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HomeFactsDo Ent Doctors Do Thyroid Surgery

Do Ent Doctors Do Thyroid Surgery

What Will Be My Physical Restrictions Following Surgery

How do I find the best thyroid doctor?

Most surgeons prefer that patients limit extreme physical activities following surgery for a few days or weeks. This is primarily to reduce the risk of a postoperative neck hematoma and breaking of stitches in the wound closure. These limitations are brief, usually followed by a quick transition back to unrestricted activity. Normal activity can begin on the first postoperative day. Vigorous sports, such as swimming, and activities that include heavy lifting should be delayed for at least ten days to 2 weeks.

How Will I Know If I Need Thyroid Surgery

  • When the results from the fine needle aspiration come back as;indeterminate,;suspicious or suggestive of cancer.
  • If the imaging shows that the nodules have unusual characteristics or if they are getting bigger.
  • If the nodule drastically affects the trachea or windpipe because;one;or;both thyroid lobes are very enlarged.

Some thyroid nodules have been known to reduce in size when the thyroid hormone is administered. However, this treatment has been an unreliable treatment method.

Current State Of Play

Regardless of training background, there is a call for more thyroid operations to be performed by high volume surgeons . In the UK, approximately 60% of thyroid operations are performed by surgeons with a training background in general surgery and 40% by head and neck surgeons with a background in otolaryngology . This has increased from 1998 when only 15% of thyroid operations in the UK were performed by head and neck surgeons . In the US, division of labour in thyroid surgery has traditionally been centre dependant . However, over the last 5 years, there has been a significant change with thyroid surgery now shared between otolaryngologists and general surgeons at major cancer centers such as Memorial Sloan-Kettering and MD Anderson. In terms of volume of surgery, UK figures from the national audit of endocrine surgery suggest 46% of members completed less than 35 cases over 2 years with 22% less than 5 operations per year . In the US, 25% of thyroid operations are completed by high volume surgeons although these surgeons made up only 3% of those completing thyroid operations . Regardless of background, the future emphasis in thyroid surgery will be on speciality training and high volume practice.

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Questions To Ask Your Doctor Before Thyroid Surgery

Duke doctors perform thyroid surgery on a patient at Duke Raleigh Hospital.

Your doctor may recommend surgery to remove part or all of your thyroid gland if its overactive, has grown very large, or has nodules, cysts or other growths that areor could becancerous. Here are essential questions to ask before you schedule thyroid surgery.

Learn more about thyroid cancer treatment at Duke.

Signs Of A Thyroid Condition

What is Thyroidectomy?

The following thyroid conditions are the most known; hypothyroidism, hyperthyroidism, thyroiditis and thyroid nodules. The following four thyroid disorders require treatment from a professional before they become too dangerous.;

  • Hypothyroidism When the body is lacking the thyroid hormone that it normally produces, hypothyroidism becomes a problem. The cause of this can be from a gland that isnt working or a missing gland from the body.
  • Hyperthyroidism This is the reverse of Hypothyroidism. The body produces too much of the thyroid hormone, which is just as bad as under producing. Graves Disease falls under this category and is common.
  • Thyroiditis Inflammation of the thyroid gland is called thyroiditis. Some variations of it can be caused by infection, so patients with sinus conditions are the most vulnerable. Some early stages of hyperthyroidism turn into Thyroiditis.
  • Thyroid Nodules Bumps in the thyroid can go from small to large if left unchecked. This is the most visual of the four thyroid conditions and should be checked by a professional immediately. ;

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Types Of Thyroid Surgeons

Several different types of surgeons can perform thyroid surgery. To some extent, the type of surgeon you’ll need depends on your specific diagnosis, but there are other considerations as well, such as how experienced a surgeon is in performing these procedures and the options available where you live.

