Dr. Robert M. Wald JR., MD

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.

Tonsillectomies are usually performed on children; however, many adults also undergo the procedure. A tonsillectomy generally only lasts for about half an hour following the administration of anesthesia. The otolaryngologist (ENT) or surgeon performing a tonsillectomy may employ a variety of medical techniques, such as:

• Cold Knife Dissection: A cold knife dissection is the most popular tonsil removal method. A surgeon removes the tonsils using a steel scalpel and repairs the region with sutures (stitches) or electrocautery (high heat) to stop bleeding. This technique is favored for those with obstructed breathing.
• Electrocautery: Other tonsillectomy methods include a full tonsil removal by electrocautery, where the surgeon uses a high heat device to burn off the tonsils and cauterize the bleeding tissue. Electrocautery is more painful than cold knife dissection.
• Harmonic Scalpel: A third technique is where the surgeon uses a harmonic scalpel (vibrating bladed device) to first cut off the tonsils, and then coagulate bleeding using the harmonic scalpel's heat and vibration. Harmonic scalpel is the most precise form of tonsillectomy.
• Radiofrequency Ablation: To perform the radiofrequency ablation technique, the surgeon places small probes into the tonsil that transmit radiofrequency energy to the tonsil tissue. The delivered energy damages and scars the tonsils, gradually minimizing the tonsils' size. Unlike the other three methods, radiofrequency ablation is performed in-office with or without general anesthesia and has minimal recovery time. Patients can expect to return to daily activities nearly immediately and may receive radiofrequency ablation every few months. While radiofrequency ablation does reduce tonsil inflammation, it is not often prescribed to those with severe tonsillitis or breathing disorders.

Patients are typically able to return home shortly after having their tonsils removed. Tonsillectomy recovery time may range from around ten days to two weeks. During this time, it is common for patients to have a sore throat, neck pain, and a hoarse voice. Patients are advised to consume soft foods such as ice cream and applesauce to avoid further throat irritation. After recovering from tonsillectomy, many patients experience improved breathing, reduced irritation, and an overall improved quality of life.