What We Do
Endocrine Surgeons are specialists in the diagnosis and management of disorders and tumours of the thyroid, parathyroid and adrenal glands and in some cases pancreatic and neuroendocrine tumours.
Training as a specialist in Endocrine Surgery comprises a concentrated period of time, usually 2-3 years, at the end of ‘higher surgical training’ in either ‘General’ or ‘Ear, Nose & Throat’ Surgery. All Endocrine Surgeons treat neck endocrine disorders and those whose original training was in General Surgery also treat abdominal endocrine disorders.
Our Department is unique in its multidisciplinary nature with Professor Palazzo and Miss Di Marco coming from a General surgical background and Professor Tolley, Ear, Nose & Throat.
Our outcomes are submitted to the UK Registry of Endocrine & Thyroid Surgery (UKRETS) and can be viewed at their website.
Thyroid
We see, investigate, offer advice and operate on patients with thyroid disease. The pathologies managed include thyroid nodules, goitres (enlargement of the thyroid gland), hyperthyroidism (overactive thyroid glands) from Graves’ disease and all types of thyroid cancer.
The department is one of the largest thyroid cancer services in the UK and is the largest thyroid surgery service in the UK performing in excess of 350 thyroidectomies a year.
Parathyroid
The Department of Endocrine & Thyroid surgery at Hammersmith Hospital performs 350-400 parathyroidectomies a year. Our surgeons have one of the UKs largest experience in surgery for primary as well as renal hyperparathyroidism. We have a special interest in parathyroid surgery in patients with genetic abnormalities and reoperative parathyroidectomy. Intraoperative PTH is used where appropriate and minimally invasive techniques ate used routinely including thoracoscopic surgery for thoracic parathyroids.
Adrenal
Professor Palazzo and Miss Di Marco work within a multidisciplinary team that investigate and treat all aspects of adrenal disease. This includes non functioning and functioning (pheochromocytoma, Conn’s, Cushing’s syndromes etc) adrenal tumours, paragangliomas and adrenal cancers.
In excess of 60 adrenalectomies are performed each year, 95% of which are via keyhole surgery using the laparoscopic or retroperitoneoscopic approach.
Technology in Endocrine & Thyroid Surgery
The best results in endocrine surgery are achieved by high-volume surgeons in high-volume centres and are undoubtedly a function of surgical experience combined with that of the team and supporting specialties. Various technical adjuncts are described as holding the key to complications encountered in endocrine surgery. Such claims must be examined via rigorous scientific testing. The devices used by our department are based on evidence in the scientific literature.
Minimally Invasive Surgery
We perform all of our procedures through the most minimal incisions while still permitting adequate visualisation.
Parathyroid and thyroid surgery for small nodules may be performed through small incisions in the anterior neck although Professor Tolley also offers robotic surgery in highly selected cases.
Adrenal surgery is performed via keyhole surgery (either anterior laparoscopic or retroperitoneoscopic) except for large or definitely malignant tumours.
Intraoperative Neural Monitoring
Permanent dysfunction of a recurrent laryngeal nerve is a recognised risk in all thyroid and parathyroid surgery. The risks are lower in high volume centres with those in our centre standing at approximately 1% and 0.02% respectively.
Intraoperative neural monitoring may assist with reducing this risk. It is therefore used in all thyroid and the majority of parathyroid operations in our department to assess the function of the recurrent and superior laryngeal nerves.
Parathyroid Assays During Surgery
Normal parathyroid glands are tiny and are the most variably located glands in the human body. This contributes to failure to cure hyperparathyroidism in a minority of cases.
Several techniques have been described for locating (gamma probe, fluorescence) parathyroid tissue and identifying it (fluorescence, histopathology) but lack evidence.
Intraoperative parathormone estimation however, has been shown to enhance cure rates in focused parathyroid surgery and is used in selected cases in our department.
How to refer to us
GPs and other specialists can refer by using the online e-RS system or by writing a letter. All two-week-wait referrals should be made via e-RS.
Alternatively, email annemarie.feeney@nhs.net
To have a patient discussed on one of our MDTs, either contact one of the consultants or the MDT coordinator directly.
MDT referrals – thyroid cancer
MDT referrals – adrenal & parathyroid
All three consultants accept private referrals. Click here for more information.