Surgery is never routine to the patient. Each surgery is likely the first for the patient and a lot is on the line! The best outcomes are with the first surgery. Complications and completeness of resection matter, especially to cancer outcomes. A thorough and honest discussion is part of every pre-operative counseling visit.
Dr. Keith Forwith is one of only 25 doctors in the world to perform the most-complex thyroid-related surgeries.
There are some unique challenges to thyroid surgery, mainly related to the structures that surround the thyroid. There is a delicate nerve called the recurrent laryngeal nerve (RLN) which runs behind the thyroid and goes to the voice box. If this nerve is stretched, injured or damaged during surgery then hoarseness of the voice or breathiness of the voice can result. There are also small parathyroid glands which monitor and control the body’s calcium level.
As a child, I suffered from allergies, migraines, and vertigo so I was quite familiar with the doctor’s office. Originally, I wanted to be a carpenter. I spent a lot of time helping my dad with woodworking and remodeling projects and was quite skilled with my hands. But I showed an aptitude for science that wouldn’t be used as a carpenter. When I was 13, my dad had an unfortunate accident and sustained facial trauma that changed my life’s path. A surgeon was called in on a Sunday evening as my father’s life hung in the balance. That surgeon’s skill saved my father and planted the seed that would grow into my life’s work.
Radiofrequency ablation (RFA) is a percutaneous treatment that results in thermal tissue necrosis and fibrosis. As a result of this process, the nodules shrink. Clinical trials in Italy and South Korea demonstrated a 50 to 80 percent durable nodule shrinkage after thyroid nodule RFA.
Which surgery is right for you depends upon a number of factors including the information we gather from ultrasound evaluation and from fine needle aspiration biopsy. These results need to be discussed with each and every patient and so is difficult to generalize. Thyroid cancer, which is highly treatable, has achieved high success rates primarily because total thyroidectomy has been the treatment of choice. There is more recent evidence that perhaps total thyroidectomy is not required in all cases and so lobectomy and hemithyroidectomy has become a viable option for selected patients. Discussions on which operation is best should be undertaken by the patient and surgeon and is certainly individualized for each and every patient. Whichever operation is chosen by the surgeon and patient after a long discussion, the risks of that surgery are going to be unique to that type of surgery. You can find more information on risks of surgery here.