Surgical Treatment of the Thyroid, Parathyroid and Adrenal Glands

Published: 18.04.2025 · Last Updated: 05.08.2026 · Prepared by the Academic Hospital Web and Editorial Board.

Endocrine Surgery is the specialty that diagnoses and treats the surgical disorders of the hormone-producing glands (thyroid, parathyroid, adrenal glands and the endocrine tissue of the pancreas). The department works in multidisciplinary coordination with endocrinology, medical oncology and general surgery; surgical decisions are taken through the tumour board. At Academic Hospital, minimally invasive laparoscopic techniques are prioritised so that the hospital stay is kept as short as possible.

Contents

What Is Endocrine Surgery?
Which Diseases and Conditions Are Treated Surgically?
When Should You Consult Us?
Preoperative Assessment and Diagnostic Methods
Operations and Surgical Procedures Performed
The Postoperative Process
Endocrine Surgery at Academic Hospital
Frequently Asked Questions
References

What Is Endocrine Surgery?

Endocrine surgery is the field in which tumours, hyperplasia and functional disorders arising in the body's hormone-producing glands are treated surgically. The thyroid and parathyroid glands, the adrenal glands and the endocrine tissue of the pancreas make up the primary working area of this department. Not only tumoural lesions but also hyperthyroidism, hyperparathyroidism and glands showing hormonal overactivity fall within the scope of surgical assessment.

Which Diseases and Conditions Are Treated Surgically?

Endocrine surgery covers the surgical treatment of tumours and functional disorders affecting the thyroid, the parathyroid glands, the adrenal glands and the endocrine tissue of the pancreas.

Thyroid cancer: papillary, follicular, medullary and anaplastic thyroid carcinoma
Large or compressive benign thyroid nodules; goitre causing cosmetic deformity
Surgical hyperthyroidism: Graves' disease unresponsive to medication and radioiodine, toxic nodular goitre
Parathyroid adenoma: primary hyperparathyroidism (high calcium, kidney stones, osteoporosis)
Parathyroid hyperplasia: secondary and tertiary hyperparathyroidism
Adrenal incidentaloma: masses with suspected hormonal activity or malignancy
Pheochromocytoma and paraganglioma
Primary hyperaldosteronism (Conn's syndrome)
Cushing's syndrome: cortisol excess of adrenal origin
Adrenocortical carcinoma
Pancreatic neuroendocrine tumours (NET): insulinoma, gastrinoma, glucagonoma, VIPoma
Surgical pathologies associated with multiple endocrine neoplasia syndromes (MEN 1, MEN 2)

When Should You Consult Us?

If you have any of the findings below, consulting an endocrine surgery specialist is advised; if the symptoms worsen suddenly, urgent assessment may be required.

When a thyroid nodule biopsy shows Bethesda III to VI (suspicious or malignant cytology)
When there is a growing mass in the neck, or thyroid enlargement together with hoarseness or difficulty swallowing
When blood calcium and PTH levels are high and accompanied by kidney stones or bone loss
When imaging has shown an adrenal mass with suspected hormonal activity or malignancy
Uncontrolled hypertension together with attacks of headache, sweating and palpitations (suspected pheochromocytoma)
Unexplained recurrent episodes of hypoglycaemia (insulinoma)
Treatment-resistant ulcer with a high gastrin level (Zollinger-Ellison syndrome)
Surgical risk assessment for family members diagnosed with a MEN syndrome

Preoperative Assessment and Diagnostic Methods

In endocrine surgery the preoperative assessment determines both the surgical plan and the safety of anaesthesia.

Method	What is assessed
Thyroid ultrasound and fine needle aspiration biopsy (FNAB)	Number and size of nodules, TIRADS classification and the cytology report
Thyroid scintigraphy	Functional status of the nodule (cold or hot nodule), diagnosis of a toxic gland
Neck CT or MRI	Tumour size, invasion of surrounding tissue, mapping of the lymph nodes
Laryngoscopic vocal cord assessment	Documentation of preoperative vocal cord movement; recurrent laryngeal nerve function
Hormone profile	TSH, fT4, fT3, thyroglobulin, calcitonin; PTH (intact), serum calcium; cortisol, aldosterone to renin ratio; metanephrine and normetanephrine (in pheochromocytoma)
Adrenal imaging	CT or MRI; PET-CT and 68 Ga-DOTATATE PET (for NET)
Preoperative alpha blockade in pheochromocytoma	An alpha blocker (phenoxybenzamine or doxazosin) is started 10 to 14 days before surgery; this removes the risk of a hypertensive crisis
Genetic counselling	RET mutation, and SDHB/SDHD analysis where a MEN syndrome is suspected

Operations and Surgical Procedures Performed

The principal operations performed in endocrine surgery reflect the range of cases handled by the department.

Operation	What is done
Total thyroidectomy	Removal of the entire thyroid gland; the standard method in thyroid cancer and large nodular goitre. The recurrent laryngeal nerve is protected with intraoperative nerve monitoring (IONM).
Thyroid lobectomy and isthmectomy	A conservative approach used in low-risk papillary microcarcinoma with a single nodule, or in pathology localised to a single lobe
Minimally invasive parathyroidectomy	Focused excision guided by intraoperative PTH (IOPTH) in primary hyperparathyroidism with a single adenoma. A fall in PTH of fifty percent or more within 10 minutes indicates success.
Conventional bilateral parathyroid exploration	Assessment of all four glands in multiple gland disease or in cases where localisation is not possible
Laparoscopic adrenalectomy	The gold standard for benign adrenal tumours and pheochromocytoma; transperitoneal or retroperitoneal approach
Retroperitoneoscopic adrenalectomy	A minimally invasive technique performed with a smaller incision in the prone position; the abdominal cavity is not entered
Pancreatic NET resections	Enucleation: removal of the tumour while preserving pancreatic tissue, in small and superficial tumours Distal pancreatectomy: for tumours in the body and tail of the pancreas, together with the spleen where necessary Whipple procedure (pancreaticoduodenectomy): for tumours in the head of the pancreas
Coordination with nuclear medicine	Planning of radioactive iodine (RAI-131) ablation after thyroid cancer surgery

The Postoperative Process

In endocrine surgery the postoperative period covers the restoration of hormonal balance and the monitoring of complications.

