Thyroid & Parathyroid Center in Central Denver
Rose Medical Center is home to the Rose Thyroid & Parathyroid Center, Colorado’s only dedicated thyroid and parathyroid center.
As the largest thyroid and parathyroid program in Denver, we are deeply experienced in recognizing, diagnosing and treating thyroid and parathyroid disease. We have pioneered newly streamlined thyroid and parathyroid medical imaging procedures to make diagnosis less time consuming, but our diagnosis of our patients’ conditions doesn’t end with the initial scan.
Our team regularly assesses your "risk level" for continued or worsening symptoms or advancing disease and are able to adjust your treatment accordingly. We do this as a regular part of our practice to ensure we are not missing any significant changes in your health but also to ensure we are not over-treating our patients.Debunking common thyroid myths
Multidisciplinary team of experts
Our center employs a multidisciplinary team of board-certified radiologists, endocrinologists and surgeons who are experts in their field specializing in the care and surgical treatment of thyroid, parathyroid, pancreas and adrenal problems. We also support a multidisciplinary tumor board made up of physicians with expertise in diagnosis, treatment and care for patients with thyroid and parathyroid disease.
Thyroid and parathyroid conditions we treat
- Polycystic ovary syndrome (PCOS)
- Testosterone and ovary disorders
- Hormonal infertility
- Lipid disorders
- Thyroid nodules
- Type I diabetes
- Type II diabetes
- Calcium/bone disorders
- Metabolic/weight issues
- Neuro-endocrine tumors
Graves’ disease is an autoimmune disorder and is the most common cause of hyperthyroidism. In affected people, the body makes antibodies, which attack the thyroid gland and also stimulate thyroid tissue to produce excessive amounts of thyroid hormone, causing the following symptoms:
- Weight loss despite unchanged eating or exercise habits
- Fast heart rate
- Increased nervousness or irritability
- Hair loss and increased growth of nails
- Changes in your menstrual periods
- Increased appetite or more frequent bowel movements
- Visual changes
Some patients develop Graves’ eye disease, also called ophthalmopathy, which may cause the eyes to become dry, irritated or inflamed. Smoking can worsen the symptoms of both Graves’ disease and Graves’ eye disease.
Treating Graves’ disease
- Medication: Medications have variable success, but often patients become resistant to medication treatment over time.
- Surgery: While generally not the treatment of choice, surgical removal of the thyroid gland may be a viable treatment option. This is more invasive and has common risks related to surgery.
- Iodine ablation of thyroid tissue: Ablation is the surgical removal of body tissue. Radioactive iodine is given as a pill that contains radiation within. Based on the result of previous thyroid nuclear medicine studies and the estimated size of your thyroid gland, a dose will be calculated specifically for you.
Fine needle aspiration biopsy
Rose Medical Center provides a range of biopsy services. We specialize in diagnosing anaplastic thyroid cancer through thyroid biopsies performed quickly by one of our board-certified surgeons or radiologists. We perform both needle (or core needle) biopsies in addition to the more traditional open biopsies.
If you were diagnosed with a thyroid lump, nodule or mass you may be recommended for a fine needle aspiration biopsy (FNA). Your doctor will be able to tell initially if a thyroid nodule is worrisome based on its size and appearance on ultrasound imaging.
An FNA is a quick, safe and reliable method of evaluating thyroid nodules. The procedure is usually less painful than a bee sting and is performed with very thin needles. A needle is inserted into the nodule, usually with the assistance of an ultrasound, and cells are extracted, or aspirated, into the needle. These cells are examined under a microscope to determine the nature of your nodule. The result of the FNA biopsy will be one of the following:
- Benign or noncancerous. These nodules can be monitored over time.
- Malignant or cancerous. You will need thyroid surgery and potentially treatment with radioactive iodine. Most patients with thyroid cancer have an excellent prognosis.
- Non-diagnostic or insufficient. The extracted thyroid cells were too few to make a diagnosis, you may need a repeat FNA.
- Indeterminate (ambiguous). Three subtypes are summarized as indeterminate:
- Follicular neoplasm (FN)
- Follicular lesion or atypia of undetermined significance (FLUS or AUS)
- Suspicious for malignancy
The optimal treatment of "indeterminate" nodules depends on patient facts, such as size, subtype and other features of the nodule. Your physician may also request an "Afirma test," which may involve a second FNA.
Afirma gene expression classifier test
The "Afirma test" is a new tool to assess "indeterminate" nodules. A separate FNA sample is submitted for molecular analysis and a so-called "gene expression classifier" is performed. This measures the activity level of more than 100 genes within the nodule. Based on which genes are expressed, the nodule is classified as benign, meaning a less than five percent risk of cancer, or suspicious, meaning a 40 to 60 percent risk of cancer. This additional information helps your physician come up with an optimal treatment plan for your thyroid nodule.
