Terris co-edits first textbook on thyroid surgery complications

Dr. David Terris, Chair of the Department of Otolaryngology-Head and Neck Surgery at the Medical College of Georgia at Georgia Regents University, is an editor of the first textbook on thyroid surgery complications.

"Thyroid Surgery: Preventing and Managing Complications," covers the spectrum of potential complications that can result from removing the small gland at the base of the neck that regulates metabolism and calcium levels.

Complications can arise from injury of the thyroid's numerous, nearby neighbors, including the windpipe, the voice box, the vagus nerve and its branches, carotid arteries, jugular vein and esophagus. While thyroid surgery is extremely safe in experienced hands, the close quarters can potentially compromise any of these important structures. "It's a small space and everything is kind of resting against everything else," Terris said.

The most common injuries are to nerves to the voice box, which can result in hoarseness or even trouble swallowing and breathing. A nearby nerve that doesn't get as much attention is the superior laryngeal nerve, which tenses the vocal cords. "If that nerve is injured in somebody like me, you would never know the difference," Terris said. "But if you are a singer, for example, that tensing of the muscles allows you to hit the high notes."

Other common injuries are to the parathyroid glands, four pea-sized glands that regulate calcium in the body and most often rest against the backside of the thyroid gland. In fact, there is a condition in which these glands are encased in the thyroid, Terris said. Damaging the parathyroid isn't a big problem unless all four glands are impacted which, unfortunately, may happen when both lobes of the thyroid need to be removed. "The first way patients know their calcium level is low is they have numbness and tingling of their fingertips and lips because the sensory nerves start to fire spontaneously," Terris said. Muscle contractions and seizures can occur without treatment as the motor nerves then start to activate.

"If not for these nerves and the parathyroid glands, a thyroidectomy would be an easy operation that anyone could do safely," Terris said. "But primarily because of those structures, the surgery is better done by someone who does a lot of them."

Benign growths, called goiters, and cancer are common reasons for thyroid surgery and thyroid cancer cases are "skyrocketing" likely because enhanced imaging techniques today detects even the smallest cancers, Terris said.

He notes that the minimally-invasive approaches, which he has helped pioneer, have not increased complication rates since cases are carefully selected. Also, to enhance visibility through the smallest incisions, surgeons use telescopes that magnify the anatomy 10 times, making even the miniscule parathyroid look giant, Terris said.

Provided by Georgia Health Sciences University