Types of thyroid surgeons and their specialties include:

Identifying And Managing Complications

Most cases of litigation in thyroid surgery come from damage to the RLN . Surgeons with a background in head and neck surgery are obviously well placed to deal with these complications and have close ties to voice therapists who will play a pivotal role in rehabilitation. In spite of planning and anticipation, complications do occur. Recognition of an asymptomatic palsy is a key in the consenting process as there may be a significant risk of the need for a surgical tracheotomy . UK data suggest that even in redo surgery, the vocal function is only checked 79% of the time . Thyroid surgeons should be able to perform direct laryngoscopy in the clinic or have close association with an otolaryngologist who can verify vocal cord function. The rate of post operative RLN palsy is significantly underplayed in the literature due to the way in which vocal cord function is assessed with studies of early laryngoscopy suggest temporary palsy rates as high a 8%. The British Association of Endocrine and Thyroid Surgeons recommend direct laryngoscopy post-operatively regardless of voice quality . There is a debate surrounding the optimal timing of examination and most surgeons would examine routinely at clinic follow up with others moving towards assessment prior to discharge.

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How Does A Doctor Check Your Thyroid

Doctors check your thyroid with blood tests and imaging. Blood tests look at levels of:

  • TSH
  • T4
  • Autoantibodies, which indicate Hashimoto’s or Graves’ disease

Imaging tests, especially for hyperthyroidism, may include an ultrasound, thyroid scan, or a radioactive iodine uptake test to identify thyroid nodules and see how active the gland is.

How Do I Find The Right Surgeon For Me

What is Otolaryngology-Head and Neck Surgery?

There are four main areas to explore as you seek the right surgeon.; They are:

  • Experience and Competence:; You want a surgeon with a proven successful track record.; There are several ways to confirm this, as discussed below.
  • Communication Style: Surgeons differ in their interpersonal styles. If you prefer to have a dialogue with your surgeon and weigh various options together, then some surgeons will be a better fit than others.
  • Institutional Affiliations & Resources:; Some surgeons are affiliated with larger institutions.; A surgeon who is affiliated with a credible institution is likely to adhere to certain high standards.; Some institutions also come with the backup resources and support of a hospital, as opposed to a private practice.
  • Practical & Financial Concerns: There are several things you have a right to know in advance.; These include insurance coverage for your surgery, the location and accessibility of the facility where you will have your operation, and any scheduling details pre- and post- surgery.
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    How Should I Be Evaluated Prior To The Operation

    As for other operations, all patients considering thyroid surgery should be evaluated preoperatively with a thorough and detailed medical history and physical exam including cardiopulmonary evaluation. An electrocardiogram and a chest x-ray prior to surgery are often recommended for patients who are over 45 years of age or who are symptomatic from heart disease. Blood tests may be performed to determine if a bleeding disorder is present.

    Importantly, any patient who has had a change in voice or who has had a previous neck operation and/or who has had a suspected invasive thyroid cancer should have their vocal cord function evaluated routinely before surgery. This is necessary to determine whether the recurrent laryngeal nerves that control the vocal cord muscles are functioning normally.

    Finally, in rare cases, if medullary thyroid cancer is suspected, patients should be evaluated for endocrine tumors that occur as part of familial syndromes including adrenal tumors and enlarged parathyroid glands that produce excess parathyroid hormone .

    What Does An Ent Do At First Appointment

    Be sure to let the ENT know when the symptoms first began. Depending on the reason for the visit, the ENT will perform a physical and visual examination. This may include looking in your ears, your nose and your throat. Your neck, throat, cheekbones and other areas of your face and head may be palpitated.

    You may ask, What is the difference between an ENT and an otolaryngologist?

    Otolaryngology is a medical specialty which is focused on the ears, nose, and throat. It is also called otolaryngology-head and neck surgery because specialists are trained in both medicine and surgery. An otolaryngologist is often called an ear, nose, and throat doctor, or an ENT for short.

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    The Importance Of A Thorough Evaluation

    After researching her options, Bostock made an appointment with;Sanziana Roman, MD. The moment I met her, I knew she would help me through this, Bostock said. She was very thorough. She was easy to communicate with. She answered all my questions.

