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COMMONLY ASKED QUESTIONS

How long does the surgery take to perform? A typical thyroidectomy takes 2-3 hours. A typical thyroid lobectomy takes 1-1 ½ hours.

What is the recovery time like? Typically patients are back to normal and feeling well after 4-5 days.

Will I need to stay overnight in the hospital? Depending on the extent of dissection, you may be required to stay overnight.

Any dietary restrictions after the surgery? None. You may eat and drink normally after your surgery.

Can I speak after surgery? You may use your voice immediately after the surgery.

Will I be sent home with any medications? You will be given pain medications and antibiotics. Additionally, if you have had a total thyroidectomy performed then you will be sent home with thyroid replacement medications, and calcium supplementation.

What types of activities can I perform after surgery? I would not recommend heavy lifting or straining immediately after surgery. You can resume heavy lifting and straining 1 week after surgery.

When do I come in for my follow-up visit? You should be seen 1-2 weeks following surgery.

Will my stitches need to be removed? All the stitches will be dissolvable, and we do not need to remove any of them.

What are the risks of thyroid surgery? Aside from possible bleeding and infection, the major risks to thyroidectomy are injury to the recurrent or superior laryngeal nerves (causing hoarseness), hypocalcemia (low calcium levels), and poor scarring. In a competent surgeon’s hands, these risks are in the single digits.

What is the central compartment and why is it important?

The central compartment (also referred to as level 6 of the neck) is defined as the area around the thyroid gland, which harbors all the lymph nodes which thyroid cancer may spread to. Here is a picture of what the central compartment of the neck encompasses:

The American Thyroid Association Guidelines published in 2009, suggest that the central compartment should be evaluated when a diagnosis of cancer has been made on a needle biopsy, and when involved should be dissected and removed.

In the case of larger tumors of the thyroid, this compartment may be dissected and removed even if there are no involved lymph nodes, given the high likelihood of metastasis to this area.

See below for an example of lymph node metastasis to the left paratracheal region. Make sure that your surgeon has experience dissecting and adequately removing the lymph nodes in this very delicate area.

What is the typical work-up of a thyroid nodule?

The work-up for a thyroid nodule (swelling) is fairly standardized and shown below as described by the American Thyroid Association in 2009.

As you can see, the work-up usually involves some blood work, and a fine needle aspiration biopsy with or without ultrasound.

When do you need to perform a ultrasound guided fine needle biopsy?

If required, I will perform an ultrasound during the clinic visit. Here are the indications for ultrasound guided fine needle aspiration biopsy.

• Complex nodule (cystic-solid) – ultrasound is necessary to needle biopsy the solid portion of the nodule
• Non palpable or small palpable (cannot feel the nodule) – in this case ultrasound is used to find the nodule
• Posterior lesions – ultrasound is used to find the nodule located deep in the neck
• Multinodular goiter – ultrasound is used to evaluate all the nodules in the neck and determine which ones need to be biopsied
• Previous non-diagnostic FNA – ultrasound is used to increase the likelihood of figuring out if a nodule is benign or malignant
• Adjacent vascular structures – ultrasound is used to avoid injury to major blood vessels in the neck

WHY IS ULTRASOUND SO IMPORTANT IN THE WORK-UP OF THE THYROID NODULE?

When performed by someone who does it often, it is fast, easy to perform, and repeatable. There is no radiation used and the technique is painless.

Ultrasound also gives you important clues to the nature of the nodule (whether a thyroid nodule is benign versus malignant).

There are several characteristics which suggest malignancy on ultrasound and these are:

• Predominantly Solid
• Hypoechogenicity
• Intranodular vascularity
• Microcalcifications
• Irregular Margins (loss of halo)
• Taller than wide on transverse view

These characteristics would make your physician more likely to perform a fine needle aspiration biopsy to rule out cancer.

Here are some examples of thyroid nodules on ultrasound imaging. See if you can tell which ones are benign versus malignant based on the characteristics listed above.

If there is evidence of cancer on the needle biopsy, then surgery is usually recommended.

If there is no evidence of cancer on the needle biopsy, then the patient can be observed and will require a routine ultrasound examination every 9 months to 1 year.

It the biopsy results are not conclusive (we can’t tell what it is) then you may have another needle biopsy or undergo a diagnostic hemithyroidectomy, depending on the level of suspicion that this is malignant.

There are several practitioners in my area who perform thyroid surgery. How should I choose one? Are there questions I should ask during the consultation?

There are a few things to consider when deciding on a surgeon.

Ask how many thyroid surgeries the surgeon has done during the past three months to get a sense of his/her experience. Thyroid surgery is technically challenging and there is no such thing as an easy thyroid surgery. Make sure that you choose someone who has the requisite technical skills.

Ask if your surgeon is fellowship trained in thyroid surgery. Bear in mind that fellowship training in thyroid surgery is relatively new. For those surgeons who have been in practice for over 5 years, this would not have been available to them. There are many competent thyroid surgeons who have not had fellowship training. Nevertheless, this is something that allows you as a patient to understand how up-to-date your thyroid surgeon is with new techniques.

Ask if your surgeon uses laryngeal nerve monitoring. Successful thyroidectomy does not always require the use of laryngeal nerve monitoring, but there has been a positive trend towards the use of monitoring during thyroidectomy. If you are undergoing thyroidectomy, you should have the state of the art technology available in order to minimize the chance of an injury to your voice.

In the end, the decision to choose a surgeon is a very personal one. Don’t be rushed through the pre-operative consultation. Make sure that you can trust what your surgeon has to say, make sure that you have adequate time to get an answer to all of your questions, and make sure that you have been able to establish a rapport with the surgeon.