Risk factors and symptoms to identifyHyperthyroidism is characterized by an excessive secretion of thyroid hormones in the blood: increased levels of triiodothyronine (T3) and thyroxine (T4). The result is that the body’s functions accelerate. These metabolic disturbances cause a wide variety of symptoms that can be easily attributed to a dysfunction of the thyroid gland.
The causes of this dysregulation remain unknown, although a family history may play a role in the development of this condition.
Self-diagnosis: main symptoms for detecting possible hyperthyroidism:
- Unexplained excessive thirst.
- Normal appetite, associated with rapid and significant weight loss.
- Intolerance to heat.
- Hot flushes and excessive sweating.
- Irritability, nervousness.
- Difficulty falling asleep, insomnia.
- Hyperactivity and fatigue.
- Presence of a goiter.
- Exophthalmos (bulging eyes that protrude beyond their orbits, reduced vision).
- Frequent loose bowel movements (diarrhea).
- Heart palpitations (tachycardia).
- Amenorrhea (menstrual periods that are less frequent or even absent).
All these symptoms may come on gradually, depending on the severity of your dysregulation. Only a blood test can accurately determine the level of TSH: in case of hyperthyroidism, the TSH level is abnormally low.
The causes of hyperthyroidismThe main cause of hyperthyroidism is Basedow’s disease, an autoimmune disease that stimulates the production of thyroid hormones. It can occur at any age with a peak frequency between the ages of 20 and 40.
Other causes include an excess of iodine (from food, medications), toxic adenoma, toxic multinodular goiter.
The case of Basedow’s diseaseBasedow’s disease (also known as Graves Basedow disease) is an autoimmune disease that mainly affects women (between the ages of 20 and 40) although it can also occur in children. If it develops during pregnancy, it can have serious consequences for the fetus (medical complications).
The body starts to make antibodies that will attack the person’s own immune system. The antibodies will attack the thyroid cells, and more specifically the receptor of TSH (Thyroid Stimulating Hormone), a hormone secreted by the pituitary gland that regulates the functioning of the thyroid (responsible for the secretion of the thyroid hormones T3 and T4).
Orbitopathy (or exophthalmos) (bulging eyes) is one of the main features of this disease. The entire orbit is affected and exhibits the following symptoms:
- Sensation of eye irritation.
- Swollen eyelids.
- Bulging eyes.
- Double vision /reduced vision.
How is hyperthyroidism treated?There are three possible treatments for hyperthyroidism:
- Medication (antithyroid medications) which stop the production of hormones.
- Radioactive iodine, very effective in case of toxic nodules or Basedow’s disease.
- Surgery: removal of all or part of the thyroid gland (Basedow’s disease or presence of toxic nodules).
To date, this disease remains quite mysterious because there has been very little progress in treatments and medical care.
Use of the FLUOBEAM® LX in endocrine surgeryThyroidectomy is an operation that consists in removing all or part of the thyroid gland (by making a horizontal incision at the base of the neck). When performing this operation, identifying the parathyroid glands can be a real challenge, even for the most skilled surgeons. Due to their small size (just a few millimeters), the parathyroid glands are often difficult to detect, which may cause them to be accidentally damaged, leading to postoperative complications (hypocalcemia).
FLUOBEAM® LX is a fluorescence imaging system developed by FLUOPTICS© and designed to provide surgeons with clear and reliable information in real time during surgery. Exclusively dedicated to thyroid and parathyroid surgery, FLUOBEAM® LX has high sensitivity specifically suited for the detection of weak fluorescence signals. This innovative device thereby allows surgeons to operate under optimal conditions.
The medical protocol consists first of detecting the parathyroid glands by autofluorescence in order to locate and preserve them during thyroid resection.
The surgeon can also decide to inject indocyanine green during surgery to identify the vessels that vascularize the parathyroid glands and preserve this vascularization during thyroid resection. The result is that FLUOBEAM® LX provides clear and reliable information allowing surgeons to operate in the best possible conditions.
