Surgery for Thyroid Cancer

Thyroid Cancer Surgery : Cancer involving the thyroid gland is more commonly encountered in women than men. Thyroid Cancers are predominantly indolent with good long term survival.  However, there are vital structures close to the thyroid gland like the parathyroid glands which control the calcium metabolism in the body as well as the nerve which controls the voice box. Thus thyroid cancer surgery requires experience and high volumes such that patients do not suffer from lifelong sequalae of inadequate and inappropriate management. The team in the clinic with over 20 years of cumulative experience and a volume of approximately 30 thyroid surgeries / year of thyroid surgeries have a complication rate of less than 5% matching centres of excellence.

As with other cancers, thyroid cancer treatment is truly multidisciplinary. The surgeons work in tandem with a nuclear medicine specialist and an endocrinologist to give the best possible care to their patients.

 

Dr. Mitali Dandekar Lall has publications on thyroid cancer surgery which can be accessed by the following links:

 

  1. Priya SR, Dravid CS, Digumarti R, Dandekar M. Targeted Therapy for Medullary Thyroid Cancer: A Review. Front Oncol. 2017;7:238.

 

  1. Chaukar DA, Deshmukh AD, Dandekar MR. Management of thyroid cancers. Indian J Surg Oncol. 2010;1(2):151-162.

 

 

  1. Dandekar M, Kannan S, D’Cruz A. The thyroid and parathyroids. In: Lumley JSP, D’Cruz AK, Hoballah JJ, Scott- Connor CEH (editors) In: Hamilton Bailey’s Demonstrations of Physical Signs in Clinical Surgery, 19th CRC Press, Boca Raton, 2016,p410.

 

SURGERY FOR GOITRE

Surgery for Goiter:

Goiter is an enlargement of the thyroid gland. Typically presents as a progressive swelling in front of the neck.

Goiter could be physiological during growing phases ( growth spurts) as well as during pregnancy ( hence commonly occurs in women). When the physiological goiter does not subside on its own, it progressively increases in size over several years. 4 problems could be encountered with goiter:

 

  1. Cosmetic deformity ( most common)
  2. Compression of adjacent structures due to a large swelling. This causes difficulty in eating due to compression on the food pipe, difficulty in breathing due to compression on the windpipe or occasional change in voice.
  3. Sudden increase in size of the swelling in the neck due to bleeding ( hemorrhage) in the nodules following trauma
  4. Malignant transformation in upto 10% swellings.

Treatment:

While physiological goiters undergo spontaneous regression ( at most require correction of hypothyroidism), multi nodular goiters are irreversible.

Surgery is the treatment of choice. Smaller goiters ( approximately less than 4cm) can be observed with serial ultrasounds and surgery can be planned electively for cosmetic reasons.

Large goiters require surgical excision to avoid rest of the problems enumerated earlier.

 

Experience of surgeons with Pranidhana:

Cumulatively, the team performs approximately 25- 30 thyroid surgeries ( majority being redo of previously operated patients elsewhere or total thyroidectomies) per year. There is evidence suggesting lesser complications (<5%) in centers practicing high volume surgeries ( 25/year).

Additionally, consultants at Pranidhana have contributed to pertinent book chapters ( reference book for medical students) as well as journal articles as follows:

 

  1. Dandekar M, Kannan S, D’Cruz A. The thyroid and parathyroids. In: Lumley JSP, D’Cruz AK, Hoballah JJ, Scott-Connor CEH (editors) In: Hamilton Bailey’s Demonstrations of Physical Signs in Clinical Surgery, 19th edition. CRC Press, Boca Raton, 2016, p410.

 

  1. Chaukar DA, Deshmukh A, Dandekar MR. Management of thyroid cancers. Indian J Surg Oncol 2010;1(2):151-62.

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