Topic	What is done
Calcium and PTH monitoring	Serum calcium and PTH are measured within the first 24 hours after total thyroidectomy, with close follow-up for hypoparathyroidism
Calcium and vitamin D support	Oral calcium and active vitamin D supplementation in temporary hypocalcaemia; started early against the possibility of "hungry bone syndrome" after long-standing hyperparathyroidism
Starting levothyroxine	Thyroid hormone replacement therapy after total thyroidectomy; TSH suppression is the target in thyroid cancer
Voice check	Vocal cord assessment on the first postoperative day and at follow-up visits; temporary hoarseness usually resolves within a few weeks
Length of hospital stay	Usually 1 to 2 days for laparoscopic adrenalectomy and minimally invasive parathyroidectomy; 1 to 2 days for total thyroidectomy; 5 to 7 days for open pancreatic surgery
Oncological follow-up	Thyroglobulin monitoring, neck ultrasound and, where necessary, RAI scintigraphy in thyroid cancer; chromogranin A and imaging follow-up in NETs
Follow-up visits	Wound check in the second week after surgery; hormone and biochemistry tests in weeks 4 to 6; comprehensive assessment in the third month

You can book an appointment with Academic Hospital Endocrine Surgery for a thyroid, parathyroid or adrenal surgical assessment.

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Endocrine Surgery at Academic Hospital

The Academic Hospital Endocrine Surgery Department carries out the surgical treatment of the thyroid, the parathyroid and adrenal glands and the endocrine tissue of the pancreas, giving priority to minimally invasive techniques; surgical decisions are taken at the multidisciplinary tumour board. The department works routinely with the following departments:

Endocrinology and Metabolism: preoperative hormone assessment and postoperative replacement follow-up
Thyroid Diseases and Treatment: nodule follow-up, the biopsy decision and definition of the surgical indication
General Surgery: shared operating theatre processes and collaboration in intra-abdominal endocrine surgery
Medical Oncology: tumour board decisions and planning of postoperative oncological treatment
Pathology: assessment of the surgical material and intraoperative consultation
Radiology: lesion mapping with ultrasound, CT and MRI
Head and Neck Surgery: joint surgical planning in advanced cases in the neck region

Frequently Asked Questions

The answers to the questions most frequently asked about endocrine surgery are given below.

Does every thyroid nodule require surgery?

No. The great majority of thyroid nodules are benign and follow-up with ultrasound is sufficient. Nodules with a biopsy result of Bethesda category III or above, nodules that grow rapidly, and nodules that press on the voice or on swallowing are referred for surgical assessment. The decision is made by considering the size of the nodule, its ultrasound features and the patient's preference together.

Is lifelong medication necessary after thyroidectomy?

Because the thyroid gland is removed completely in a total thyroidectomy, levothyroxine replacement therapy continues for life. The dose is adjusted regularly according to the TSH target; in thyroid cancer the TSH is generally kept suppressed, and this monitoring is carried out jointly with endocrinology.

Is any special preparation needed before pheochromocytoma surgery?

Yes. To prevent the risk of a hypertensive crisis during surgery, alpha-blocker treatment (phenoxybenzamine or doxazosin) is started 10 to 14 days before the operation. This preparation must not be skipped; the anaesthesia team also monitors blood pressure closely throughout the procedure.

Does calcium return to normal after surgery for a parathyroid adenoma?

After a successful parathyroidectomy, serum calcium usually returns to normal within a few days. In patients who have had long-standing hyperparathyroidism the bones take calcium back rapidly; this "hungry bone syndrome" can cause temporary hypocalcaemia and is managed with calcium and active vitamin D support.

How many days is the hospital stay after laparoscopic adrenalectomy?

The hospital stay after laparoscopic adrenalectomy is usually 1 to 2 days. Discharge follows once drainage has returned to normal and oral feeding has been established. Patients return to daily activities after 1 to 2 weeks and to heavy physical exertion after 4 to 6 weeks.

Can a pancreatic neuroendocrine tumour be malignant?

Yes. Some pancreatic NETs carry malignant potential. Insulinomas are mostly benign, whereas gastrinoma, glucagonoma and VIPoma can metastasise more frequently. The treatment decision is made at the multidisciplinary tumour board according to tumour size, the Ki-67 index and the stage.

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References

The general information given on this page about the indications for endocrine surgery, preoperative preparation and postoperative follow-up is supported by the reliable health sources listed below.

Mayo Clinic, "Thyroid Cancer: Diagnosis and Treatment", mayoclinic.org
Bilezikian JP et al., "Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fourth International Workshop", Journal of Clinical Endocrinology & Metabolism, pubmed.ncbi.nlm.nih.gov
Lenders JWM et al., "Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline", Journal of Clinical Endocrinology & Metabolism, pubmed.ncbi.nlm.nih.gov

The information on this page is for informational purposes only; it does not replace medical examination, diagnosis or treatment. Please consult a healthcare institution regarding your complaints.