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Dr John McGuinness is an expert in surgery of the thyroid and parathyroid glands. Dr McGuinness only performs operations in the head and neck region, which is quite different to many surgeons.  Most surgeons perform thyroid operations only a few times per year, if at all. Dr McGuinness personally performed over 70 operations on the thyroid glands in the last year alone. This means he is extremely comfortable operating in the neck, he is familiar with the anatomy and because of his background in head and neck cancer surgery is extremely comfortable with difficult cases and revision thyroid and parathyroid surgery.

Concentrating on only one area means that Dr McGuinness can remain at the forefront of this rapidly developing field. We offer in room ultrasound examination of the thyroid with same visit fine needle biopsy (FNAC) if required. This avoids multiple visits to different specialists and aims to make the whole process as pain free and convenient for you as possible.

It is our strong belief that thyroid and parathyroid surgery should be performed without unexpected complications. All thyroid operations are performed with intra-operative nerve monitoring (IONM) of the laryngeal nerves. We think that this ensures optimal voice results for all of our patients. Minimally invasive, endoscopic (key-hole) thyroidectomy is also available but only if we think it is right for your particular thyroid problem. 

We work closely with a team of endocrinologists (medical thyroid specialists) to ensure that all patients with thyroid and parathyroid problems get the best possible advice and treatment.

The Thyroid Gland

The thyroid gland is a butterfly shaped organ that sits in front of the windpipe at the base of the neck. You cannot usually see the thyroid gland except in very thin people. There are two thyroid lobes joined in the middle by the isthmus. The thyroid is attached to the trachea (windpipe) and moves with swallowing.

Thyroid Hormones

The job of the thyroid gland is to make hormones. T3 (tri-iodothyronine) and T4 (thyroxine) are the two main hormones. To make these hormones, the thyroid absorbs dietary iodine from the circulation and uses it as a building block to make thyroid hormones. The production of these thyroid hormones is controlled by another important hormone from the pituitary gland (part of the brain) this is called thyroid stimulating hormone or TSH for short. TSH makes the thyroid gland secrete more hormones into the bloodstream. T3 and T4 act on many tissues throughout the body especially those involved in growth and metabolism. A simple blood test, called a thyroid function test, measures these hormones in the blood stream and can help to diagnose problems with the thyroid gland.

An Overactive or Underactive Thyroid

Producing too much or too little thyroid hormones can make you unwell. These common conditions can be looked after by your family doctor though they may need to ask an expert on hormone problems, an Endocrinologist, for advice. Only rarely would you require an operation for an underactive or overactive thyroid gland. Surgery can sometimes be useful if you have an overactive gland and medicines do not control the problem or are not suitable for you. (See Surgery for Hyperthyroidism)

An underactive gland- Hypothyroidism

When the thyroid gland does not produce enough thyroid hormone, it is called hypothyroidism. This is an extremely common condition and is ten times more common in women than in men.

What causes an underactive thyroid gland?

  • Aplasia- this is where the thyroid gland does not develop leading hypothyroidism. Affected babies do not produce thyroid hormones and may have problems with mental and growth retardation unless the condition is recognised and treated with thyroid hormones.
  • Lack of Dietary Iodine - the gland is missing a key ingredient needed to make thyroid hormones; this causes the gland to enlarge (a Goitre) and produces hypothyroidism if iodine levels are very low. In some areas, the diet contains very little iodine and so hypothyroidism and swollen thyroids are common (Endemic Goitre).
  • Dyshormonogenesis-this means that the thyroid lacks the chemical enzymes to turn iodine into thyroid hormones. This can be caused by
    • Genetic problems
    • Some drugs which can interfere with hormone production and lead to hypothyroidism e.g. Amiodarone
  • Autoimmune Thyroiditis- this is the most common cause of hypothyroidism. It is similar to rheumatoid arthritis where the body mistakenly produces antibodies to the cartilage in the joints. In autoimmune thyroiditis the antibodies bind to parts of the thyroid gland (thyroid autoantibodies). They cause damage and inflammation of the gland leading to swelling and underactivity.
    • Atrophic hypothyroidism
    • Hashimoto’s Thyroiditis. This condition progressively damages the gland and prevents it from making thyroid hormones resulting in hypothyroidism. It is also a common cause of thyroid nodules.
  • Following Total Thyroidectomy or Radio-iodine treatment. Some of the treatments used for overactive thyroid glands and for the treatment of swollen or cancerous glands may produce hypothyroidism as a side effect.

What are the symptoms of hypothyroidism?

Thyroid hormones play a role in controlling metabolism. Too little thyroid hormone slows down the metabolism, making you feel as if you lack energy and can cause you to gain weight. Your hair may become thin and change in texture. Your heart rate, movements and reactions may all become slow.

How is hypothyroidism diagnosed?

A Thyroid Function Test (TFT) is a simple blood test that can tell your doctor if your thyroid gland is working well. Thyroid autoantibodies can also be detected in the blood and can help in diagnosing autoimmune hypothyroidism. In hypothyroidism there is usually a:

  • Raised TSH
  • Low T3, T4
  • Elevated Thyroid Auto-antibodies may occur with autoimmune hypothyroidism (Hashimoto’s Thyroiditis)

Is there any treatment for hypothyroidism?

The most common treatment for hypothyroidism is hormone replacement with Oroxine (T4 or thyroid hormone). It is taken once daily as a tablet and the dose adjusted using the TSH level in the bloodstream as a guide.

Tips for Taking Thyroxine (Oroxine)

Sometimes it is a struggle to find the right dose of thyroxine for a particular patient. This often happens if the patient takes the right dose in the wrong way. Following these simple instructions should help:

  • Oroxine is taken as a tablet. You must take it once a day every day. Do not miss days except on the instructions of your doctor.
  • Take it after fasting for 4 hours,
  • Do not take any other food for at least 20-30 min
  • Avoid other drugs especially calcium carbonate (Caltrate) for at least 30 min before or after your Oroxine
  • Fruit juices may interfere with Oroxine absorption

So the best advice is to take your thyroxine when you wake up in the morning and don’t eat or drink anything except water for 30 minutes afterwards.

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