid surgeries performed in the past. The incision will be placed in the natural skin crease of your neck, which will help to make it less noticeable or not visible at all.

However the scaring tendency is dependant on the individual skin healing proprieties. The surgeon will make all efforts to have best cosmetic result possible.

COMPLICATIONS:

Voice changes:

Only 1 in 100 patients experience complications related to the damage of the nerve goes to the vocal cords. When this occurs the patient will have hoarse voice or inability to make high-pitched sounds. In about 1 in 50 operations patient might experience temporally voice changes which resolve in 8 to 12 weeks.

Low calcium level:

In about 1 in 200 the patient with operations for total or subtotal removal of parathyroid glands may experience low calcium levels. If it happens, patients need to stay on calcium and vitamin D supplementation permanently.  Because of the nature of the surgery, all patients with removal of all four or three and a half parathyroid glands will go home on calcium pills for 2-3 weeks. If patient develops cramps in the hands or legs, or tingling of the face muscles it will indicates that the calcium level is low. In this case you should immediately take calcium pill and call your doctor.

Bleeding:

With current technique the incidence of bleeding is close to zero.

Wound infection:

With current technique the incidence of wound infection is close to zero. You do not need any antibiotics for the surgery, unless you have condition which requires you to take antibiotics with every procedure.

POSTOPERATIVE CARE: 

Incision site:

The skin glue will peel off on its own in 6-8 days. After that you can apply moisturizer to the wound. Try not to have sun exposure to the wound for about 1-2 months (especially during summer months), such as it will cause skin discoloration in the wound area and it will look different from the other skin areas.

Physical restrictions:

There are no physical restrictions. Most of the patients resume their normal physical activities within day after the surgery.

Shower:

You can take shower next day. Do not scratch or peel off the skin glue, just wipe it with the towel.

Pathology report:

Usually available within 5-7 days after the surgery

Problem calls:

Please immediately call doctor if you develop significant neck swelling or shortness of breath shortly after surgery, or you develop cramps in your hands or legs after the surgery.

Postoperative visit:

2-3 weeks after the surgery: for wound check , pathology report, and PTH and calcium check 

Minimally invasive adrenal surgery

Minimally invasive adrenal surgery is laparoscopic removal of adrenal tumor through the abdominal or back approaches. There will be 3 - 4 small incisions instead of one large as it used to be in a past.  This technique makes the healing process faster and with minimum scar formation

Scar 2 weeks after left laparoscopic adrenalectomy:

SURGERY:

Anesthesia

The procedure is done under general anesthesia

Length of hospital stay

The average length of stay is 24 hours. Most patients require only overnight stay.

Pain

Postoperatively most of the patients have little pain which is easily controlled with postoperative pain medications or injections.

Drain: there will be no drains.

Stitches and Scars:

The surgery performed through 3-4 small incisions, the stitches will be small, subcutaneous which dissolves on its own and do not required removal. Steri-strips will be applied and will stay for 3-6 days. They will peel off on its own. Because the incisions will be small and the stitch will be subcutaneous the size of the scar will be much less than that with traditional open surgeries performed in the past.

However the scaring tendency is dependant on the individual skin healing proprieties. The surgeon will make all efforts to have best cosmetic result possible.

COMPLICATIONS:

Bleeding:

With current technique the incidence of bleeding is minimal.

Wound infection:

With current technique the incidence of wound infection is minimal.

POSTOPERATIVE CARE: 

Incision site:

The steri-strips will peel off on its own in 6-8 days. After that you can apply moisturizer to the wound.

Physical restrictions:

There will be limited physical restrictions for about 2 weeks after the surgery. Most of the patients resume their normal physical activities within several day after the surgery.

Shower:

You can take shower in 48 hours (2 days) after the surgery. Do not scratch or peel off the strei-strips, just wipe it with the towel.

Pathology report:

Usually available within 5-7 days after the surgery

Problem calls:

Please immediately call doctor if you develop significant pain, abdominal swelling fever or chills after the surgery. We are available  24 hours a day 7 days a week  on our pager.

Postoperative visit:

2-3 weeks after the surgery: for wound check and pathology report.