    Roman is an endocrine surgeon specializing in thyroid diseases who has treated more than a thousand thyroid cancer patients. It really is a matter of experience, Roman said. Patients can present in different ways with different types of diseases of the thyroid gland. Understanding the biology of each of them is very important in assuring patients get the right care.

    Roman ordered neck mapping, an ultrasound exam of the lymph nodes in Bostocks neck to determine ifand wherethe cancer might have spread. The suspicious lymph nodes were biopsied, too. Results showed the cancer had spread from Bostocks thyroid into her lymph nodes.

    A thorough evaluation of the extent of the thyroid cancer before surgery is paramount, said Roman, who added that its the most important step in treating thyroid cancer. Knowing how extensive the cancer is and how much of the thyroid needs to be removed allows patients to get neither too little nor too much surgery, she said. While this approach is routine at Duke, its not the case everywhere. I see a lot of patients who have had surgeries which are not comprehensive, and then risky repeat surgeries need to be done, Roman said.

    Finding A Thyroid Parathyroid Or Endocrine Surgeon

    Flexible Robotics allows for better throat surgery

    Suppose your endocrinologist has advised you to consult an endocrine surgeon based on your diagnosis.; What do you do next?

    You may already be feeling a range of difficult emotions.; Now, selecting a new and vital part of your medical team can pile on yet additional stressors.

    The aim of this post is to help you navigate your decision, by pointing out some of the important criteria involved in choosing a surgeon.; Hopefully this results in a more actionable list of considerations.

    It is important to remember to look for the surgeon who is right for YOU.;

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    Ent Doctor For Thyroid

    How can an ENT doctor help you with your thyroid? There are various reasons to turn to an ENT doctor for thyroid help and support. The thyroid is a gland located at the base of your neck. It aids in the production of hormones. Those hormones race through your body, telling organs how to function and keeping you overall healthy. Hormone regulation is often times due to problems with the thyroid gland. When these problems become significant, you may need a specialist to help you with the condition. An ENT can often help in this way.

    Category Two: Communication Style

    Surgeons are people.; People all differ in how they interact.; Among surgeons, there is a wide variety of doctor-to-patient communication styles. Ask yourself: What kind of dialogue do I want with my surgeon?;

    If, for example, you prefer to discuss your treatment in depth, you have every right to state that openly.; If you sense that a surgeon is impatient or unwilling to answer your questions thoroughly, then feel assured there is probably a better fit elsewhere.;

    That is not to say that you need to discuss every detail of your operation.; Perhaps you are someone who finds it most reassuring to leave the intricacies of each medical decision to the surgeons expertise and only speak about things at a high level.; Ultimately, the right fit depends on what makes you feel most comfortable with your treatment.

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    Who Treats Thyroid Disease

    Several types of doctors can play a role in managing thyroid disease and its symptoms. Some people only see one doctor for thyroid-related issues, while others have a medical team they work with to manage their disease. The types of doctors you may want to consider include:

    • Primary care doctors
    • Holistic thyroid practitioners, including naturopaths and chiropractors

    Head And Neck Surgeon And The Thyroid Gland

    Thyroid surgery – choosing the best thyroid surgeon

    The head and neck surgeon is confronted with the thyroid and parathyroid glands and the laryngeal nerves on a daily basis. The surgical treatment of several hypopharyngeal or subglottic carcinomas include at least a hemithyroidectomy and, in selected cases, a total thyroidectomy. In partial pharyngolaryngectomies and partial laryngectomies, such as hemilaryngectomies or cricohyoidopexies, the recurrent as well as the superior laryngeal nerves must be identified and spared, to guarantee vocal cord function minimizing aspiration. Similarly, surgery of the thyroid, the central compartment of the neck, and the superior mediastinum requires equal exposure and expertise in identification and preservation of recurrent laryngeal nerves. In selected cases, the thyroid gland may even be used for the reconstruction of laryngeal defects . In rare cases, differentiated thyroid carcinomas invade laryngeal structures or the trachea and require appropriate pre-operative assessment and surgical management .