The symptoms of hyperthyroidism are easy to identify … The most common cause is Basedow’s disease, an autoimmune disease which mainly affects women, usually between the ages of 20 and 40. Thyroidectomy is a surgical option to be considered according to the severity of thyroid gland dysfunction … An operation that induces a certain amount of stress because of the possible postoperative complications (such as hypocalcemia, the most common, which is related to inadvertent damage to the parathyroid glands). Routine use of the FLUOBEAM® LX system could significantly reduce the rate of postoperative hypocalcemia. This reliable, easy to use device provides real-time assistance to surgeons allowing them to operate under optimal conditions.
What are the symptoms of hyperthyroidism?Hyperthyroidism is a disorder related to a dysfunction of the thyroid gland, a butterfly-shaped endocrine gland located at the base of the neck. Hyperthyroidism has different causes, the most common (75-80% of cases) being Graves’ disease, an auto-immune disorder, which mainly affects women and results in an over-production of thyroid hormones.
Symptoms that may indicate potential hyperthyroidism:
- Persistent fatigue;
- Unexplained weight loss;
- Excessive thirst;
- Oversensitivity (irritability);
- Heart palpitations and tremor;
- Bulging eyes;
- Visible goiter, due to enlargement of the thyroid gland;
- Irregular heartbeat;
- Hot flushes;
- Polycystic ovary syndrome (hypothyroidism/hyperthyroidism).
All these symptoms may indicate that your thyroid is overactive. Hyperthyroidism can be caused by a number of factors including a benign tumor in the thyroid gland, thyroid cancer, a toxic nodule or a goiter.
What are the symptoms of hypothyroidism?Hypothyroidism is a thyroid disorder related to a deficiency of thyroid hormones. The secretion of thyroid hormones (T3 and T4) is regulated by the pituitary gland, which produces TSH (Thyroid Stimulating Hormone). The result: metabolism is slowed down.
After the age of 50, women are more exposed to the risk of hypothyroidism.
Here are the main symptoms of hypothyroidism:
- Persistent fatigue;
- Unexplained chilliness (always feeling cold);
- Unexplained weight gain;
- Decreased appetite;
- Slowed heart rate;
- Elevated blood cholesterol level;
- Painful joints, muscle aches;
- Changes in menstrual patterns;
- Unusual constipation;
- Presence of a goiter (enlarged thyroid gland);
- Puffy face, bulging eyes;
- Difficulty concentrating, impaired memory;
- Dry skin (possibly with redness);
- Fragile, brittle nails;
- Hair loss;
- Hoarse or cracked voice.
When the thyroid doesn’t produce enough hormones, there can be a number of causes:
- Hashimoto’s disease (which leads to destruction of the gland). Hashimoto’s thyroiditis is the most common cause;
- Iodine deficiency;
- Post-operative complication of a thyroidectomy (removal of the thyroid gland);
- Some medications.
Congenital hypothyroidism is a disorder related to abnormal functioning of the thyroid gland right from birth. In developed countries this disorder affects 1 in 3,000 newborns.
Some cases of mild hypothyroidism can be treated with natural precursors of thyroid hormones which are very effective and avoid the side effects of certain thyroid medications.
Palpation of the neck to better detect the signsPalpation of the base of the neck is the first step in a thyroid exam to detect any thyroid abnormalities, before referral for an ultrasound.
Palpation of the thyroid gland is done while the patient is seated. The physician gently places his or her hands on both sides of the neck, under the jaw, then slides the fingers downward to the base of the neck where the thyroid gland is located.
The purpose of palpation is to assess the symmetry of the gland and detect any possible enlargement.
The physician then palpates the anterior and posterior cervical lymph nodes.
Thyroid: when is it necessary to operate?Thyroidectomy involves making a small incision at the base of the neck. The need for surgery (thyroidectomy) can arise in two situations: when medication alone does not succeed in stopping enlargement of the gland (causing problems with swallowing), and when there is a toxic nodule (symptoms of thyroid cancer).
Surgery for suspicious nodules involves removing all or part of the thyroid gland.
Before surgery, the physician orders several exams including an ultrasound and Doppler (to assess the vascularization of toxic nodules and for cytological puncture).
When is surgery needed?
- A large nodule measuring more than 4 cm;
- Presence of several nodules forming a goiter;
- Nodule filled with fluid;
- When a risk of thyroid cancer is suspected.
In some thyroid cancers, radioactive iodine therapy is recommended to complete the surgery.
