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Friday, 31 December 2010

Thyroidectomy (Thyroid Surgery) Risks

Posted on 16:03 by Unknown
Thyroid removal (either total or only one side) is a common surgery performed by general surgeons as well as ENTs for thyroid cancer or masses suspicious for cancer.

Though I no longer perform this surgery, I often get asked for my opinion regarding this surgery. Rationale for why surgery should be done or not, I leave to others as it would literally take a textbook, especially given the controversy regarding when to observe and when to surgically remove. Back when I WAS performing thyroidectomy, I should state my bias was towards removal... and belief that a needle biopsy is not 100% accurate. Indeed, in certain situations, a needle biopsy (FNA) is at best no better than flip of a coin whether cancer is present (it is wrong 50% of the time!).

In any case, there are several risks involved when this surgery is performed. Other than the typical risks common to all surgeries like infection and the ho-hum bleeding, there are several unique risks specific to thyroid surgery. Let's go over each one:

Windpipe
Given the thyroid is located over the windpipe, the surgeon may accidentally (or deliberately if thyroid cancer is invading the windpipe's wall) enter into the airway. Why may this be a problem? Well, it may cause air to leak into the neck causing it to suddenly swell up and potentially lead to a pneumothorax (collapsed lung) if severe enough. The scary thing is that it could potentially occur days after the surgery though if it is going to happen, it usually occurs within hours after surgery.

Bleeding
Bleeding is ALWAYS a risk of surgery causing a hematoma to form. What makes this particular complication especially concerning is that it often occurs DAYS after surgery. Even more worrisome is that it could lead to death as the hematoma formation can cause significant swelling with resulting airway compression (remember that the thyroid is located over the windpipe). This particular complication unfortunately occurs not uncommonly... and often leads the patient to obtain emergency care in the local ER by a local surgeon to drain/remove the hematoma and stop the bleeding even if the surgery was done by surgeon located an hour or more away. A tracheostomy (a hole in the neck to the windpipe) may need to be performed at this time as well.

Recurrent Laryngeal Nerve Damage
The nerve that allows you to talk is called the recurrent laryngeal nerve. This nerve is RIGHT NEXT to your thyroid gland. As such, it can be damaged or cut resulting in a very breathy sounding voice. Oftentimes, it is temporary. Rarely, BOTH nerves can get cut if undergoing total thyroidectomy causing stridor or airway problems mandating a tracheostomy.

In the event that a patient suffers a vocal cord paralysis from recurrent laryngeal nerve damage, it can be corrected surgically resulting in an almost normal sounding voice. If BOTH vocal cords are paralyzed... well... breathing and talking will be a problem and options are quite limited if this unfortunate complication occurs.

Superior Laryngeal Nerve Damage
With this type of nerve damage, you can talk just fine... but you lose your upper range and falsetto.

Parathyroid Gland Loss
The parathyroid glands are located behind the thyroid gland in the 4 corners as depicted by the golden nuggets seen in the diagram to the right. These glands are very important regulating the calcium levels in the blood. In the devastating event that all 4 parathyroid glands get damaged or removed (as might occur during total or completion thyroidectomy), the patient loses the ability to maintain calcium levels in the blood resulting in cardiac and neurologic problems that could lead to death if not immediately addressed. Even if the parathyroid glands are preserved, if the blood supply to the 4 glands get cut off or damaged by the thyroid surgery, blood calcium levels may deteriorate.

Summary
Thyroid surgery has risks and should be performed by a well-qualified surgeon. However, keep in mind that the best person to take care of you should you experience any surgical complication is the surgeon who actually did the surgery (one of many factors to take into consideration when considering having the surgery done far from home).

References:
Mediastinal emphysema and pneumothorax following thyroidectomy. The Journal of Clinical Endocrinology Vol. 9, No. 10 987-998 doi:10.1210/jcem-9-10-987

