If you need or are considering a thyroid operation, the most important first step is to find the best thyroid surgeon.

Unfortunately, nearly 90 percent of thyroid operations in the United States are performed by very inexperienced thyroid surgeons who perform less than two thyroid operation per month. To make this matter worse, many consider thyroid surgery a very common, simple and straightforward operation…and there is nothing further from the truth.

The thyroid surgeon’s experience, skill, supporting high resolution thyroid ultrasound imaging team, pathology and cytology, and nursing/anesthesia, and support staff are all integral in providing excellence in care. All these components must be at the highest level to assure you the best outcome in your thyroid surgery care. The best thyroid surgeon may not be down the street, or even in your state, but you will have to decide what is best for your health. Being thoughtful in finding the best thyroid surgeon is critical in advocating for your best outcome.

Top 4 Reasons To Find The Best Thyroid Surgeon

Patients may require a thyroid surgeon because they have a variety of conditions including a concerning thyroid nodule,  thyroid cancer, extensive thyroid goiter disease, Graves’ disease, thyrotoxicosis, as well as difficult to control Hashimoto’s disease. As a patient, you must advocate for yourself. You must ask the right questions of your thyroid surgeon including understanding their experience as well as their outcomes.

#1 Reason to find the best thyroid surgeon: Experience means everything

We can give you a thousand examples, but experience and practice mean everything in thyroid surgery. The New York Times bestselling author,  Malcolm Gladwell wrote the book “Outliers” that demonstrates this point. It can pertain to sports, music and so many other things, but it is especially true in thyroid surgery. If you shoot a 3 point basketball shot ten thousand times, or practice your violin or piano ten thousand times, you can achieve things that others believe are not possible. Simply stated, the more you do, the more you focus your practice results in a quicker, safer and better thyroid operation. 

Thyroid surgery is literally an art form. Thyroid surgery doesn’t become easier after ten or one hundred or five hundred or even a thousand thyroid operations. It becomes exceptional after you have performed thousands of thyroid operations. We often see patients who have been told that they are “inoperable”, but we are able to perform a thyroid operation that cures them of their disease and they leave our hospital the next day. In a similar fashion, some patients are told their thyroid operation will take four or five hours and their operation only takes our thyroid surgeons 45 minutes. The best thyroid surgeons perform more thyroid operations in one year than most thyroid surgeons accomplish in their entire careers. In academic centers, residents and trainees often are placed in situations where they are performing thyroid operations. Literally, the most inexperienced and ill prepared individual may be assigned to an operation. The outcome of your thyroid operation is dependent on your thyroid surgeon’s skill, training and ultimately their lifetime experience. 

At the Hospital for Endocrine Surgery, you will have two expert thyroid surgeons performing your operation. We do not employ residents or fellows in training. Your two thyroid surgeons will be the the experts your see listed here.

#2 Reason to find the best thyroid surgeon: Complications from thyroid surgery can be lifelong and devastating and are largely preventable

The complications from thyroid surgery can be devastating.

Clinical studies have clearly established that the best thyroid surgeons are unquestionably high-volume thyroid surgeons. Both the sensory and movement nerves of the voice box are at risk in thyroid operations. The only safe way to perform thyroid surgery is to directly identify and preserve these structures. Nerve monitoring does not save nerves to the voice box. Expert thyroid surgery is the only way to preserve these structures by safely identifying them and preserving them.  Even in the most beautiful thyroid operation imaginable, temporary dysfunction of these nerves will rarely occur producing temporary hoarseness which will completely resolve. Damage to bilateral (right and left) movement nerves of the voice box is a devastating complication of thyroid surgery and can produce lifelong difficulty with breathing as well as swallowing. In my opinion, occasional thyroid surgeons (surgeons performing less than 50 thyroid operations per year) should not perform total removal of the thyroid gland due to the much higher risk of damage to these critical nerves.

The parathyroid glands, the glands that control calcium levels in your blood, lie immediately adjacent and sometimes even within the capsule of the thyroid gland. Removal or permanent damage to these glands produces long time complications with calcium levels in the blood, bone mineral density, wellness, and much more. There are usually four parathyroid glands in every individual and effort must be made to spare each and every gland whenever feasible. The best thyroid surgeons understand where these glands are located, how to preserve them on their natural blood supply and when these glands need to be autotransplanted back into the patient. Long-term risk of dysfunction of parathyroid glands in total thyroidectomy among the best thyroid surgeons occurs in less than 1% of patients however among occasional or low volume surgeons, the risk approaches 40%. 

