Our Summary

The research paper is about a newer method of thyroid surgery called transoral endoscopic thyroidectomy vestibular approach (TOETVA), which leaves no visible scars. The researchers compared TOETVA to traditional thyroid surgery in terms of early outcomes and the learning curve for surgeons. They looked at 56 cases of TOETVA and 745 traditional surgeries performed at a cancer center.

They found that in the TOETVA group, about 14% of patients had complications, but none of these were permanent or serious like vocal cord paresis (weakness) or hypocalcemia (low calcium levels in the blood). After the first 15 TOETVA cases, the average surgery time dropped from 167 to 117 minutes.

When they compared TOETVA to traditional surgery, they didn’t find any significant difference in the rate of complications. However, TOETVA did take longer to perform. The researchers concluded that TOETVA is a safe and feasible method, with surgeons typically becoming proficient after about 15 cases.

FAQs

  1. What is transoral endoscopic thyroidectomy vestibular approach (TOETVA)?
  2. How does the rate of complications in TOETVA compare to traditional thyroid surgery?
  3. How many cases does it typically take for surgeons to become proficient in performing TOETVA?

Doctor’s Tip

A helpful tip a doctor might tell a patient about thyroidectomy is to carefully follow post-operative instructions, including taking any prescribed medications as directed, attending follow-up appointments, and watching for signs of complications such as difficulty breathing, excessive bleeding, or changes in voice or swallowing. It’s also important to communicate any concerns or questions with your healthcare provider.

Suitable For

Patients who are typically recommended for thyroidectomy include those with:

  1. Thyroid cancer
  2. Large thyroid nodules causing symptoms such as difficulty swallowing or breathing
  3. Hyperthyroidism (overactive thyroid gland) that does not respond to other treatments
  4. Thyroid nodules that are suspicious for cancer
  5. Graves’ disease (an autoimmune disorder that causes hyperthyroidism)
  6. Recurrent thyroid nodules or goiters
  7. Family history of thyroid cancer or other thyroid issues

It is important for patients to discuss their individual case with their healthcare provider to determine if thyroidectomy is the best treatment option for them.

Timeline

Before the thyroidectomy:

  • Patient undergoes pre-operative evaluation, including blood tests, imaging studies, and possibly a fine needle aspiration biopsy of the thyroid gland to determine the need for surgery
  • Patient may be placed on thyroid hormone replacement therapy to optimize thyroid function before surgery
  • Patient meets with the surgeon to discuss the procedure, risks, and potential outcomes
  • Patient is instructed on pre-operative preparation, including fasting before surgery and medications to avoid

After the thyroidectomy:

  • Patient is monitored in the recovery room for any immediate complications, such as bleeding or difficulty breathing
  • Patient may stay in the hospital for 1-2 days for observation and pain management
  • Patient may experience temporary hoarseness or difficulty swallowing due to irritation of the vocal cords or surrounding structures
  • Patient is discharged with instructions on wound care, pain management, and follow-up appointments
  • Patient may need to take thyroid hormone replacement medication for the rest of their life to maintain normal thyroid function
  • Patient is advised on lifestyle modifications, such as dietary changes and exercise, to promote overall health and well-being

Overall, the patient’s journey before and after thyroidectomy involves thorough evaluation, informed decision-making, careful preparation, and ongoing support for optimal recovery and long-term management of thyroid health.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a thyroidectomy, specifically with the TOETVA approach?
  2. How does the recovery process differ between TOETVA and traditional thyroid surgery?
  3. How long will it take for me to recover and return to normal activities after a thyroidectomy using the TOETVA approach?
  4. Will I need to take any medications or supplements after the surgery, such as thyroid hormone replacement or calcium supplements?
  5. How experienced is the surgeon in performing TOETVA procedures, and how many cases have they done successfully?
  6. Will I need to have any follow-up appointments or tests after the thyroidectomy to monitor my thyroid function and overall health?
  7. Are there any specific dietary or lifestyle changes I should make after the surgery to support my recovery and thyroid health?
  8. Are there any restrictions on physical activity or lifting heavy objects after a thyroidectomy using the TOETVA approach?
  9. How will the lack of visible scarring from the TOETVA approach impact my appearance and self-confidence?
  10. Are there any long-term considerations or potential complications I should be aware of after undergoing a thyroidectomy using the TOETVA approach?

Reference

Authors: Lira RB, Ramos AT, Nogueira RMR, de Carvalho GB, Russell JO, Tufano RP, Kowalski LP. Journal: Oral Oncol. 2020 Nov;110:104871. doi: 10.1016/j.oraloncology.2020.104871. Epub 2020 Jun 30. PMID: 32619928