Improving Outcomes after Thyroidectomy

Thyroidectomy, the removal of all or part of the thyroid gland, is a surgical procedure used to treat cancer and other thyroid disorders such as an enlarged thyroid (goiter) or overactive thyroid (hyperthyroidism).

When I see patients with thyroid cancer, I always like to reassure them that thyroid surgery is fairly safe, and deaths from thyroid cancer are rare. Nevertheless, as with any surgery there are risks of complication, the degree of which vary according to the experience level of the surgeon.

Surprisingly, about 85 percent of thyroidectomies are performed by surgeons who do less than five of the procedures each year – far short of the American Association of Endocrine Surgeons’ recommendation of 50 or more each year. So, what does this mean to the patient facing thyroid surgery? Risk factors and complications to be considered are:

  1. Scarring. While scarring is not a life or death issue, it is one of the first things many patients ask about. The thyroid gland is located at the base of your neck, so an unsightly scar will be noticeable. I like to make my incision higher on the neck where it can be hidden among natural folds and wrinkles in the skin. Some physicians are exploring other options to reduce scarring, such as going through the armpit, but I believe the procedures are too high-risk and I won’t do them.
  2. Bleeding. Bleeding is uncommon but unpredictable. About one in 1,000 patients will have a bleeding problem that could result in death. I keep all my patients in the hospital overnight so that we can monitor them. Some doctors are performing thyroidectomies on an outpatient basis, but in my opinion the risk is too great.
  3. Vocal cord damage. The recurrent laryngeal nerves (RLN) that control the vocal cords lay right under the thyroid, so damaging them and causing a permanent hoarse or weak voice due to nerve damage is a real risk. Using a superior–inferior approach in identifying the RLN – the approach I and many experienced surgeons use – reduces the risk of vocal cord damage and hypoparathyroidism, as discussed below.
  4. Damage to the parathyroid glands. The parathyroid glands are four small glands about the size of a sesame seed that are located behind your thyroid. Because they are so small, parathyroid glands are easy to ignore and inadvertently damage. Damaging the parathyroid glands can lead to hypoparathyroidism, which causes abnormally low calcium levels in your blood. Calcium balance is crucial to the normal functioning of the heart, nervous system, kidneys and bones.

For the past 10 years, I’ve performed about 200-300 thyroidectomies each year. For patients facing this surgery, I recommend that they place their care in the hands of a surgeon who is an expert in the field.

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