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 yourself when making this important decision. 

The Questions

  1. Is the surgeon qualified?
  2. Does the surgeon perform a lot of these operations?
  3. What are the complication rates?
  4. What are the outcomes?
  5. Will I be treated as an individual?
  6. Will the surgeon answer my questions? Before? Day of surgery? After surgery?
  7. Will the surgeon be there to take care of any problems?
  8. Is the surgeon interested in me or just my thyroid?
  9. Is the surgeon honest? Do I trust the surgeon?
  10. Do I need a second opinion?

The Answers

  1. 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. 
  2. Volume matters! 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. 
  3. Complication rates have been shown in many peer reviewed journals to be proportional to the volume of these type cases. Surgeons performing less than 50 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 makes every surgeon better- whether they are mediocre or world class. Obviously, you want the best surgeon who gets the most practice!
  4. 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. 
  5. While so many papers focus on treating populations, my sole focus is on the individual patient in front of me. Each person brings different factors into their care. A patient who just had a relative pass away from cancer will look very differently at surgery than a patient whose family member just experienced a problem after their surgery.  
  6. 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. 
  7. 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. 
  8. I take a personal interest in every patient, especially thyroids! Both my wife and myself have thyroid nodules so thyroid care is personal to me. 
  9. 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 earns 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! 
  10. I think second opinions are valuable. Here's my page on why I encourage second opinions!