Endocrine Surgery Program

Thyroid disorders

The thyroid gland is a butterfly-shaped gland located at the front of the neck. The hormone that it produces controls the body’s process of converting food into energy (metabolism) and is essential for growth and development as well as cardiac and bone function.

The following thyroid disorders can be surgically treated by our endocrine surgery team.

Thyroid cancer

Thyroid cancer is classified as either well-differentiated, when cancer cells appear similar to healthy thyroid cells, or poorly differentiated, when cancer cells do not look or behave like other cells.

We treat all thyroid cancers including:

• Papillary: This is the most common type of thyroid cancer and arises out of the “well-differentiated” cells. It often grows slowly.
• Follicular: This is the second most type of thyroid cancer. It also arises out of well-differentiated cells.
• Medullary: This represents an uncommon form of thyroid cancer originating from neuroendocrine "C-cells," which may be associated with an inherited syndrome but not in all cases.
• Anaplastic: This is the most rare and aggressive type of thyroid cancer. It requires a multidisciplinary team approach.

Our team expertly treats all stages of thyroid cancer—cancer that has spread to other parts of the body (metastatic), cancer that returns after remission (recurrent), and advanced thyroid cancer. We see complex patients in our multidisciplinary Advanced Thyroid Cancer Center.

Hyperthyroidism

Hyperthyroidism is an over-activity of the thyroid gland that results in too much thyroid hormone in the bloodstream. The two most common causes of hyperthyroidism are:

• Graves’ disease, an autoimmune disorder
• Toxic nodules, non-cancerous growths in the thyroid

Thyroid nodules

Thyroid nodules are common growths in the thyroid that can be benign (non-cancerous) or malignant (cancerous). They may need to be removed if cancer is suspected, if the nodule is secreting excess thyroid hormone (known as a hot nodule), or if they are causing symptoms, such as compression in the neck that makes breathing and swallowing difficult.

If a thyroid nodule meets the criteria for biopsy, a biopsy can be performed at the Mass General Brigham Thyroid Biopsy Clinic at Newton-Wellesley Hospital. This multidisciplinary clinic brings together endocrinologists, thyroid surgeons, and cytologists in one location. The clinic is intended to provide up to date, streamlined care to patients, along with dedicated evaluation and fine-needle aspiration for thyroid nodules.

Thyroid goiter

A thyroid goiter is an enlarged thyroid gland. Thyroid glands with multiple benign thyroid nodules may also be referred to as a multinodular goiter. Depending on the size and cause of the overgrowth, symptoms, such as compression in the neck or secretion of excess thyroid hormone, it may require surgery.

Pediatric and adolescent thyroid tumors

Dedicated thyroid surgeons at Mass General Brigham perform these operations frequently in adults. However, children have different anatomical and physiologic considerations. Thyroid disorders requiring surgery are less common in children. The Pediatric Thyroid Surgery Program combines an experienced adult thyroid surgeon with a pediatric surgeon who is an expert at dealing with the unique aspects of pediatric patients. This collaboration allows us to provide the highest quality of care available for children with diseases of the thyroid.

Parathyroid disorders

The parathyroid glands are four pea-sized glands located in the neck next to the thyroid gland. The hormone produced by the parathyroid glands plays a key role in regulating calcium, phosphorous, and vitamin D levels in the blood.

The following parathyroid disorders can be surgically treated by our endocrine surgery team at Mass General Brigham.

Hyperparathyroidism

Primary hyperparathyroidism is an over-activity of the parathyroid gland(s) resulting in elevated calcium levels in the blood. High calcium levels can lead to other problems in the body, such as kidney stones and bone thinning. Our team has expertise in determining whether you have surgically correctable disease and treatment.

Parathyroid cancer

Parathyroid tumors are rare growths inside the parathyroid gland(s). Most parathyroid tumors are noncancerous (benign). Parathyroid cancer can be treated by our multidisciplinary surgical team.

Adrenal disorders

The adrenal glands are small glands located at the top of the kidneys that produce many important hormones that regulate several bodily functions including metabolism, blood pressure, and response to stress.

The following adrenal disorders can be surgically treated by our endocrine surgery team at Mass General Brigham.

Incidental adrenal nodules

Adrenal nodules can be detected on imaging studies for other diseases and can be functional (cancerous) or non-functional (non-cancerous, as it does not produce hormones). The majority of adrenal nodules are benign. Our multidisciplinary group can help determine if you need to have an adrenal nodule removed.

