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Minimally Invasive Thyroid and Parathyroid Surgery

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MOST COMMON MISTAKES MADE BY PATIENTS HAVING THYROID SURGERY

                               

Commonly Made Mistakes

 

1. Not getting a second opinion.

The initial diagnosis of a thyroid mass is typically made by your primary care physician or endocrinologist.  He or she may then refer you to a surgeon.  This initial referral is many times based on factors such as personal relationships between doctors, location of the surgeon, and insurance issues rather than the technical skill of the surgeon. You owe it to yourself to obtain a non biased second opinion.  Your insurance company is required to pay for your second opinion evaluation you owe it to yourself and family to get one.

 

2. Not appreciating the risk of vocal cord paralysis.

There is a risk of vocal cord paralysis during thyroid surgery.  If one vocal cord is paralyzed, you will have a hoarse voice.  If both vocal cords are paralyzed, you will need a permanent tracheostomy tube to breathe.  Although these complications are rare, they can occur.  Seeking consultation with an experienced head and neck surgeon minimizes these risks. Why? Head and neck surgeons are board certified to operate on every structure within the head and neck area including the vocal cords, voice box, esophagus, and pharynx.  All of these structures are in danger while performing thyroid surgery.  During your second opinion evaluation choose a surgeon that is comfortable working on and around all the structures in your neck. You should also have a video examination of your vocal cords prior to your procedure to establish their baseline function.

 

 

 

 

 

 

 

 

 

 

3. Not addressing the risks of unsightly scarring.

Most surgeons have little regard for the length or postoperative appearance of the thyroidectomy scar despite the fact that the scar lies in the most visible aspect of the neck and most patients are women.  In addition, few surgeons recognize the fact that the lower neck and upper chest skin has a higher propensity to develop keloids and hypertrophic scars. Therefore preventative wound care is essential.

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Not considering the risk of a thyroid nodule being cancer.

Although most thyroid masses (nodules) are benign, some patients have a true thyroid cancer.  When making your appointment to see a physician for a second opinion remember that thyroid cancer is best managed by a surgical team that is fellowship trained in head and neck oncology.

 

5. Being treated by a surgeon who is not qualified to treat thyroid cancer.

Although many surgeons are comfortable treating benign thyroid disease, few are trained to treat thyroid cancer. Thyroid cancer can spread to the lymph nodes in the neck requiring a lymph node neck dissection where the lymph nodes that surround the jugular vein, carotid artery, and vagus nerve (responsible for swallowing, speaking, and taste) are removed from the neck.  The decision to do a lymph node dissection is often made during the operation and can not  always be decided beforehand.  This leaves the inexperienced surgeon in and uncomfortable position during your surgery.  Remember this not an operation that  general surgeons or a general ENT performs routinely.  Ask your physician during your second opinion appointment that you have arranged how many neck dissections they perform yearly.  The number should be over 40.   

Standard Thyroid Incision

Mini-Thyroid Incision

Normal Vocal Cords

Tracheostomy

Paralyzed Left Vocal Cord

Osborne Head and Neck Institute