Dr. Shaha specializes in head and neck surgery, with a particular interest in thyroid and parathyroid surgery. He uses an algorithm of selective thyroid tumor criteria (the size, location, stage and type of cancer, along with the patient’s age), to tailor therapy to each individual’s circumstances.
In this interview, topics include:
* The first question a surgeon should ask and why.
* When talking active surveillance or observation, changing the language to deferred intervention, ‘we are going to defer’.
* Understanding the biology of the cancer
* The biology of thyroid cancer is a friendly cancer.
A different approach to treating thyroid cancer compared to the U.S.
Dr. Takahiro Okamoto helped write the Japanese guidelines on thyroid cancer. He is Professor & Chair of the Department of Surgery at Tokyo Women’s Medical University.
Key points from this episode include:
* Most Western countries carry out total thyroidectomies, whereas in Japan, the approach is more conservative with a fundamental practice of hemithyroidectomy whenever possible.
* By not doing a total thyroidectomy, this allows the patient to not avoid taking thyroid replacement medication.
* Complete thyroidectomy is conducted when 80-90% of lymph nodes have metastasis.
* I-131 treatment is decreasing despite cases of cancer increasing
* For I-131 treatment, patients wait more than 6 months post surgery.
* When receving I-131 treatment, patients be admitted to hospital for several days.
* TSH suppression therapy is common in Western countries, whereas in Japan, measures are taken to avoid TSH suppression by not removing all of the thyroid.
* Normal TSH in Japan is 4.3 or less.
Dr. Özer Makay is an expert in nerve monitoring during thyroid surgery, and has been a guest faculty member in South Korea, Italy, France, the Netherlands, Germany, Belgium and Bulgaria.
This episode covers the following topics:
* Protecting the recurrent laryngeal nerve (RLN) and superior laryngeal nerve during thyroid surgery.
* Outcomes of damaging these nerves during surgery include no voice, hoarseness, shortness of breath, problem with drinking water or aspiration, impaired physical exertion with something as simple as climbing a flight of stairs.
* Why some centers have a higher occurrence of damage during thyroid surgery and include an error rate as high as 10%
* The cause of the damaged nerve include stretching or traction, and cutting or stitching.
* How to reduce risk.
* Is it possible to reattach a cut nerve?