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    Which Thyroid Operation Do I Need

    • The extent of thyroid surgery performed depends on the specific thyroid condition being treated
    • The goal is to treat the condition to the best extent possible, while maintaining the lowest risk
    • Surgery will be recommended if the condition cannot be adequately treated medically, i.e. if cancer is found or suspected, if the airway is obstructed, or if medical treatment is unsuccessful
    • Depending on the specific condition, the extent of thyroid surgery will vary from removing only one lobe of the thyroid, or half of the gland (this procedure is called a thyroid lobectomy or hemithyroidectomy to removing the entire thyroid, called a total thyroidectomy
    • Thyroid surgery may be performed through a standard neck incision or by a mini-incision depending on the underlying thyroid condition

    Thyroid Surgery By An Ent Head And Neck Surgeon

    • ENT head and neck surgeons can provide a complete evaluation and treatment options regarding thyroid problems
    • An ENT specialist can receive up to 15 years of university and post-graduate training in surgery, concentrating on ear, nose and throat procedures
    • Because they study the complex anatomy, physiology, and pathology of the entire head and neck, ENT specialists are uniquely qualified to perform the procedures that affect the thyroid gland

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    Fine Neeedle Aspiration Biopsy Of Thyroid Nodules

    One of the major;advances in the treatment of thyroid nodules over the past 25 years has been the adoption of fine needle aspiration as a screening tool to help determine when thyroidectomy is required. Thyroid nodules are extremely common but only approximately 10% of all nodules are cancerous. While advanced malignancies are usually readily apparent, most benign and malignant nodules cannot be differentiated on the basis of examination alone.

    Giving Expression To Cancers Impact

    ENT Department doctors

    Bostock says her experience with thyroid cancer prompted her to devote more time and energy to her lifelong interest in painting.

    Painting allows me to express myself on canvas, she said. For me, its a meditation and an outlet. Her passion has turned into a small business, with a website where she sells her works and writes a blogoccasionally about her thyroid cancer experience.

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    Types Of Thyroid Surgery

    Thyroid surgery can involve a total or partial removal of the thyroid. The type of thyroid surgery recommended will depend on the thyroid disorder being treated. Thyroid surgery options include:

  • Total thyroidectomy: Removal of the entire thyroid gland, thyroid tissue, and surrounding lymph nodes. Typically recommended for thyroid cancer, inflammation or swelling of the entire gland, or occasionally, Graves disease. Benefits include fast results with a lower rate of relapse or recurrence.
  • Subtotal thyroidectomy: Removal of the thyroid gland while leaving a portion of thyroid tissue intact to allow for some thyroid function. Often used to treat hyperthyroidism brought on by Graves disease.
  • Lobectomy: Removal of either the right or left thyroid lobe where swelling and/or nodules are present. The remaining lobe can usually maintain all or some hormonal function.
  • After a total thyroidectomy, the hormones naturally produced by the thyroid will need to be replaced with daily hormone medication. A subtotal thyroidectomy may also result in insufficient hormone production and require hormone therapy.

    Benefits Of Thyroid Surgery With An Otolaryngologist

    Thyroid surgery, known as a thyroidectomy, is employed to treat a host of thyroid conditions including: thyroid nodules, compressive thyroid mass, thyroid cancer, and hyperthyroidism. The process involves removing all or part of the thyroid gland.

    About one in five Americans has some type of thyroid disease; and women are five to eight times more likely than men to develop thyroid problems.

    Thyroid surgery is performed by otolaryngologists or general surgeons. So, what are the differences between the two specialties of general surgery and otolaryngology with regards to thyroid surgery? ;

    According to Henry N. Ho, M.D., board certified otolaryngologist, specializing in head and neck cancer, president of The Ear, Nose, Throat and Plastic Surgery Associates and co-director of the Head and Neck Program at the Florida Hospital Cancer Institute, there are some differences in training and expertise.

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