Our Adrenal Nodule/Secondary Hypertension Program is a multidisciplinary group of primary care physicians, endocrinologists, and surgeons that will evaluate and triage patients with incidentally found or functional adrenal nodules/tumors. Call the program at 617-643-7359.

Adrenal cancers

We treat a full range of both primary adrenal cancer (those that arise from the adrenal gland) and secondary adrenal cancer (those that spread to the adrenal glands from other organs). Primary adrenal cancer is a rare form of cancer treated by a multidisciplinary team of endocrinologists, surgeons, and medical oncologists, all of whom are expert in evaluating and treating all types of adrenal tumors.

Functional adrenal tumors and nodules

Functional adrenal tumors and nodules are often non-cancerous (benign). Functional growths result in overproduction of adrenal hormones and may lead to:

• Cushing’s disease (also known as hypercortisolism), which occurs when the body produces too much cortisol, a hormone related to the body’s stress response.
• Primary hyperaldosteronism, which occurs when the adrenal glands produce too much aldosterone, the hormone responsible for balancing potassium and sodium.
• Pheochromocytoma, a rare tumor that can form in the adrenal glands.
• Sex-hormone-secreting tumors, which are tumors that produce estrogen, progesterone, or testosterone, resulting in behavior changes.

Inherited syndromes

Certain uncommon inherited syndromes, such as multiple endocrine neoplasias, have a familial tendency and can affect multiple endocrine organs. Our team is well-versed in assisting patients and their families in securing accurate diagnoses, conducting genetic testing and counseling, and providing treatment for these rare diseases.

Thyroid

Thyroid ultrasound and fine needle aspiration

Thyroid nodules are very common. They are most often found through a physical exam or incidentally with imaging for other diseases. When a thyroid nodule is discovered, your provider may recommend that you undergo a thyroid ultrasound and fine needle aspiration. This is a minimally invasive procedure used to remove a small tissue sample from a nodule found within the thyroid gland. The sample undergoes analysis in the laboratory to determine and test for the presence of cancer. This technique can also be used for specialized molecular and gene expression profiling.

If a thyroid nodule meets the criteria for biopsy, a biopsy can be performed at the Mass General Brigham Thyroid Biopsy Clinic at Newton-Wellesley Hospital. This multidisciplinary clinic brings together endocrinologists, thyroid surgeons, and cytologists in one location. The clinic is intended to provide up to date, streamlined care to patients, along with dedicated evaluation and fine-needle aspiration for thyroid nodules.

Thyroid radiofrequency ablation

Thyroid radiofrequency ablation (RFA) is a minimally invasive thermal technique involving the precise delivery of targeted energy into a thyroid nodule through a thin needle-like electrode. The electrode is guided through the nodule, administering controlled heat that causes the nodule to break down, leading it to decrease in size without harming the surrounding thyroid tissue. RFA is particularly effective for treating symptomatic or cosmetically bothersome benign thyroid nodules that are overactive. Unlike conventional thyroid surgery, which requires general anesthesia and results in scarring, RFA is performed through a small skin puncture under ultrasound guidance. Please call 617-643-3421 to refer a patient for thyroid radiofrequency ablation.

Thyroid lobectomy

A thyroid lobectomy is the removal of half of the thyroid gland (one lobe) and the tissue that connects the thyroid lobes (isthmus). It is most often used to treat thyroid cancer, thyroid nodules, and conditions causing an overproduction of the thyroid hormones, such as hyperthyroidism.

Total thyroidectomy

A total thyroidectomy is the removal of the entire thyroid gland. This procedure is most often used to treat thyroid cancer, or it may be recommended for other conditions that are unable to be treated using other techniques.

Sistrunk procedure

A Sistrunk procedure is done to remove thyroglossal duct cysts, which are small, soft lumps that form in the throat, typically at birth (congenital). Thyroglossal cysts are very rare and usually benign.

Lymph node removal

A lymphadenectomy, or removal and dissection of the lymph nodes, is done for patients who have recently been diagnosed with certain types of cancers that are likely to spread to the lymph nodes. By studying the lymph nodes closest to the tumor, your care team can learn if the cancer has spread beyond the tumor and, if so, how far it has spread. This will help to determine the best approach for treating and preventing further spread of the cancer. Our endocrine surgeons have extensive experience in performing lymph node removal, also called neck dissections.

Parathyroid

Parathyroidectomy

A parathyroidectomy is the removal of the parathyroid gland. At Mass General, our endocrine surgery team performs parathyroidectomies through both minimally invasive techniques, such as entering through the mouth so that an incision is not needed, and traditional techniques, such as four-gland exploration. This procedure is most often used to treat hyperparathyroidism, parathyroid nodules, and parathyroid tumors.