What are the benefits of the new FLUOBEAM® LX?In the field of endocrine surgery, significant progress has been made in medical imaging. The new FLUOBEAM® LX is an innovative system designed to improve the quality of thyroid surgery. Developed by FLUOPTICS©, the FLUOBEAM® LX is a state-of-the-art imaging system enabling surgeons to clearly see the parathyroid glands in real time thanks to the autofluorescence of these glands.
This innovative protocol allows surgeons to first identify the parathyroid glands so as to locate them and preserve them during resection of the thyroid.
The surgeon may also decide to inject indocyanine green during surgery to locate the vessels that perfuse the parathyroid glands, and thereby preserve their vascularization during thyroid resection.
Lastly, at the end of surgery the surgeon can check the perfusion of the parathyroid glands using another injection of indocyanine green.
With a sensitivity, specifically adapted to detect low level of fluorescence intensities, the FLUOBEAM® LX provides surgeons with clear, precise information to better meet medical needs and operate in the best possible conditions.
Each year, 45,000 people undergo thyroid surgery, a common procedure but one which has certain risks, such as hypocalcemia. Thanks to the progress made by FLUOPTICS© in the field of medical imaging, the rate of postoperative complications of thyroidectomy has dropped from 20 to 5%. With this innovative system, surgeons have a reliable, easy to use tool enabling them to clearly and accurately identify the parathyroid glands and avoid inadvertently damaging or excising them.
Thyroidectomy (partial or total removal of the thyroid gland) is performed in around 45,000 patients in France each year, and in millions of people worldwide. Like any type of surgery, this procedure has risks and can cause postoperative complications.
FLUOPTICS© opens up new perspectives in endocrine surgery with its FLUOBEAM® imaging system based on autofluorescence technology, enabling detection of parathyroid glands in autofluorescence. By making It possible to view the parathyroid glands in real-time during surgery, it assists the surgeon and makes surgery safer. Today, FLUOPTICS© goes a step further with its launch of FLUOBEAM® LX, a device exclusively dedicated to thyroid and parathyroid surgery. A major innovation whose aim is to significantly reduce some of the risks inherent to this type of procedure.
To read more about it : How is thyroid dysfunction detected?
Thyroid surgery: what are its characteristics?
A thyroidectomy is the total or partial removal of the thyroid gland. This surgery is indicated in different situations, such as thyroid cancer, suspicious toxic nodules or cancerous cells, enlarged goiter, etc. It is performed under general anesthesia and involves making a small horizontal incision at the base of the neck. The thyroid gland, which produces the hormones T3 and T4, is responsible for regulating many vital bodily functions including metabolism, body temperature and heart rate.
A patient who has a total thyroidectomy must receive lifelong hormone replacement therapy (based on TSH level which is progressively adjusted).
What are the complications?
Thyroid surgery can cause a number of postoperative complications, mainly due to inadvertent damage to the pharyngeal nerves (the nerves of the vocal cords) which are exposed during surgery, or due to injury to the parathyroid glands, which are very small and difficult to see.
- Hypoparathyroidism (or hypocalcemia): when the parathyroid hormones can no longer regulate calcium levels after thyroid surgery (because the parathyroid glands were accidentally damaged or excised during surgery). In 90% of cases, this complication is reversible.
- Postoperative hematoma: this is a very rare complication which can be serious if the hematoma compresses the trachea.
- Hoarseness and difficulty swallowing: these are very common postoperative complications due to the position of the inferior pharyngeal nerves. These symptoms can last for up to eight weeks after surgery.
- Laryngeal dyspnea: breathing problems caused by a decrease in the caliber of the laryngheal branch (extremely rare).
- Postoperative hemorrhage: very rare.
Although these complications are rare if one looks at the total number of thyroid surgeries performed, they nonetheless occur in nearly 200,000 patients worldwide!
FLUOBEAM® imaging system
The FLUOBEAM® fluorescence imaging system has made great strides in thyroid surgery. Since 2015, it has been used in more than 2,000 thyroid surgeries to guide the identification of the parathyroid glands in autofluorescence. In close to 30% of cases, FLUOBEAM® Identified the parathyroid glands before the surgeon could even see them! Indeed, due to their small size, the parathyroid glands can be difficult to locate, even for a skilled surgeon, which may cause them to be accidentally damaged or excised. Thanks to their detection by autofluorescence, FLUOBEAM® makes surgery safer. One study showed that the rate of postoperative hypocalcemia could be reduced from 20 to 5%!