Complications of Thyroid Surgery. EMedicine




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Posted in breathy, calcium, hoarseness, paralysis, parathyroid, thyroid, thyroidectomy, vocal cord | No comments
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  • placebo
  • plan
  • planet
  • planetree
  • plastic surgery
  • plastics
  • plugs
  • pocket
  • police
  • policy
  • pollen
  • polly hunsberger
  • polonium
  • polyp
  • pons
  • poor
  • popping
  • popular
  • popularity
  • portable
  • portman
  • positive
  • post
  • post-nasal
  • post-nasal drainage
  • posterior
  • pouch
  • power
  • ppo
  • practice
  • predicting
  • prediction
  • prednisone
  • pregnancy
  • pregnant
  • premarin
  • prenatal
  • prescribing
  • prescription
  • prescriptions
  • pressure
  • prick
  • prilosec
  • primer
  • problem
  • problems
  • procedure
  • process
  • professional
  • propel
  • protein kinase
  • provider
  • public
  • publication
  • puck
  • pulsatile
  • pumpkin
  • punishment
  • purchase
  • purulent
  • pus
  • puzzle
  • pylori
  • quickly
  • quickmark
  • r. kelly
  • radiation
  • radio
  • radioactive
  • radioactivity
  • radiological
  • radiology
  • raft
  • ragweed
  • random
  • rapid
  • raspy
  • RAST
  • reaction
  • reader
  • real-time
  • rebound
  • reckitt
  • record
  • recording
  • records
  • recurrent
  • red eyes
  • reduction
  • referral
  • reflux
  • regurgitation
  • rehm
  • removal
  • renovation
  • renovations
  • repair
  • repellant
  • replacement
  • reporter
  • research
  • residency
  • resident
  • resistance
  • response
  • resurface
  • resurfacing
  • review
  • rhinitis
  • rhinoplasty
  • richmond
  • right
  • ringing
  • rinse
  • risk
  • robert
  • robot
  • robotic
  • rock
  • roger
  • roof
  • room
  • rotating
  • routine
  • rubber
  • runny nose
  • rupture
  • ryan
  • safe
  • sale
  • saline
  • saliva
  • salivary stone
  • saltwater
  • santa claus
  • scan
  • scans
  • scar
  • scheduling
  • science
  • scientist
  • SCIT
  • scopolamine
  • scramble
  • scratch
  • screening
  • SD
  • seafood
  • search
  • seasonal
  • seaweed
  • secondhand
  • secure
  • security
  • sedated
  • sedation
  • self-pay
  • sensory
  • sepsis
  • septal
  • septo
  • septoplasty
  • septum
  • sermo
  • service
  • set
  • severe
  • sex
  • shampoo
  • shape
  • shark
  • shenandoah university
  • shop
  • shortness of breath
  • shot
  • shots
  • show
  • shrimp
  • sialadenitis
  • sialendoscopy
  • sialoadenitis
  • sickness
  • side
  • side effect
  • silent
  • silver nitrate
  • singer
  • singing
  • singing cat
  • singulair
  • singultus
  • sinuneb
  • sinuplasty
  • sinus
  • sinus fracture
  • sinus infection
  • sinus lift
  • sinus surgery
  • sinusitis
  • skating
  • skin
  • skin cancer
  • skull
  • sleep
  • sleep disorder
  • SLIT
  • sluder
  • small
  • smartphone
  • smell
  • smoke
  • smoking
  • sms
  • sneeze
  • sneezing
  • snore
  • snoring
  • snot
  • snotty nose
  • social
  • social media
  • social networking
  • soda
  • sodium
  • soft
  • song
  • sore
  • sore throat
  • sour
  • spa
  • spam
  • spanish
  • spasmodic
  • spasmodic dypshonia
  • spasmodic dysphonia
  • spasms
  • special
  • specialist
  • speech
  • speech therapy
  • spinal
  • spinning
  • spit
  • splints
  • split tube
  • spray
  • spur
  • ssnhl
  • staph
  • starvation
  • stat
  • station
  • stem
  • stereoisomer
  • sterile
  • steroid
  • steroids
  • sticky
  • stink
  • stone
  • stones
  • stops
  • storybooks
  • strange
  • strep
  • strep throat
  • stridor
  • strobe
  • stroboscopy
  • stroke
  • stuck
  • stud
  • student
  • study
  • stuffed animals
  • stuttering
  • sublingual
  • submandibular
  • submaxillary
  • sudden
  • sudden hearing loss
  • sun
  • sunblock
  • sunscreen
  • sunshine
  • superbill
  • superbowl
  • superbug
  • support
  • surgeon
  • surgery
  • surgical
  • survey
  • suture
  • swallow
  • swallowing
  • swelling
  • sword
  • symbicort
  • symphony
  • symptom
  • symptoms
  • syndrome
  • T-tube
  • tablet
  • talk
  • talking
  • tall
  • target
  • taste
  • tea
  • teacher
  • technology
  • teen
  • teenager
  • teeth
  • television
  • temperature
  • terrorism
  • terrorist
  • test
  • testing
  • tests
  • text messaging
  • the doctors
  • the onion
  • theory
  • therapy
  • thick
  • throat
  • throat cancer
  • throat clearing
  • throat-clearing
  • thrombosis
  • thrombus
  • throwing
  • thyroid
  • thyroidectomy
  • tia
  • tic
  • tic cough
  • tick
  • tilt
  • time
  • times
  • tinnitus
  • tiny
  • Tionne
  • TLC
  • TMJ
  • tobacco
  • TOCPM
  • today
  • tongue
  • tonsil
  • tonsil stones
  • tonsillectomy
  • tonsilliits
  • tonsillitis
  • tonsilloliths
  • tonsillotomy
  • tonsilolith
  • tonsiloliths
  • tony
  • tooth
  • tooth pain
  • top
  • topical
  • TORD
  • torres
  • tors
  • torticollis
  • tour
  • toxin
  • toyota
  • trach
  • tracheostomy
  • training
  • trans
  • translation
  • transmedics
  • transmission
  • transplant
  • transplantation
  • transportation
  • trauma
  • treating
  • treatment
  • tremor
  • trend
  • triangle
  • trombone
  • trouble
  • tube
  • tubes
  • tucci
  • tumor
  • turbinate coblation
  • turbinate hypertrophy
  • turbinate reduction
  • turning
  • tutorial
  • TV
  • tween
  • tweet
  • twitching
  • twitter
  • two
  • tylenol
  • tympanic
  • type
  • ulcer
  • ulpa
  • ulrich
  • ultrasound
  • unable
  • unclog
  • under
  • uninsured
  • united kingdom
  • university
  • Update
  • upper
  • upper respiratory infection
  • uppp
  • urgent
  • URI
  • urine
  • urticaria
  • usa
  • USA today
  • uva
  • uvula
  • uvulectomy
  • uvulopalatopharyngoplasty
  • vaccination
  • vaccine
  • vagal neuropathy
  • vascular
  • vasomotor
  • vasomotor rhinnitis
  • vcd
  • ventilation
  • versus
  • vertigo
  • ves
  • vessel
  • viagra
  • vibration
  • video
  • viral
  • virginia
  • virus
  • viruses
  • vit d
  • vitamin
  • vitamin A
  • vitamin d
  • vivosonic
  • vlog
  • vocal
  • vocal cord
  • vocal cord dysfunction
  • vocal cord paralysis
  • vocal cord paresis
  • vocal cords
  • vocal process
  • voice
  • voice therapy
  • voicebox
  • voicelift
  • volume
  • vomit
  • vs
  • wait
  • waiting
  • wall
  • wall street journal
  • warm
  • warrenton
  • washes
  • washington
  • washington dc
  • washington post
  • water
  • watkins
  • wax
  • wearable
  • web
  • web 2.0
  • webapp
  • Website
  • Website Update
  • wedge
  • weight gain
  • whale
  • what to do
  • wheezing
  • where
  • whisperer
  • whispering
  • white
  • who
  • whooping
  • wierd
  • wifi
  • will.i.am
  • wind
  • windows 7
  • winter
  • wire
  • wireless
  • withdrawal
  • without
  • woman
  • word
  • world
  • world voice day
  • world's
  • worlds
  • wound center
  • wp
  • wrestling
  • wrong
  • wsj
  • x-ray
  • xeomin
  • xray
  • xylitol
  • xyzal
  • youtube
  • zenker's
  • zenkers
  • zeta
  • zicam
  • zinc
  • zyrtec

