Minimizing Complications of Thyroid Surgery: Avoid the Low-Volume Thyroid Surgeon

Thyroid Disease Awareness Month is a pivotal time for raising awareness about the pros and cons of thyroid surgery—one of the most common operations performed in the US. Unfortunately, about 20% of patients having a thyroid operation have something go wrong, resulting in a less than desirable outcome.

Thyroid surgery, or thyroidectomy, is typically performed on individuals dealing with thyroid growths, thyroid nodules, thyroid cancers, or overall enlargements of the thyroid gland which are called goiters. Too little thyroid hormone production—called hypothyroidism—is usually not an indication for thyroid surgery. But too much thyroid hormone production (hyperthyroidism) is occasionally treated with thyroid surgery.

"Choosing a high-volume thyroid surgeon is pivotal in ensuring successful outcomes and minimizing complications."

The relatively high rate of undesirable outcomes stems from the fact that thyroid surgery is highly technical, but many surgeons with little or no specific training are performing this operation. In the US, it is estimated that 80% of thyroid surgery is performed by surgeons who perform less than 10 thyroid operations per year. As predicted, the outcomes for these patients are not as good, with complication rates up to 10 times higher and cure rates for cancer often being up to 25% lower. Thyroid surgery, like most things in life, has better outcomes and higher cure rates when performed by surgeons who do more than 100 of these operations per year.

Dr. Gary Clayman, Founder of the Clayman Thyroid Center at the Hospital for Endocrine Surgery in Tampa, Florida emphasizes, "Our mission has always been to provide the highest standard of care for patients. Choosing a very high-volume thyroid surgeon is pivotal in ensuring successful outcomes and minimizing complications, but unfortunately, most people don't do their homework and simply go to the 'local guy' they were referred to. Our thyroid surgeons perform thyroid surgery only—they don't do any other type of surgery."

Understanding Thyroid Surgery:

Thyroid surgery typically involves removal of half or the entire thyroid gland, depending on the size of the problem and the disease that is being treated. Like all operations, there are potential complications, but these can be decreased to almost zero when the operation is performed by a thyroid surgeon who performs hundreds of thyroid operations per year.

With this article for Thyroid Disease Awareness Month, the Clayman Thyroid Center and its world-renowned surgeons hope to educate the public and encourage them to take control of their thyroid health. Dr. Rashmi Roy, widely recognized as the "Goiter Guru" on YouTube, adds, "Informed decisions about who will be your surgeon is the first step toward optimal thyroid health. Education empowers individuals to make choices that positively impact their lives."

Common Complications of Thyroid Surgery:

• Voice Changes: Damage to the vocal cord nerves can lead to hoarseness or changes in voice. The thyroid gland is situated right on top of the recurrent laryngeal nerves and their branches, which control vocal cord movement. Even a slight damage to one of these nerves can cause the patient to lose their voice for months—or even permanently.
  
  Dr. Nate Walsh, senior surgeon at the Hospital for Endocrine Surgery, emphasizes, "Inexperienced surgeons have a 10-times higher rate of inadvertently damaging this nerve, leading to temporary or even permanent voice changes, difficulty swallowing, or worst case, difficulty breathing if both nerves are damaged at the same time. That's why it's so important to be mindful in who you are selecting as your surgeon. There can be serious consequences."
  
  High-volume surgeons are much more adept at identifying and preserving these very small and delicate nerves to the voice box. The nerves are isolated routinely by high-volume surgeons in every operation whereas low-volume surgeons simply try to avoid this area of the neck which can lead to cancer being left behind. This is a very technical aspect of the operation that is performed with magnification and requires many years of training to become an expert.
  
  Dr Clayman adds, "Preservation of vocal cord nerve function is so important that we place an amniotic membrane cover over each nerve during the operation to protect it and help the healing process. It has made a huge difference, to the point that we won't perform thyroid surgery without a biologic covering over the nerve."
  
  
• Bleeding: Excessive bleeding during or after surgery can be a concern, necessitating the expertise to control it. High-volume thyroid surgeons have learned to minimize the risk of bleeding through experience, learning where the potential bleeding points can be hiding. Only by performing a high number of thyroid operations annually (more than 100 per year) can a surgeon gain an in-depth knowledge of the anatomy and the surgery itself along with common and uncommon variations and challenges that may arise with both. This significantly reduces the risk of bleeding during and after a thyroidectomy.
  
  
• Hypoparathyroidism: The four parathyroid glands live on the back side of the thyroid and control the amount of calcium in the bones and blood. The most common complication following thyroid surgery is hypoparathyroidism which occurs when these tiny glands are damaged. As many as 80% of patients undergoing thyroid surgery will experience this problem resulting in low blood calcium problems for weeks or months---or even for their lifetime in 5% of cases. During a thyroidectomy, it is imperative to identify and preserve all the parathyroid glands. Unfortunately, this is difficult to do, with most low-experienced surgeons being unable to find and preserve these tiny glands. Again, multiple medical publications have shown that low-volume surgeons experience this complication as much as ten times more frequently than high-volume thyroid surgeons.
  
  
• Scar Formation: A visible and unsightly scar is often a concern for patients undergoing thyroidectomy. Although the appearance of scars varies from person to person, experienced and skilled thyroid surgeons employ techniques to minimize scarring and promote optimal healing. High-volume thyroid surgeons typically use a plastic surgery type of closure, which helps to ensure a scar that is not visible once completely healed. Dr. Roy has released several YouTube videos about the strategic placement of the incisions and how well the scars heal.
  
  The ultimate in scar outcomes is to avoid an incision in the neck altogether. Only a few surgeons offer robotic thyroid surgery, which hides the incisions in the arm pits. The highest volume robotic thyroid surgeon in the US is Dr. Hyunsuk Suh, Medical Director of the Robotic Thyroid Surgery Center at the Hospital for Endocrine Surgery. He performs state-of-the-art robotic thyroid surgery exclusively which leaves behind no neck scar and states: "Robotic thyroid surgery offers the potential for zero scars on their neck, providing patients with both medical and cosmetic benefits."

Choosing the Right Thyroid Surgeon:

When selecting a thyroid surgeon, do your homework! Dr. Roy created a video to guide you in questions to ask your potential thyroid surgeon. You should also consider:

• Credentials: Verify specialized training in thyroid surgery. Just being a board- certified general surgeon is not enough.
  
  
• Referrals & Reviews: Seek recommendations from healthcare providers and trusted resources. Check the practice's Google reviews and look up the surgeon on HealthGrades. Seek out testimonials and see what past patients have to say.
  
  
• Experience: Inquire about the surgeon's experience and success rate. Ask how many thyroid operations they perform each year, and ask about their complication rates. If they can't tell you, then you may want to seek another opinion.
  
  
• Communication: Choose a surgeon who promotes open and transparent communication.
  
  
• Hospital Affiliation: Ensure affiliation with a reputable medical center.

As we observe Thyroid Disease Awareness Month, it is crucial to prioritize thyroid health and informed decision-making. If you have thyroid cancer, thyroid nodules or another type of thyroid disease, surgery may be necessary – but keep in mind there are steps you can take to minimize the complications, and they begin with choosing an expert thyroid surgeon.