Used across several surgical indications – breast reconstruction, endocrine surgery, hepatic surgery – this polyvalent system has been roundly applauded by the scientific community.
The first imaging system approved (in Europe and the United States) for looking at the parathyroid glands by autofluorescence, intraoperative fluorescence imaging technology was designed to be used in a variety of surgical procedures and so there is still room for improvement in this particular indication. Therefore, based on the experience acquired over several years of FLUOBEAM® use, FLUOPTICS© has devised a solution dedicated to thyroid and parathyroid surgery.
FLUOBEAM LX: a tailor-made device for thyroid and parathyroid surgery
To better meet the needs of surgeons, FLUOPTICS© is introducing the new FLUOBEAM® LX, specifically developed and dedicated to thyroid and parathyroid surgery in order to provide optimal ease of use in this indication. With a sensitivity, specifically adapted to detect low level of fluorescence intensities, it allows the detection of parathyroid glands in autofluorescence with suitable Image fluidity (25 images per second), a large depth of field and a use compatible with the ambient lighting of the operating theatre.
Designed to be held effortlessly above the operative field, and controlled with one hand by the surgeon, FLUOBEAM® LX is a true third eye which makes thyroid surgery safer.
Benefits for patients
FLUOBEAM® LX is a significant technological advance in the field of thyroid surgery. Above all it helps reassure patients, who are often worried about undergoing thyroidectomy. The FLUOBEAM® LX system dedicated to thyroid surgery could greatly reduce certain postoperative risks: reduced rate of auto-transplantation, postoperative hypocalcemia, hoarseness and swallowing problems, etc.
Benefits for surgeons
In the operating theatre, FLUOBEAM® LX facilitates the surgeon’s work by assisting the surgeon in accurately identifying the parathyroid glands (located near the thyroid gland), enabling them to be seen in real-time and preserved during surgery. An even more powerful imaging system that means surgeons can operate in optimal conditions for more accurate surgical decisions.
FLUOPTICS©: 10 years of research and innovation
The European expert in fluorescence imaging guided surgery, FLUOPTICS© , in collaboration with research teams from around the world, has developed a line of products (the fruit of 10 years of research) enabling real-time visualization during surgery of physiological and pathophysiological phenomena, whichh are often invisible to the naked eye, to improve the quality of surgery.
With the new FLUOBEAM® LX, FLUOPTICS© takes another technological leap forward in thyroid surgery to better address patients’ health issues and make surgery safer. An improved imaging solution designed exclusively for the specifics of thyroid and parathyroid surgery, to better guide surgeons.
Are you scheduled to undergo thyroid surgery and mulling over the potential complications? Any type of surgery has its risks and is always a cause for concern. In France, each year, 10,000 cases of thyroid cancer are diagnosed and 45,000 people have a thyroidectomy (complete removal of the thyroid gland).
When thyroid surgery is indicated, there may sometimes be postoperative complications, such as, among others, damage to the vocal cords or unexpected excision of the parathyroid glands. Below is a description of the thyroid gland, thyroid disorders and treatments, thyroid surgery and new surgical instruments, i.e., an overview of this tiny but very important gland…
The thyroid: what is it?
The thyroid is a small butterfly-shaped gland at the base of the neck.
Essential for the body to function properly, this endocrine gland secretes two types of hormones, namely T4 (tetraiodothyronine) and T3 (triiodothyronine). These hormones regulate many vital bodily functions including metabolism, body temperature and heart rate. Proper functioning of the thyroid depends on another gland called the pituitary gland. Located at the base of the skull, the pituitary gland produces the hormone TSH which regulates metabolism and the secretion of the thyroid hormones T3 and T4.
When the thyroid isn’t working properly and malfunctions, two things can happen. Either it makes too much of the thyroid hormones (hyperthyroidism), or it doesn’t make enough (hypothyroidism).
What are the types of thyroid disorders?
