Choosing a Surgeon
Choosing a surgeon is an important matter. You need to trust and be comfortable with any individual you choose. When it comes to thyroid/ parathyroid and adrenal conditions, you should look for an experienced endocrine surgeon. At the BIDMC Thyroid and Parathyroid Center , we will make every effort to eliminate the need for surgery by using techniques such as ultrasound and fine needle aspiration. Thyroid and parathyroid surgery is a highly specialized field, which can only be mastered by well-trained surgeons with years of experience. The more training your surgeon has, the more adept he or she will be at determining whether surgery is required. Also, remember that the surgeon's title is not necessarily relevant to his or her experience. For example, a head and neck surgeon may not be an expert in thyroid or parathyroid surgery, so inquire about the surgeon's specific experience. We believe the more informed you are as a patient, the better your outcome will be. Below are a few questions you can ask your surgeon:
How many thyroid/parathyroid surgeries do you perform each year?
When you talk to the surgeon, ask for specific numbers. An answer of "many" is too vague. Expert thyroid and /or parathyroid surgeons will perform at least 50 such operations per year. Sometimes, their entire practice may be dedicated to thyroid or parathyroid surgeries, or they may perform other complex and delicate procedures such as surgery for other cancers.
Do you perform thyroid or parathyroid surgery with local anesthesia? If so, do you perform these routinely?
Generally speaking, this kind of surgery is minimally invasive and only done routinely in patients with small parathyroid tumors, which have been previously localized to one side of the neck. There are two main approaches for parathyroid surgery: unilateral (one side of the neck) and bilateral (both sides). Bilateral surgery is best for the patients who are at risk for multi-glandular parathyroid disease which occur in about 10-15 % of patients; or for the patients at risk for co-existing thyroid nodules, in about 20% of patients.
Please keep in mind that only surgeons who are trained to perform thyroid or parathyroid surgery using local anesthesia are doing so on a routine basis. If a patient chooses local anesthesia over general, he or she is given a mild sedative to ease anxiety, but is awake throughout the operation and can interact with the surgeon. Most patients do not experience any pain during the procedure and report a quicker post-operative recovery.
Do you have experience with intra-operative testing for parathyroid hormone levels during parathyroid surgery?
The rapid parathyroid hormone assay (PTH assay) has been used for approximately five years. It allows surgeons to assess whether the parathyroid tumor resection is complete without visualizing all the parathyroid glands. If intra-operative PTH levels do not decrease during surgery, a bilateral neck exploration will be performed (under local or general anesthesia). Once the PTH levels normalize, the operation is completed. Some surgeons use this technique routinely, while others use it selectively (only in some cases). If your surgeon plans on using it, it is important that he or she be experienced in this technique.
Do you have experience with recurrent laryngeal nerve monitoring techniques and do you use them in your practice?
Some surgeons use recurrent laryngeal nerve monitoring during thyroid surgery to help visualize or identify the location of the recurrent laryngeal nerve. It is certainly not a foolproof technique and its use does not guarantee that the recurrent laryngeal nerve will be spared. According to recent studies, the surgeon's experience and nature of the patient's thyroid disease appear to be the main predictors of nerve injury. You can ask your surgeon about his or her experience with the technique. But remember, many experienced thyroid surgeons rarely use this technique yet have excellent results.