Adrenal

Robotic adrenalectomy

Robotic adrenalectomy is a minimally invasive approach that uses small incisions and tools to remove an adrenal gland if it is cancerous or producing too much adrenal hormone. A minimally invasive approach to adrenalectomy means less pain after surgery, faster recovery times, minimal scarring, shorter hospital stays, and more. Using our robotic surgical system, our surgeons can ensure surgical precision. Robotic surgery enhances your surgeon's ability to clearly visualize the surgical site and operate using a stable, computer-guided tool.

Laparoscopic adrenalectomy

A laparoscopic adrenalectomy is a minimally invasive approach that uses small incisions and tools to remove an adrenal gland if it is cancerous or producing too much adrenal hormone. A minimally invasive approach to adrenalectomy means less pain after surgery, faster recovery times, minimal scarring, shorter hospital stays, and more.

Open adrenalectomy

Although the majority of adrenal surgery can be performed laparoscopically, large and/or advanced tumors sometimes require a larger incision to remove the tumor along with surrounding tissue and organs. Our surgeons have a wide range of experience in performing open procedures.

Frequently asked questions

How do I request an appointment for endocrine surgery?

You can request an appointment by calling our team at 617-643-7359. Our care coordinator will then answer any questions you may have and guide you through the process.

Our goal is to schedule the first appointment within one to two weeks of the initial request. In order to expedite the scheduling process, we encourage you to confirm your coverage with your health insurance and/or obtain a referral from your primary care physician prior to your first visit.

Why would I need endocrine surgery?

Endocrine surgery aims to treat disorders that affect the thyroid, parathyroid, and adrenal glands. These glands release hormones into the bloodstream for the body to use in various ways—the thyroid glands release hormones to regulate your metabolism, the parathyroid glands release hormones to regulate calcium, vitamin D, and phosphorous levels, and the adrenal glands release hormones to regulate stress and reproductive health. Your doctor may recommend endocrine surgery to treat a diseased or malfunctioning gland.

What Is the thyroid gland and its function?

The thyroid gland is shaped like a butterfly; the lobes of the thyroid look like wings and the connecting piece between the lobes (isthmus) looks like the butterfly’s body. The thyroid gland sits on top of and to the sides of the windpipe (trachea) just above the collar bone.

The thyroid gland produces hormones that are essential for growth and development, energy metabolism, and normal cardiac and bone function. When your thyroid is under-functioning (hypothyroid), you may feel cold and tired, and experience muscle aches, dry skin, and hair loss. When your thyroid is over-functioning (hyperthyroid), you may feel anxious and hot, involuntarily lose weight, feel palpitations and rapid heartbeat, and have a difficult time sleeping and breathing.

What are the parathyroid glands and their function?

The parathyroid glands are four pea-sized glands located in the neck behind the thyroid gland. The hormone produced by the parathyroid glands plays a key role in regulating the calcium levels in the blood as well as phosphorus and vitamin D levels.

When your parathyroid gland is overproducing hormone (hypercalcemia), you may experience joint and bone pain, muscle aches and cramping, thirst and frequent urination, and fatigue. When your parathyroid gland is underproducing hormone (hypocalcemia), you may experience skin tingling, muscle cramping, dry skin, and confusion.

What are the adrenal glands and their function?

The adrenal glands are small, triangle-shaped glands located at the top of the kidneys. They produce many important hormones that regulate several bodily functions, including metabolism, blood pressure, and the body’s response to stress.

The signs of a problem with the adrenal glands will depend on the condition and which hormone is being affected. You may experience metabolic symptoms such as involuntary weight gain or loss, fatigue, or weakness; symptoms related to the immune systems such as frequent sickness; or symptoms related to blood pressure such as high or low blood pressure.

What are some common endocrine disorders treated with surgery?

Conditions commonly treated by endocrine surgery are:

• Thyroid tumors (benign and malignant)
• Adrenal tumors (benign and malignant)
• Parathyroid cancer (benign and malignant)
• Hyperthyroidism
• Hyperparathyroidism
• Thyroid nodules
• Thyroid goiter
• Cushing’s disease

What happens if my endocrine system is damaged?

Endocrine disorders indicate a hormonal imbalance, which is when the body is either over or underproducing a particular hormone. This imbalance could either be long-term or temporary. The symptoms will vary based on the glands that is affected and the hormone that is out of balance. Your care team will perform tests to check your hormone levels and determine if you have an endocrine disorder.

If one is discovered, your Mass General Brigham endocrine team will work with you to create your personalized care plan to treat the disease.