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How to avoid the risks of thyroid and parathyroid surgery?

Avoiding Injury to Nerves

The first risk of thyroid surgery is injury to nerves, both the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve. The recurrent laryngeal nerve innervates (supplies with nerves) most of the muscles that control a patient’s vocal cords. The external branch of the superior laryngeal nerve innervates only one muscle, the cricothyroid muscle, which is what gives us the ability to sing high notes and yell really loud.

The way to avoid injury to these nerves is simply to identify them. The recurrent laryngeal nerve should be identified 100% of the time—every time, no excuse. The external branch of the superior laryngeal nerve is much smaller and it can sometimes be found underneath the muscle.

The external branch of the superior laryngeal nerve can be identified about 85% of the time and the key to finding it is to look for it every time, which is how a surgeon avoids injury. When a surgeon knows the anatomy and knows the different variances of where the nerves can be they are better able to avoid injury. This is why having an experienced head and neck surgeon specializing in thyroid and parathyroid surgery is so important.

Avoiding Injury of the Parathyroid Glands

The next risk would be injury to the parathyroid glands, both temporary and permanent. The parathyroid glands are stuck to the thyroid gland. If you imagine the thyroid gland as being wrapped in Saran wrap like a capsule, then the parathyroid glands would be attached (two on the top and two on the bottom). The parathyroid glands are stuck to the thyroid gland, but they have nothing to do with the function of the thyroid gland and their job is completely different. The parathyroids’ job is to create parathyroid hormone, whereas the thyroid produces thyroid hormone. Parathyroid hormone is what keeps your calcium levels normal.

In the operating room, a surgeon has to dissect those parathyroid glands away and they’re small, only millimeters (really tiny!). But still, a surgeon must dissect them away from the thyroid gland and leave them on these tiny little blood vessels and leave those in the neck. The parathyroid glands are very fragile and they can become bruised easily and they can shut down temporarily—which happens about 15% of the time. And so there is a risk of temporary injury to the parathyroid glands, where they shut down and then they recover. This recovery can take anywhere from two weeks to four to five months.

There is a small risk of permanent damage to the parathyroid glands called hypoparathyroidism, in which the parathyroid glands never wake up, which means that a patient must take calcium the rest of their life. The risk of permanent hypoparathyroidism is less than 1-percent, but it is a risk. To prevent against damage to the parathyroid gland, a surgeon must be very meticulous and gentle in their handling and dissection of the glands. It is important to always identify them so that they are not removed with the thyroid gland.

Avoiding the Risk of Bleeding

The final risk of thyroid surgery is bleeding and this risk is really low—approximately 1 in 500 patients. Bleeding following thyroid and parathyroid surgery is avoided by ensuring that the neck is completely dry before the case is over. Even meticulous attention cannot prevent bleeding in every scenario, though, and it does happen, though it is rare.

An experienced surgeon knows the risks and will take every precaution to minimize those risks and give patients a safe surgery.