Dr. Ashok Rai, MD

Today, most gallbladder surgeries are done laparoscopically. Four tiny incisions are made in the abdomen, and small tools are inserted through these tiny incisions to perform the surgery. Because the incisions are much smaller, recovery time is much faster with this type of surgery. Patients are usually discharged from the hospital the same day. Sometimes, open surgery is used to remove a gallbladder. In this type of surgery, a cut about six inches long is made in the upper right abdomen. After the gallbladder is removed, it is sutured or stapled closed. With open surgery, patients usually stay in the hospital for two to three days to recover before they are discharged.

Gallbladder removal, like any surgery, carries some risks, such as bleeding, infection, or the development of blood clots. Doctors will tell patients how to minimize their risk for complications. After surgery, patients are advised to avoid strenuous activity for several days. They should not soak in a bath until their sutures or staples have been removed. Patients should wash hands before touching the area around the incision. It will take a couple of days until patients feel like themselves again and a few weeks until their scar has healed and faded.

When excessive sweating is the main complaint and is not related to any other condition, it is called primary hyperhidrosis. There is no known cause, but it does tend to run in families. Secondary hyperhidrosis is sweating that is caused by another medical condition, such as anxiety, cancer, hyperthyroidism, or menopause. Sometimes treating the underlying condition can improve this type of sweating.

There are tests doctors can use to diagnose hyperhidrosis. One involves simply soaking up the perspiration with paper and then weighing the paper to measure how much extra sweat is being produced. Another test, called the starch-iodine test, involves covering the body with powder. This powder turns blue in any areas where sweat is produced.

Treatment depends on the severity of the hyperhidrosis and the areas affected. Some options are:

• Prescription antiperspirants, which contain aluminum chloride and work by plugging the sweat ducts. This signals the sweat glands to decrease sweat production. They work for moderate cases of hyperhidrosis and are relatively affordable.
• Lontophoresis, a procedure that uses small amounts of electricity and a tray of tap water to decrease production of sweat glands in the hands or feet.
• Botox, which can be injected into the nerves that control sweat glands in the underarms.
• Sympathectomy, a surgery for severe cases that can be performed to cut the nerves that stimulate sweat production. Sympathectomy is most effective for hyperhidrosis of the hands. It may cause new symptoms of sweating elsewhere on the body.
• Surgery to remove sweat glands, most often in the underarms.

Hyperhidrosis is a serious medical condition that causes both physical and emotional distress. Treatments are available, and support groups exist to help patients cope.

Both hypothyroidism and goiters are caused by an autoimmune reaction where the body produces antibodies that attack the thyroid cells for unknown reasons. The thyroid reacts by releasing too little or too much T3 and T4 thyroid hormones, impairing thyroid function and causing irregular metabolism. Goiters develop from the autoimmune reaction causing continued antibody damage to the thyroid over time. Thyroid goiters are large, swollen lumps that can be felt near the base of the neck. Obstructive goiters can cause pain, coughing, and abnormal breathing. Hypothyroidism may also be caused by iodine deficiency, as iodine is needed to produce thyroid hormones.

The exact cause of thyroid cancer and thyroid nodules or cysts is unknown. While thyroid cancer and thyroid nodules or cysts can occur in individuals with thyroid disorders, they are not associated with a malfunctioning thyroid.

Physicians may prescribe thyroid surgery if blood tests reveal patients' thyroid stimulating hormones (TSA) are outside of the acceptable range, indicating a malfunctioning thyroid. Thyroid biopsies (tissue samples) and tests for thyroid-attacking antibodies are also criteria for surgery.

An ENT or general surgeon performs thyroid surgery. While a patient is placed under anesthesia, the surgeon makes an incision at the center of the neck and removes the thyroid gland. Two alternative methods of thyroid surgery are transoral (incision through the mouth) and endoscopic, where a surgeon operates a video camera for live footage to help guide the removal process.

Thyroid surgery requires minimal aftercare. Most patients recover quickly and resume normal activities within a few days of surgery. However, thyroid surgery patients must take daily synthetic thyroid medication (levothyroxine) for life to replace their removed thyroid.