Thyroid Gland: An Overview
Guest: Dr. Denise Carneiro-Pla - Surgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Denise Carneiro-Pla, an endocrine surgeon here at the Medical University of South Carolina. She has a specialty in the surgical treatment of various endocrine glands within the body. But, for this podcast, let’s focus on the thyroid. Dr. Carneiro-Pla, I understand that you are a real expert in the surgical resection of enlarged thyroid. So, let’s talk about the ways in which the thyroid can get enlarged. One of them, of course, is a goiter. Just what is a goiter?
Dr. Denise Carneiro-Pla: A goiter is an enlargement of the thyroid. You can have what we call a multinodular goiter, which are multiple nodules inside the thyroid. Most of the time, multinodular goiters are benign; they’re not cancer, even though they could have cancer inside the thyroid nodules. So, when a person has a goiter, the first thing they should do, after having their thyroid function checked to see if they’re hypo, meaning, under functioning of the thyroid, or hyperthyroid, when the thyroid is working too much, is get an ultrasound of the thyroid.
If an ultrasound of the thyroid shows a specific thyroid nodule, in this big goiter, that is dominant, you should have a fine needle aspiration. With the fine needle aspiration, which is a biopsy, we take a few cells of the thyroid and look under the microscope to see if they’re cancer, or not. If the goiter is benign, you don’t have to have it removed. You just follow up on the goiter with an ultrasound every six months to a year, depending on your physician.
On the other hand, if you have symptoms related to the goiter, difficulty swallowing, food and pills getting stuck in the area of the neck where the goiter is, or you have difficulty breathing, some patients, when they move their head up and down, side to side, have various symptoms of obstruction. At this point, surgery should be indicated, if these symptoms are related to the thyroid enlargement.
Dr. Linda Austin: Can you describe the surgery itself?
Dr. Denise Carneiro-Pla: The way I practice, I do thyroidectomies through an incision in the lower part of the neck, close to the clavicle bones, about five to six centimeters, more or less.
Dr. Linda Austin: That would be about two inches.
Dr. Denise Carneiro-Pla: Above the clavicle bone. So, the incision is done transversely, from one side of the neck to the other. We remove the thyroid through that small incision. We dissect the tissues in that area and pull the thyroid out, resecting it.
Sometimes you need to have both sides of the thyroid removed, and sometimes you only have to take one side. The risks of taking only one side are less than taking both sides.
Dr. Linda Austin: Because, why? Why is it safer to take just one side?
Dr. Denise Carneiro-Pla: If you take both sides of the thyroid, you put the four parathyroids at risk. These are the little glands behind the thyroid. They’re very attached to it, so you kind of have to shave them off the thyroid. And when you do that, the blood supply that goes to the parathyroids is at risk. And if that happens, you can end up with low calcium following surgery. This is a very debilitating complication. You have to take calcium and vitamin D afterwards. Usually it’s temporary, but it could be forever.
Dr. Linda Austin: So, you try to avoid that.
Dr. Denise Carneiro-Pla: We try to avoid a total thyroidectomy, if it’s possible. Sometimes you can’t, and you have to do a total thyroidectomy. The other risk of doing the thyroidectomy is the nerves that go through the vocal cords. Those nerves, if injured, could change someone’s voice. And if they’re injured on both sides, which is a very rare complication, but it happens, you have an airway obstruction, meaning, you can’t breathe. So, sometimes patients have to have a tracheostomy. So, it’s a procedure that doesn’t have a lot of risks; they’re very rare, but when they happen, they’re important. So, when you discuss with your surgeon what procedure you’re going to have, you’ve got to make sure that they explain to you and you understand, exactly, what the consequences are in case something goes wrong, which can happen, even using proper technique.
Dr. Linda Austin: And that’s why it’s so important to have someone who is as highly trained as you are. Talk a little bit about your training, if you would. How many years did you train to learn to do this very delicate, important, surgery?
Dr. Denise Carneiro-Pla: My story is a little complicated. I started medical school in Brazil. In our country, you do six years of medical school. I did my residency in general surgery in Brazil. So, when I went to Miami to do research in endocrine surgery, I specialized in only that for four years. Between research and clinical training, my area was intraoperative hormone measurements, learning how to operate on endocrine glands that could produce tumors.
After four years of endocrine surgery, I had to repeat my training in general surgery to be able to practice endocrine surgery in this country. I’ve been doing this for about 12 years. Since I finished medical school, I’ve been doing surgery. But I did four years of training in endocrine surgery.
Dr. Linda Austin: My goodness.
Dr. Denise Carneiro-Pla: It’s a long time.
Dr. Linda Austin: So, you’ve done this many, many times, which, actually, is good news for patients because it means that you’re so experienced. Thank you so much for talking with us today.
Dr. Denise Carneiro-Pla: Thank you.
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