Getting Prepared for Thyroid Cancer Surgery

This year, nearly 40,000 Americans will discover that they have thyroid cancer. Most will be women. In fact, thyroid cancer case numbers in American women are going up faster than than breast or lung cancer figures. The good news is that with appropriate first line surgical therapy and follow-up radioiodine treatment, most thyroid cancer can be controlled or cured.

The main obstacle that Americans with thyroid cancer face is getting a proper pre-operative evaluation and finding the right thyroid cancer surgeon. In 2010, the pre-operative evaluation for thyroid cancer requires considerable technical and intellective expertise on the part of the managing endocrinologist. Ideally, the endocrinologist should personally perform pre-operative neck ultrasonography to evaluate the anatomy of the thyroid cancer mass in the central neck and to assess whether lymph nodes in the central or lateral neck are involved. Without such an assessment, it is common for cancerous nodes to be missed by even the best surgeons, particularly in the lateral neck, outside the carotid arteries. Leaving enlarged and cancerous lymph nodes in the neck is a serious problem because post-operative radioiodine therapy is only effective against very small cancer deposits, not large deposits hiding inside enlarged lymph nodes. The surgeon needs to have an accurate ultrasonographic map of neck lymph node architecture prior to making a surgical plan for removing the cancer. While it is true that such a map can be constructed by a radiologist or a radiology technician, in the United States, only a few technicians are up to this challenge and most radiologists do not actually perform ultrasonography anymore. From a practical standpoint, patients should seek out endocrinologic thyroid cancer specialists who are expert in neck and thyroid ultrasonography and who personally perform the ultrasonographic evaluations in their offices. Such endocrinologists are certified by the American Association of Endocrinologists and carry the ECNU designation (Endocrine Certification in Neck Ultrasound).

But the pre-operative evaluation should consist of more than a neck anatomy assessment. The endocrinologist must determine the patient's vitamin D status. Fully 60% of adult females in this country do not have adequate vitamin D stores. Remember that near total thyroidectomy with lymph node removal is very stressful to the body's calcium control systems and vitamin D insufficiency increases the likelihood of transiently low blood calcium levels. Such blood calcium drops often necessitate intravenous calcium infusions and longer hospital stays after thyroid surgery.

The final and most important component of 21st century thyroid cancer care is the surgeon. Ideally, your surgeon should be specifically trained in thyroid cancer removal and lymph node dissection. The American College of Surgeons suggests that your surgeon should perform at least 100 neck surgeries per year to hone his or her skills in this area. Sadly, more than 50% of the thyroid cancer surgeries in this country are performed by general surgeons who do less than 50 neck surgeries per year. The central neck is loaded with vital structures like the parathyroid glands that control blood calcium levels, and the voice box nerves that control speech. Careful and competent neck surgeons have the experience to recognize these vital structures and stay from them with scalpels and cautery devices. The simple question that you must ask your neck surgeon prior to thyroid cancer surgery is: "How many neck surgeries did you perform last year?"

Once you have selected your surgeon and had your pre-operative evaluation, you can rest assured that the likelihood of a good outcome with your cancer is very high. Most patients do not die from thyroid cancer, they live with it. Lymph node recurrence of the cancer locally is our largest obstacle, and recurrence is minimized with a proper initial evaluation and a carefully planned first surgery.