There are many pathologies associated with thyroid disorders.
Hyperthyroidism: when the thyroid overproduces thyroid hormones;
Basedow ‘s disease (also known as toxic diffuse goiter) is an autoimmune disease which stimulates the production of thyroid hormones and is often associated with hyperthyroidism;
Hypothyroidism: when the thyroid is underactive and doesn’t make enough T3/T4;
Nodular goiter, caused by an enlarged thyroid (formed by multiple nodules);
Thyroid cancer: 5% of thyroid nodules turn out to be cancerous;
Differentiated thyroid cancer is more common and has a cure rate of 85%. Undifferentiated thyroid cancer is more difficult to treat and mainly affects older people.
Subacute thyroiditis (also called a thyroid cold) refers to an inflammation of the thyroid gland;
Thyroiditis of pregnancy: some women experience hyperthyroidism for a few months after giving birth.
The possible treatments: synthetic hormones, antithyroid agents and iodine
Hypothyroidism is treated with synthetic hormones (Levothyrox is the most widely known medication) to restore adequate levels of T4 (tetraiodothyronine). The dose is determined by the endocrinologist according to your weight, height and age.
Hyperthyroidism is more difficult to treat: antithyroid medications counteract the overproduction of thyroid hormones.
Radioactive iodine is used as curative treatment to kill off any remaining cancer cells and to destroy suspicious or toxic nodules.
Operating on the thyroid: why is there no such thing as zero-risk?
Surgery is often indicated when cancerous or precancerous nodules are detected or when a goiter becomes too large and symptomatic.
95% of thyroid nodules are benign, and 5% are cancerous.
Surgical removal of all or part of the thyroid gland is a procedure that can cause postoperative complications, even when performed by an experienced surgeon.
What are the possible complications?
One risk of this type of surgery involves inadvertent damage to the pharyngeal nerves, although this is a rare occurrence (5% of cases). These nerves are located just behind the thyroid gland and are exposed during surgery. For weeks following the operation, patients experience hoarseness and vocal fatigue.
Hypocalcemia (abnormally low level of calcium in the blood) is another possible complication of total thyroidectomy. It is caused by trauma to the parathyroid glands. These tiny glands, partially hidden by the thyroid, are difficult to locate during surgery and may therefore be inadvertently excised. Hypocalcemia is usually temporary but if the parathyroid glands are damaged or accidentally removed, hypocalcemia may be permanent and require lifelong hormone replacement therapy.
As with any surgical procedure, there is a risk of hematoma (an accumulation of blood near the operating site) and infection. In some cases an emergency procedure may be necessary to evacuate the hematoma and rapidly identify the bleeding vessel.
The innovation: autofluorescence, a technology that improves parathyroid gland identification
Identification of the parathyroid glands – of which there are usually four – during surgery is often challenging even for skilled surgeons due to their small size. This is why they may be accidentally damaged or excised, leading to postoperative complications.
To facilitate the surgeon’s work, researchers have developed an innovative system for use in endocrine surgery. This technology, already used by numerous medical teams in Europe and the United states, enables real-time identification of the parathyroid glands thanks to the phenomenon of natural autofluorescence.
This innovation, integrated in the FLUOBEAM® fluorescence imaging solution developed by the French company FLUOPTICS©, makes surgery safer by enabling surgeons to accurately visualize the parathyroid glands which are usually difficult to detect.
Another advantage of this fluorescence imaging solution concerns parathyroid gland vascularization. FLUOBEAM® enables surgeons to clearly visualize the vascularization of the parathyroid glands to assess their viability on completion of the surgery.
What is the cost of the FLUOBEAM® fluorescence imaging system to the patient?
This instrument means that surgeons can operate in safer conditions and significantly reduces the rate of postoperative complications. This innovation benefits everyone at no additional cost to the patient.
Autofluorescence imaging is a breakthrough innovation for endocrine surgery. Non-invasive for the patient, FLUOBEAM® makes thyroid surgery safer and in doing so it significantly reduces the risk of postoperative complications such as hypocalcemia.
For more information:
FDA certified for the US market, the FLUOBEAM® fluorescence imaging system is unique and thefirst in the world that detects parathyroid tissue in real time during surgery.