image: Dr. David Terris, Chair of the Department of Otolaryngology-Head and Neck Surgery at the Medical College of Georgia at Georgia Regents University, holds "Thyroid Surgery: Preventing and Managing Complications," the first textbook on thyroid surgery complications. view more
Credit: Phil Jones
AUGUSTA, Ga. - 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.
Other editors include Dr. Paolo Miccoli, Professor of Surgery, University of Pisa, Italy; Dr. Michele N. Minuto, Assistant Professor of Surgery, University of Genoa, Italy; and Dr. Melanie W. Seybt, Columbia Ear, Nose and Throat Associates, Columbia, S.C.
For more information, visit the companion website, www.wiley.com/go/miccoli/thyroid, which includes video of the surgeries covered in the textbook.
Terris is Porubsky Professor and Director of the Endocrine-Head and Neck Fellowship at MCG and the Georgia Regents Health System. He is a member of the Residency Review Committee for Otolaryngology of the Accreditation Council for Graduate Medical Education. He recently completed a four-year term as Chair of the American College of Surgeons Advisory Council for Otolaryngology and is Secretary-Treasurer of the Southern Section of the American Laryngological, Rhinological and Otological Society Inc., also known as the Triological Society. Terris received the 2012 American Academy of Otolaryngology-Head and Neck Surgery Foundation's Distinguished Service Award and is a member of the academy's Endocrine Surgery Committee. Other memberships include the American Thyroid Association Clinical Affairs Committee and the American Head and Neck Society Endocrine, Publications and Relative Value and CPT Advisory Committees and Advanced Training Council.
He is an Associate Editor for the journal Head & Neck and serves on the editorial boards of Laryngoscope, Operative Techniques of Otolaryngology-Head and Neck Surgery and Otolaryngology-Head and Neck Surgery.