Dr. Monther Saud Amer Altiti, MD, FACS

One kind of parathyroid surgery is called bilateral neck exploration. The surgeon finds and looks at all of the parathyroid glands on both sides of the neck, visually identifying any that are diseased and removing them. Minimally invasive, or focused, parathyroidectomy is done to remove a single diseased gland. The gland causing problems is identified before surgery using localization techniques such as hormonal or radiology testing. Since in most cases only one gland is causing problems, focused parathyroidectomy is a common alternative to bilateral neck exploration. Both procedures are safe and effective.

In the rare case that all four glands are diseased, the surgeon will either remove three and a half glands and leave one half in place, or all four will be removed and part of one gland will be transplanted into the forearm. This is done to keep calcium levels where they should be.

After surgery, patients will have a bandage on their neck and a sore throat. Patients may only want liquids or very soft food for the first day, and thy may be asked to take calcium supplements for a while until their remaining parathyroid glands begin functioning well again. Recovery is fairly quick, and within a few days patients should be feeling like themselves again.

Both hypothyroidism and goiters are caused by an autoimmune reaction where the body produces antibodies that attack the thyroid cells for unknown reasons. The thyroid reacts by releasing too little or too much T3 and T4 thyroid hormones, impairing thyroid function and causing irregular metabolism. Goiters develop from the autoimmune reaction causing continued antibody damage to the thyroid over time. Thyroid goiters are large, swollen lumps that can be felt near the base of the neck. Obstructive goiters can cause pain, coughing, and abnormal breathing. Hypothyroidism may also be caused by iodine deficiency, as iodine is needed to produce thyroid hormones.

The exact cause of thyroid cancer and thyroid nodules or cysts is unknown. While thyroid cancer and thyroid nodules or cysts can occur in individuals with thyroid disorders, they are not associated with a malfunctioning thyroid.

Physicians may prescribe thyroid surgery if blood tests reveal patients' thyroid stimulating hormones (TSA) are outside of the acceptable range, indicating a malfunctioning thyroid. Thyroid biopsies (tissue samples) and tests for thyroid-attacking antibodies are also criteria for surgery.

An ENT or general surgeon performs thyroid surgery. While a patient is placed under anesthesia, the surgeon makes an incision at the center of the neck and removes the thyroid gland. Two alternative methods of thyroid surgery are transoral (incision through the mouth) and endoscopic, where a surgeon operates a video camera for live footage to help guide the removal process.

Thyroid surgery requires minimal aftercare. Most patients recover quickly and resume normal activities within a few days of surgery. However, thyroid surgery patients must take daily synthetic thyroid medication (levothyroxine) for life to replace their removed thyroid.

By far the most common of the gastric bypass surgeries is called Roux-en-Y. During this surgery, part of the stomach and small intestine are detached from the gastrointestinal tract, in order to make the tract smaller. The surgeon divides the stomach into two parts. The working stomach, at the end of the esophagus, is now tiny - only the size of a walnut. This makes patients feel full after eating a small amount of food. Then the small intestine is also divided, and after bypassing a section of the small intestine to reduce food absorption, the intestine is attached to the small stomach pouch. The patient now has a working stomach and intestine like before, only much smaller.

Because gastric bypass is used to treat extreme obesity, it can reduce the risk of some of the problems associated with obesity. Gastric bypass can help treat or reduce the risk for such conditions as heart disease, high blood pressure, sleep apnea, and type 2 diabetes. However, it is a major surgery and also carries risks itself. Any surgery can lead to infection, bleeding, or blood clots, and weight loss surgery in particular carries risks of leaks in the gastrointestinal system, malnutrition, bowel obstructions, and vomiting.

Typically patients are considered candidates for gastric bypass surgery if they have a BMI greater than 40, or sometimes if they have a BMI between 35 and 40 but are suffering from obesity-related illnesses such as diabetes. The outlook is generally good, with most patients losing between 50-75% of their excess weight in 1-2 years. However, patients must follow strict diet guidelines so that the stomach can heal, starting with no food at all, then followed by a liquid diet for some time. For many severely obese patients who have tried strict diets before without success, gastric bypass surgery is the tool that allows them to finally achieve their weight loss and health goals.