Blog Archive

  • ►  2011 (190)
    • ►  September (26)
    • ►  August (22)
    • ►  July (20)
    • ►  June (15)
    • ►  May (10)
    • ►  April (18)
    • ►  March (12)
    • ►  February (33)
    • ►  January (34)
  • ▼  2010 (267)
    • ▼  December (23)
      • Thyroidectomy (Thyroid Surgery) Risks
      • ENT Problem at the Biblical Wall of Jericho
      • How Does Coblation Work?
      • Pacemaker To Cure Obstructive Sleep Apnea (OSA)?
      • Santa Claus, A Sick Patient Needing Medical Care
      • Can Placebo Be Used to Help People Instead of Drugs?
      • Can Humming Ease Sinus Problems?
      • ICD-10 Coding Primer for Otolaryngologists
      • Google Body Browser (Google Maps of the Human Body)
      • Robotic Surgery for Oral Cancer
      • Patient Experience Just As Important As Clinical E...
      • Dr. Chris Chang Mentioned in a Medical Blog
      • New Video on Septoplasty to Correct Nasal Obstruct...
      • Has Evidence-Based Medicine Gone Too Far?
      • Dr. House Video Clip Illustrating Doctor-Patient C...
      • Different Types of Immunotherapy for Allergy Cure
      • Can A Person Have Allergies Even if Allergy Testin...
      • Will.i.am Suffers From Tinnitus
      • Extremely Discounted Blood Tests for Cash-Paying o...
      • Physician Marketing Using Groupon
      • Strange But True Allergies People Suffer From (Sex...
      • What Makes A Great Surgeon or Doctor?
      • New Video On Performing a Tracheostomy
    • ►  November (18)
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    • ►  September (30)
    • ►  August (35)
    • ►  July (16)
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    • ►  May (22)
    • ►  April (27)
    • ►  March (11)
    • ►  February (13)
    • ►  January (13)
  • ►  2009 (43)
    • ►  December (11)
    • ►  November (13)
    • ►  October (19)
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