Dr. Sharini Venugopal, MD, MBBS

Adrenal surgery can be open or laparoscopic. Laparoscopic adrenalectomy is a minimally invasive procedure that inserts a thin tube with a camera (laparoscope) through several small incisions on the abdomen. The surgeon uses the laparoscope to guide the procedure and is able to access and remove adrenal glands through the small incisions. Laparoscopic adrenal surgery lasts approximately 1-2 hours.

Laparoscopic adrenalectomy is associated with shorter recovery periods, reduced risk of infection, and smaller scars. Although these factors may be desirable, the location of the tumor, its size, and the severity of the condition may require that an individual instead undergo open surgery. An open adrenalectomy is typically done for larger adrenal tumors and requires a single, large incision on the abdomen. Open adrenal surgery takes around 2-4 hours.

Following the operation, patients will remain in the hospital for 1-2 days for a laparoscopic adrenalectomy or 3-5 days for an open adrenalectomy. Patients will likely have a liquid diet immediately after their surgery, but should be able to return to solid foods after a day. If both of the glands are removed, patients will be given drug therapy to replace the hormones they produced.

At the most basic level, nutrition counseling can be simply a talk with a family physician. Doctors receive training in nutrition as part of their education, and they are generally qualified to make recommendations about diet for their patients. Some doctors take a professional interest in nutrition and become experts by taking extra classes or studying nutrition in their practice. In general, however, complex nutrition guidance will be referred to a nutrition specialist, generally a dietitian.

Registered dietitians are nutrition experts that have passed specific higher education, accreditation, and internship requirements. They may work in hospitals, nursing facilities, or private practices to provide nutrition therapy and advise patients about their health and diet. Like dietitians, nutritionists also work to counsel patients about food and health. Some nutritionists have degrees in nutrition or food science, but the title 'nutritionist' is not protected by law. In the United States, anyone is allowed to call themselves a nutritionist, regardless of their education level.

Nutrition counseling can be useful for anyone who is looking to get to a healthy weight, manage a chronic illness through diet, or simply lead a healthier lifestyle. Some examples of issues that benefit from nutrition counseling include:

• Obesity
• Eating disorders
• High cholesterol
• High blood pressure
• Food allergies
• Kidney disease
• Digestive disorders, such as irritable bowel syndrome
• Cancer
• Pregnancy or lactation
• Participation in competitive sports

During a nutrition counseling appointment, the provider -- doctor, nutritionist, or dietitian -- typically will look over a the patient's medical history and talk to them about their current diet, their goals, what kinds of food they like, and any problems that they are currently struggling with in their health or diet. Then the specialist will help the patient set food goals and create a customized plan to help them meet their nutritional needs. Nutrition specialists may also offer classes, workshops, cooking demonstrations, and more. Their role is not to lecture the patient about what one should be eating, but to offer education and resources to make eating healthy foods easier.

Hashimoto's is the leading cause of hypothyroidism, which is when the thyroid does not produce enough hormones to stimulate adequate metabolism. The condition is diagnosed by blood tests that measure TSH (thyroid stimulating hormone) and detect Hashimoto's antibodies. Symptoms of hypothyroidism include sluggish metabolism, inflammation, fatigue, weight gain, brittle hair, dry skin, and sensitivity to cold. To supplement impaired thyroid function, patients with Hashimoto's are typically prescribed synthetic thyroid hormone pills. Such patients may need to consume synthetic thyroids for the rest of their lives. Other treatments may include dietary changes, such as the avoidance of certain foods and medication to reduce inflammation. Frequent blood tests can inform patients if their TSH levels are within a normal range.

Grave's disease is most frequently the cause of hyperthyroidism, which is when the thyroid produces too many hormones, overstimulating one's metabolism. The condition is also diagnosed by blood tests that measure TSH and detect Grave's antibodies. Elevated heart rate, high blood pressure, sweating, bulging eyes, and weight loss are common symptoms of hyperthyroidism. Treatments for hyperthyroidism include oral radioactive iodine, which slowly shrinks the thyroid, slowing the production of excess thyroid hormone. Other anti-thyroid medications such as methimazole (Tapazole) also reduce the production of thyroid hormones. Blood pressure medications known as beta blockers can ease the increased heart rate caused by hyperthyroidism. If treatments are unsuccessful, patients may be prescribed a thyroidectomy, or surgery to remove part or all of the thyroid. Some patients with hyperthyroidism may require ophthalmological (eye medicine) treatments such as eye drops, prednisone, and surgery to reduce eye swelling and bulging.

Untreated thyroid disorders frequently lead to goiters or thyroid nodules. A thyroid goiter is a large lump that can be felt near the base of the neck and is made of swollen thyroid tissue or nodules (excess cell growth). Nodules and goiters are diagnosed by CT scan or ultrasound. Obstructive goiters can cause pain, coughing, and abnormal breathing. The most common cause of goiters is hyperthyroidism (overactive thyroid). However, Hashimoto's is also known to cause goiters or nodules. Goiters develop from continued damage from antibodies to the thyroid over time. At times, a goiter can result from a cancerous thyroid tumor. Most goiters and nodules are themselves benign.

The exact causes of thyroid cancer are unknown. People who develop thyroid cancer may or may not have another thyroid problem such as Hashimoto's or Grave's disease. Symptoms of thyroid cancer include a nodule that can be felt on the neck, hoarseness, difficulty swallowing, swelling in the neck, and neck and throat pain. CT and MRI scans are used to diagnose thyroid cancer. There are four types of thyroid cancer which vary in intensity. Thyroidectomy (thyroid removal surgery) is usually prescribed to treat thyroid cancer.

Thyroid problems are often long-term conditions that require some form of treatment. With regular monitoring and medication, many people with thyroid problems are able to lead active and fulfilling lives.