A genetic counselor is a healthcare professional with special training in medical genetics and psychosocial counseling. The genetic counselors at Rose are part of our thyroid and parathyroid multidisciplinary team and they work to help evaluate the likelihood that a hereditary cancer condition is responsible for your personal and/or family history of cancer.
Prior to an initial genetic counseling appointment, one of our genetic counselors will complete a risk assessment and review it with you at your appointment. You will discuss possible genetic testing options. If you have concerns about a hereditary cancer condition, please speak with your physician for a referral to one of our genetic counselors.
Individuals with a hereditary cancer condition are at an increased risk for specific types of cancer. If you are determined to have a hereditary cancer condition your physician and genetic counselor will create a personalized screening protocol to try and prevent future cancers through early detection and prevention. Additionally, your genetic counselor will discuss the implications for family members who may be at risk for the same hereditary cancer condition.
As part of the genetic counseling appointment, your genetic counselor will discuss the cost of genetic testing to ensure you are aware of potential expenses prior to submitting a blood sample and discuss genetic discrimination before genetic testing. There are federal and state laws that protect you against genetic discrimination.
Thyroid and parathyroid imaging
At Rose Thyroid & Parathyroid Center, we offer the following diagnostic imaging services to help diagnose thyroid and parathyroid conditions:
- Detailed thyroid ultrasound for thyroid cancer
- Lymph node mapping for thyroid cancer
- Parathyroid ultrasound
- Thyroid nuclear scan and iodine uptake (six and 24 hours)
- Parathyroid dual isotope nuclear scan
- Parathyroid single isotope nuclear scan
- 4D parathyroid CT scan
- Post-surgical follow up imaging
- Radioactive iodine whole body nuclear scans and treatments
In addition to our imaging services, The Rose Thyroid & Parathyroid Center offers genetic counseling for thyroid and parathyroid diseases through the aid of our diagnostics and laboratory services.
Thyroid and parathyroid surgery
The most common reason a person may require part or all of his or her thyroid removed is due to a worrisome mass or nodule. Many times, these have been biopsied through fine needle aspiration (FNA) and the nodule has been found to be abnormal. It may have been found to be a cancer, a nodule highly suspicious for cancer or inconclusive and in need of further testing, in these instances, surgery is usually the next step.
In some instances, a person may need his or her thyroid removed due to its extreme size, bothersome symptoms caused by size or over-functioning or as a treatment for difficult-to-control hyperthyroidism.
There are three basic types of thyroid surgery:
- Lobectomy: removal of one half of the thyroid.
- Sub-total thyroidectomy: removal of almost all of the thyroid, where only a small amount of the thyroid is left behind.
- Total thyroidectomy: removal of all of the thyroid.
Most thyroid surgery is accomplished through a small incision on your lower neck. However, new techniques are being developed—some with the help of a robot that allows for the incision to be hidden in your arm pit or along the back of your neck.
For most patients with hyperparathyroidism, the treatment involves the surgical removal of the overactive parathyroid gland or glands. This is accomplished through a small incision in the front of the neck and the enlarged gland is removed. Recovery from parathyroid surgery is usually quick with minimal pain. Most people return to work in a week or less.
Risks of surgery
In addition to the risks that go along with traditional surgery, there are three main risks associated with thyroid surgery, all of which are typically uncommon:
- Injury to the nerves that control your vocal cords, resulting in hoarseness, inability to sing high notes and in unusual and extreme cases, difficulty breathing.
- Injury to your parathyroid glands, resulting in temporary or permanent problems with low calcium levels.
- Bleeding, which is a rare but serious problem in this area because it can cause difficulty with breathing due to the fact that your windpipe is right below your thyroid gland and significant bleeding can compress the windpipe.
Sarah Cannon at Rose Medical Center has outstanding thyroid cancer survival rates. 75 percent of Stage IV Rose thyroid cancer patients are alive five years after treatment compared to 64 percent of patients treated at other Colorado facilities. With the help of the Rose Thyroid & Parathyroid Center we are able to treat the following types of thyroid cancer:
- Differentiated thyroid cancer (Papillary, follicular or Hurthle Cell types)
- Medullary thyroid cancer
- Anaplastic thyroid cancer
Anaplastic thyroid cancer is a fast-growing, rare form of thyroid cancer that can be hard to treat. This cancer tends to be aggressive as it spreads to other parts of the body. Chemotherapy and radiation therapy are preferred treatment options to surgery.