The Complex Endocrine Surgery Unit of Gemelli Isola Tiberina Hospital deals with the surgical diseases of the endocrine glands with particular attention to the surgical treatment of thyroid and parathyroid diseases. Particular attention is paid to the oncological pathology of the thyroid. The latest international guidelines on the treatment of thyroid carcinomas are in favour of personalised surgical treatment.
The new techniques and technologies available, combined with scientific evidence, allow an individualized treatment strategy, in order to plan an adequate extension of the surgical intervention. The diagnostic-therapeutic-assistance protocols and guidelines recognised by the main national and international scientific societies (Italian Unitary Society of Endocrine Surgery, European Society Endocrine Surgeons, American Association of Endocrine Surgeons, American Thyroid Association) are applied at our Centre.
Surgery is the first treatment option in most cases of thyroid cancer. It is now recognized that Accredited Centers that perform a greater number of surgical procedures have better results. At our Centre, protocols adapted to the latest standards of care and innovative techniques such as minimally invasive surgery (MIVAT) are used. The most advanced technologies are also used, including intraoperative nerve monitoring.
The Endocrine Surgery Operating Unit has clinics dedicated to the management of endocrine diseases where it is possible to perform, in addition to the surgical examination, also the endocrine specialist examination and the ultrasound evaluation of the neck.
It is also possible to perform a specific diagnostic procedure for nodular thyroid and neck pathology thanks to a specific complex outpatient package (PAC) that, in addition to the ultrasound-guided aspiration needle, includes the performance of laboratory tests and a specialized evaluation (endocrine-surgical and/or endocrinological).
Main conditions treated
Thyroid
- Thyroid nodules, goiter (increased thyroid volume)
- Thyroid cancer
- Thyroid dysfunctions: hypothyroidism, hyperthyroidism, Basedow-Graves disease, thyroiditis (including Hashimoto’s thyroiditis, subacute thyroiditis, postpartum thyroiditis etc.)
- Thyroid dysfunction in pregnancy
- Drug-induced thyroid dysfunction (including chemotherapy, immunotherapy, etc.).
Parathyroid
- Hyperparathyroidism
- hypoparathyroidism
Adrenal
- Adrenal disease of surgical relevance (incidentaloma/adrenal nodule, Cushing’s syndrome, hyperaldosteronism, pheochromocytoma)
- Addison’s disease
Services Provided
Elected admission for surgery
The Operating Unit carries out scheduled hospitalizations and the evaluations of preparation for the intervention are carried out before the hospitalization in pre-hospitalisation with a consolidated and efficient path during which the patient is fully guided. Hospitals with a “fast-track” approach are offered to patients outside the region with a pre-hospitalisation and same-day hospitalisation programme.
Integrated endocrine pathology clinic
- Endocrine surgery visit
- Endocrinology visit (Diagnostic insights)
- Thyroid and parathyroid ultrasound
- Thyroid and parathyroid echocolordoppler
- Ultrasound of the Neck
- Diagnostic thyroid nodule PAC (ultrasound-guided aspiration needle, specialist visit, laboratory tests)
- Follow-up of thyroid carcinoma (Follow-up)
Mini-invasive video-assisted thyroidectomy (MIVAT)
It is a technique that, thanks to the use of a camera and dedicated endoscopic instruments, allows the removal of part or all of the thyroid gland through a central cervical incision of 1.5-2 cm. The results of numerous studies have shown that MIVAT is not only a technique associated with a better aesthetic result and post-operative course, but also a safe and reproducible method, making it, among the minimally-invasive approaches to thyroidectomy, the technique that has been most widespread in the world.
MIVAT has also been shown to be effective and safe in the treatment of selected cases of thyroid cancer. To date, in the Reference Centres, about 30% of cases of thyroid disease of surgical relevance are treated with MIVAT. MIVAT is a safe and reproducible method, with complications comparable to conventional surgery, compared to which it has significant advantages in terms of pain and postoperative course. Obviously, there are advantages in terms of aesthetic results.
DIAGNOSTIC INSIGHTS
During the endocrinological evaluation, the need for any further information will be assessed, which may include:
- Evaluation of thyroid function tests and any tumor markers (e.g. calcitonin)
- Ecocolordoppler of the thyroid and neck lymph nodes
- Scintigraphy of the thyroid gland
- Thyroid needle aspirate with fine needle
- CT, MRI, PET/CT
- Genetic tests
In particular, the execution of the thyroid nodule diagnostic PAC is available at our center, which, on the same day, provides for a specialized evaluation (endocrine-surgical and/or endocrinological), the execution of laboratory tests and the execution of needle aspiration.
THYROID CARCINOMA FOLLOW-UP
Surgery is the treatment of first choice and most effective in the treatment of thyroid cancer, but subsequent outpatient checks are then essential to establish the continuation of the therapeutic process and ensure the most complete health care for the patient. For this reason, our operating unit includes an outpatient clinic dedicated to the care of patients undergoing surgery. The surgery includes personalized endocrinological and ultrasound checks during which the appropriate therapy to replace thyroid function will be evaluated and the possible need for further treatments (including radioiodine therapy) established. The OU is networked with the multidisciplinary board (endocrinologist, endocrine surgeon, nuclear doctor, oncologist, radiotherapist, anatomist-pathologist) “Thyroid Cancer Team” of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore.
