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Keith Forwith

Innovative Thyroid Surgeon

How to wisely choose a thyroid surgeon

The technical challenges of thyroid surgery are well known. For the best possible outcomes and the least chance of complications patients need to make well-informed and wise decisions. Here are the basic questions to ask when making this important decision.

The Questions

Is the surgeon qualified?

A qualified surgeon will be board certified either by the American Academy of Otolaryngology/Head and Neck Surgery or a member of the American Association of Endocrine Surgeons. General surgeons board certified by the American College of Surgeons do not have advanced training in head and neck surgery but may feel qualified to perform basic thyroid and parathyroid operations. Advanced cases, especially those requiring neck dissections should be done by surgeons with advanced training specifically in those procedures.

Does the surgeon perform a lot of these operations?

Volume matters! Surgeon experience is the number one predictor of complication rates. The American Thyroid Association states that low volume surgeons, who perform more than 80% of thyroidectomies in the US, have a 19% complication rate. This is far too high! By contrast, the ATA cites high volume surgeons as averaging 7.5% rate of complications- which is still too high! By the ATA definition, low volume surgeons do less than 10 thyroid operations per year – which explains why nearly one in five patients have complicaitons. By comparison, a high volume surgeon exceeds 100 operations per year and only 1 in 13 patients have complications (2015 ATA Thyroid Nodule Guidelines) . For many surgeons, thyroidectomy represents the most delicate and challenging surgery they perform. For the head and neck surgeon, parotidectomy (where the facial nerve is at risk) presents finer and more numerous nerves that require surgical dissection. The results show permanently on the patients face – just as the voice will indicate the status of the nerves encountered in thyroidectomy. You want a surgeon who does many delicate surgeries and is comfortable in the small spaces of the neck.

What are the complication rates?

Complication rates have been shown in many peer reviewed journals to be proportional to the volume of these type cases. Surgeons performing less than 100 operations per year had substantially higher rates of both temporary and permanent complications. High volume surgeons performing more than 100 operations per year had the lowest complication rates and the best outcomes. Repetition and practice make every surgeon better- whether they are mediocre or world class. Obviously, you want the best surgeon who gets the most practice!

What are the outcomes?

Outcomes are measured in many ways. For some surgeons, outcomes are measured in the number of cases. A recent study on thyroid screening focused on the death rate from thyroid cancer. While, that is important it ignores quality of life as a critical component. Earlier detection means less extensive surgery and fewer adjunct therapies.

Who will be doing my surgery?

Young surgeons need to learn. They need to learn by operating on real people. So, we need residents and fellows to perform operations so that they can learn. You should ask who will be learning during your case, and how closely supervised those young surgeons will be. I perform each and every one of the operations for my patients. While I welcome students and residents to observe, I still do each and every operation myself. I also use the same surgical assistants for every single case. These physician assistants were trained, by me, to assist in exactly the manner I demand. The result? My complication rates are far lower than even the high-volume surgeons cited above.

Will the surgeon answer my questions? Before? Day of surgery? After surgery?

One of the things I go to great effort to ensure is that each patient and family understands both their diagnosis and their treatment options. If anything, I may be guilty of trying to explain too much! But I truly believe that patients make the best decisions for themselves when they are fully informed, and their questions are answered in a manner that they can understand.

Will the surgeon be there to take care of any problems?

My care remains consistent in every phase of treatment – including after the surgery is done. I don’t pass off patients to another provider as soon as the wound is closed.

Is the surgeon interested in me or just my thyroid?

I take a personal interest in every patient, especially thyroids! Both my wife and I have thyroid nodules so thyroid care is personal to me.

Is the surgeon honest? Do I trust the surgeon?

Good relationships are built on honesty. I’m not very good at hiding my thoughts and emotions – so I don’t really try (which is why I don’t play poker for money!). I want my doctors to always be up front and forthcoming with me, so I take this approach with my patients. I hope that my openness and honesty earn the trust of each and every patient. In fact, this website is a reflection of who I am and my core values. As a Christian, my call goes beyond just a job or a career – I try each day to walk in the shoes of the great physician, Jesus Christ! If you know him, then you know what I mean, if you don’t – well I’d love to introduce you to him!

Do I need a second opinion?

I think second opinions are valuable. If I do my job right, an honest second opinion will only make me look good. If a surgeon is offended by your interest in another opinion, go elsewhere! You need to be comfortable with your decision as you will live with the consequences of those decisions far longer than the surgeon you choose. Don’t let the thought of offending a surgeon keep you from the peace of mind that a second opinion can bring! Here’s my page on why I encourage second opinions!

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