Surgery

Thyroid Disorders

At Mount Sinai, our endocrine surgeons are world-renowned for their treatment of thyroid gland disorders. From innovative research to discover the causes of thyroid disorders to leaders in the use of pioneering treatments, we are able to provide the most innovative treatments of your thyroid condition.

About Thyroid Glands

The thyroid gland holds an important role in your endocrine system. Located in your neck, your thyroid gland consists of two lobes, which sit to the right and the left of the trachea, or windpipe. The two lobes of your thyroid gland are connected by thyroid tissue that runs across the front of the trachea. Often described as looking like a butterfly, the thyroid is essential to your body’s metabolism and wellness.

Though small, your thyroid gland performs an important function in regulating your body. It produces a hormone called thyroxine, which, once released into your bloodstream, controls your body's metabolism, determines the rate at which your heart beats, and regulates the movement of your gastrointestinal tract. Thyroxine affects bone loss, as well as how your body makes and uses sugar. The function of your thyroid gland is regulated by your brain via the pituitary gland, which releases thyroid-stimulating hormone (TSH), which signals your thyroid gland to make and release thyroxine into your body.

Thyroid Conditions We Treat

If your thyroid gland produces too much or too little of thyroid hormone, your body reacts, creating imbalances or disorders of the gland. In addition, your thyroid gland may develop cancerous growths. Thyroid cancer is increasing in frequency, but like other thyroid disorders, thyroid cancer is treatable. The earlier we discover and treat any condition of the thyroid, the better.

  • Graves’ disease—a type of hyperthyroidism
  • Hyperthyroidism—overactive thyroid gland
  • Hypothyroidism—an underactive thyroid gland
  • Thyroid nodules—can be benign or malignant
  • Thyroid cancer—cancerous cells in the thyroid gland
  • Thyroid goiter and substernal goiters—benign enlargement of thyroid gland which may extend into your chest
  • Hashimoto’s thyroiditis—autoimmune related inflammation of the thyroid gland which may lead to hypothyroidism over time.

Thyroid nodule

A thyroid nodule is a common condition in which abnormal thyroid cells form a lump within the thyroid gland. Most thyroid nodules are benign (non-cancerous) though some thyroid nodules are at risk of being malignant (cancerous).

Most thyroid nodules do not cause any symptoms, but some of the symptoms may include:

  • A visible swelling at the base of your neck
  • Shortness of breath or difficulty swallowing when you press on your neck area
  • Increased thyroid hormone production may lead to weight loss, anxiety, sweating and an irregular heart beat
  • Mount Sinai’s experienced specialists may make a diagnosis of thyroid nodules by taking a detailed history and physical exam. Our surgeons also perform a thyroid ultrasound, a thyroid scan, and a fine-needle aspiration biopsy with or without ultrasound guidance.

Thyroid Cancer

While thyroid cancer is becoming more common, it is also increasingly treatable, especially when found early. Papillary thyroid cancer is the most common type of thyroid cancer, with follicular, medullary, anaplastic, and lymphoma being less common. A sign of thyroid cancer may be a nodule in the thyroid gland, or a hard lymph gland in the neck area.

To diagnosis thyroid cancer, we may perform a fine needle aspiration biopsy, a thyroid ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), a chest X-ray, a flexible nasolaryngoscopy, and a blood test, as needed.

Hyperthyroidism

Hyperthyroidism, a common disorder, is the result of too much thyroid hormone in the body due to an overactive thyroid gland. There are several types of hyperthyroidism, each with a different particular cause and different options for therapy, including:

  • Graves' disease—caused by antibodies in the blood which stimulate the thyroid to grow and produce excess hormone
  • Toxic multinodular goiter—an enlarged, lumpy thyroid gland in which individual thyroid nodules are responsible for excess thyroid hormone production
  • Thyroid adenoma—a single nodule within the thyroid gland
  • Thyroiditis—inflammation of the thyroid, possibly caused by an infection

We diagnose all types of hyperthyroidism with a physical exam, laboratory tests, and functional imaging. We measure your thyroid stimulating hormone (TSH) levels of thyroid hormone, and thyroid-stimulating antibodies that cause Graves' disease. We also conduct a radioactive iodine scan to analyze the over activity of your thyroid gland and if your hyperthyroidism is caused by Graves' disease.

Thyroid Treatments We Provide

At Mount Sinai, we offer a comprehensive, multidisciplinary approach to caring for you. Our thyroid specialists give you the convenience of a one-stop environment, where we meet all your thyroid needs in one location. Impressively, Mount Sinai is the only institution in the United States and one of a few in the world to offer three types of remote access, or “hidden-scar” approaches to thyroidectomy.

Those three approaches are as follows:

  • Transoral endoscopic thyroidectomy—the transoral endoscopic thyroidectomy approach (TOETVA) is a novel technique for performing minimally invasive node removal of your thyroid gland through hidden incisions. The procedure uses small incisions inside and underneath the lower lip to insert an endosopic camera and instruments to remove the thyroid gland. With this approach there is no incision or scar on the neck; the incisions in the oral cavity heal very quickly and are not visible with 7-10 days of surgery.
  • Robotic-assisted thyroid surgery—the latest robotic technology for large benign thyroid disorders and advanced thyroid cancers; uses four small incisions to the breasts and underarms. Referred to as the BABA approach (robotic bilateral axillo-breast approach), robotic instruments and a 3D camera are used for your optimal safety and effectiveness of the procedure. True pioneers in this field, Mount Sinai surgeons performed the first BABA procedures, including thyroid and modified radical neck (lymph node) dissection surgeries in the United States in 2015.
  • Endoscopic transaxillary thyroid surgery—a small incision is made under your arm so that the scar will be hidden (referred to as hidden scar surgery). May be used for partial or total thyroid removal for early stage thyroid cancer or Graves' disease.

We specialize in the more traditional techniques as well, including:

  • Open conventional thyroidectomy
  • Mini-incision thyroid surgery—a very small incision (between two and four centimeters or one inch) is made along natural skin creases in your neck to minimize the visibility of the scar; may be performed under local anesthesia with intravenous sedation.
  • Thyroid surgery under local anesthesia—the thyroid anesthesia team administers light sedation to ensure pain control and a very quick recovery.
  • Intraoperative nerve monitoring—during your surgery, your surgical team will be monitoring the nerves which control your voice box to ensure that your voice qualities are maintained
  • Lymph node excision (modified radical neck dissection, central neck dissection)— advanced thyroid cancers often spread to the adjacent lymph nodes. In such cases, lymph node dissection will be performed by your expert surgeons at Sinai to cure and prevent future cancer recurrence.

Through surgery, we are eliminating the cause of your thyroid condition, to restore and maintain your wellbeing. Follow up care may include medications, blood work and imaging studies.