Dr.Fatih YıldırımGeneral Surgery, Medical Aesthetics & Longevity
Endocrine

Nerve-sparing surgery for delicate glands.

In thyroid, parathyroid and adrenal surgery, a nerve-sparing approach (recurrent laryngeal nerve neuromonitoring) is part of standard care. The incision site and technique are planned individually for each patient.

Conditions Treated

  • Thyroid nodules (cases with a surgical indication)
  • Toxic multinodular goitre
  • Graves' disease
  • Hyperparathyroidism (primary/secondary)
  • Adrenal adenoma, phaeochromocytoma

Techniques

Conventional thyroidectomy (RLN neuromonitoring)

Cervical approach, nerve preservation.

Minimally invasive parathyroidectomy

Small incision under imaging guidance.

Laparoscopic adrenalectomy

Transabdominal/retroperitoneal approach.

Pre-Treatment Protocol

Preparation and support program for your treatment.

Preparation, IV infusion and micronutrient support protocols planned after physician evaluation. All applications are personalized individually; effectiveness varies from person to person.

NAD+ IV support protocol

NAD+ infusion sessions (loading protocol) planned in the pre-operative period following physician assessment.

Why:

NAD+ is a coenzyme involved in cellular energy metabolism and DNA repair. Approaches aimed at raising NAD+ levels, which decline with age, have been reported to have favourable effects on biomarkers; their potential contribution to metabolic resilience before surgery is under investigation.

Glutathione + alpha-lipoic acid IV

Antioxidant infusion protocol planned with physician approval.

Why:

Antioxidant strategies for managing the oxidative stress that surgery can generate are discussed in the literature. Individual effectiveness varies from person to person.

Vitamin C and B complex

IV/oral micronutrient support in the pre-operative period, as recommended by the physician.

Why:

Vitamin C acts as a cofactor in collagen synthesis. Its role in the wound-healing process has been recognised for many years.

BPC-157 (within a research framework)

BPC-157 is not a licensed medicinal product under German or EU legislation; it is assessed within the framework of international research protocols.

Why:

Preclinical studies have reported effects on tissue healing and gastrointestinal protection; human clinical evidence is limited and regulatory approval processes are ongoing. Any use is planned solely under physician responsibility, with informed consent and within a framework that complies with applicable regulations.

Hormone and micronutrient assessment

TSH, T4, T3, calcitonin/PTH, vitamin D and magnesium tests.

Why:

Optimising hormone and micronutrient status before surgery contributes to surgical safety. Vitamin D levels are of particular importance with regard to the risk of post-operative hypocalcaemia.

Iodine loading (in Graves' cases, with physician approval)

Pre-operative administration of Lugol's solution in Graves' disease.

Why:

It can reduce the vascularity of the gland and may contribute to reducing the risk of intraoperative bleeding.

Treatment Process

Treatment Steps

1

Anaesthesia + nerve neuromonitoring set-up

Use of an endotracheal tube with RLN electrodes.

2

Thyroid exposure

Lateral retraction of the strap muscles.

3

Nerve preservation + gland removal

Identification of the RLN, preservation of the parathyroid glands.

4

Haemostasis + closure

Haemostasis with ultrasonic energy devices.

Post-Treatment Protocol

Post-treatment support program.

Care, micronutrient and support protocols applied in line with physician recommendations. Individual recovery times may vary.

Multimodal support protocol

IV hydration, micronutrient support and a controlled mobilisation programme in the post-operative period.

Why:

Contemporary ERAS (Enhanced Recovery After Surgery) approaches report that multimodal protocols support the recovery process.

Anti-inflammatory micronutrient support

Minerals such as magnesium, zinc and selenium, together with antioxidant IV support as recommended by the physician.

Why:

The perioperative role of micronutrients that act as cofactors in immune modulation and tissue repair has been reported.

Collagen, glycine and protein support

Oral collagen and a balanced protein/amino-acid nutrition plan (8-12 weeks).

Why:

The role of collagen substrate support in the regeneration of wound tissue and connective tissue has long been discussed in the literature.

Peptide support assessment (within a research framework)

Peptides such as BPC-157 are assessed within the framework of German/EU legislation and physician responsibility.

Why:

Although preclinical evidence exists, the level of clinical evidence is still limited. Use requires informed consent and physician follow-up.

Thyroid hormone replacement titration

Initiation of levothyroxine after total thyroidectomy, with titration based on periodic TSH checks.

Why:

TSH targets are set individually in accordance with the standard endocrine follow-up protocol.

Calcium/vitamin D monitoring

Calcium check within the first 24-48 hours after surgery, with oral/IV support where required.

Why:

Transient hypocalcaemia can occur to some extent after thyroidectomy; early monitoring is part of standard care.

Treatment Journey

Day-by-Day Recovery

−6 weeks

Diagnostic assessment

Ultrasound (USG), fine-needle aspiration (FNA), Bethesda category.

−4 weeks

Hormone and micronutrient preparation

TSH normalisation, vitamin D and Mg assessment.

−1 week

Anaesthesia consultation

Airway assessment (important in large goitres).

Day 0

Operation

Procedure duration varies by case.

Days 1-2

Discharge

Provided calcium levels are satisfactory.

Week 1

Pathology + hormone initiation

Thyroid replacement dose titration.

Weeks 6-8

TSH check + titration

First titration review.

Month 3

Clinical check-up

Assessment of hormone levels and wound healing.

FAQ

Frequently Asked Questions

Scientific Sources

The references below are the literature sources for information on this page. For informational purposes only; treatment decisions are made through face-to-face physician evaluation.

  1. 1.Cao Y, Lu Y, Chen P, et al. ERAS guidelines and hospital length of stay, readmission, complications, and mortality: a meta-analysis of randomized clinical trials — JAMA Network Open, 2024. Source
  2. 2.Vinten H, Petersen K, et al. NAD+ precursor supplementation in human ageing: clinical evidence and challenges — Nature Aging, 2025. Source
  3. 3.Vasireddi N, Hahamyan H, Salata MJ, et al. Emerging Use of BPC-157 in Orthopaedic Sports Medicine: A Systematic Review — HSS Journal, 2025. Source
  4. 4.Haugen BR, Alexander EK, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer — Thyroid, 2016. Source

Information: The information on this page is provided for medical information purposes and does not replace a consultation with a physician. The perioperative approaches described are based on current data in the literature; individual results vary from person to person and may not be suitable for every patient. Treatment decisions are made after an in-person consultation.

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