#3 Reason to find the best thyroid surgeon: Nearly fifty percent of thyroid cancers are not able to be diagnosed until pathology is analyzed following the thyroid operation

Despite high resolution ultrasound, contemporary fine needle aspiration and microscopic examination of these cells and the most advanced genetic analysis of needle biopsy of the thyroid, nearly 50% of thyroid cancer patients are still not able to be diagnosed until following their thyroid surgery and pathologic (microscopic) examination of the thyroid is performed. Therefore, thyroid surgery does not need to be aggressive, by any sense of the term, but it must be cancer appropriate and complete so that patients do not require a second operation once their final pathology is understood days till up to a week following their thyroid operation.

The best thyroid surgeon will identify the best operation for each patient. A thyroid cancer appropriate operation does not mean complete removal of the thyroid gland. But it does mean a thyroid operation which allows the thyroid cancer patient the least operation which provides the greatest likelihood for control of the thyroid cancer disease and the cure of the patient in combination with the lowest risk of complications to the patient. 

#4 Reason to find the best thyroid surgeon: Over 10% of thyroid cancer patients have an incomplete first operation and persistent thyroid cancer in their neck following their initial operation

In a study by Hundahl et. al. published in Cancer in the 2000s, among 5583 consecutive patients with thyroid cancer undergoing a “curative” operation”, 11% had persistent thyroid cancer found in their neck following their initial thyroid cancer surgery.  This is an alarming statistic which not only indicates the high frequency of an incomplete operation but also the frequent need for unnecessary second thyroid operations among thyroid cancer patients as well as the increased cost of medical care and the increased potential complications of this additional much more complicated surgery.

Finding the best thyroid surgeon tremendously reduces the thyroid cancer patients’ risk for persistent or recurrent thyroid cancer. The patient must be their greatest advocate.

Do your research and ask your thyroid surgeon questions about their experience.

• Do they do one thyroid operation a week, or do they do ten thyroid operations per week?
• What do other doctors and health care providers tell you about the thyroid surgeon? 
• Does your thyroid surgeon do all different types of surgery or just thyroid surgery?
• Does your thyroid surgeon do breast surgery and general surgery? 
• Does your thyroid surgeon do sinus, tonsil and other ENT operations as well? 

You should also search the surgeon’s reviews on Google, Health Grades and other physician review sites. The best thyroid surgeons are readily identifiable based upon what others have to say about them.

Bonus Reason to find the best thyroid surgeon: The best thyroid surgeons are associated with the most expert high resolution ultrasound teams

This high-resolution ultrasound is most critical in evaluation of the thyroid patient in determining the extent of thyroid surgery which is required.

The imaging team associated with the best thyroid surgeon must be as expert as the surgeon themselves. If not, the surgeon literally does not know what and where the thyroid disease is located and therefore the right operation may not be chosen or performed. Just like discussed in the surgeon’s experience, the high-resolution ultrasound of the thyroid is equally dependent upon experience. But it is also dependent upon the quality of the ultrasound equipment, the appropriate set up of the ultrasound machine, the transducer (the ultrasound wand that scans the neck), and the imaging specialist that must interpret the imaging.

We performed a study of the quality of ultrasounds of the thyroid performed by imaging facilities around the country and presented our research at the American Thyroid Association. In this analysis, over 90 percent of the ultrasounds which we reviewed were incomplete studies. Among patients with thyroid cancer, 17% had failed to identify thyroid cancer which had spread to lymph nodes in the neck. Therefore, based upon the quality of the ultrasounds which we were able to review, nearly one out of every five patients with thyroid cancer would have potentially still had thyroid cancer if their operation was planned based upon their initial ultrasound analysis. Dedicated and highly experienced thyroid ultrasound teams are indicated to provide the highest quality of care for patients undergoing evaluation for thyroid surgery.

Conclusion

You are your own best advocate. Do your research and select the best thyroid surgeon you can find to ensure your best chance at being cured with the lowest chance of experiencing complications.

Dr. Gary Clayman is the highest volume and most experienced thyroid surgeon in the country. Get to know him better here.

Additional Resources

• Become our patient by filling out the form at this link. 
• Learn more about The Clayman Thyroid Center here. 
• Check out Dr. Rashmi Roy's YouTube Channel, where she documents her most interesting cases.
• Learn more about our sister surgeons at the Scarless Thyroid Surgery Center, Norman Parathyroid Center, and Carling Adrenal Center
• Learn more about the Hospital for Endocrine Surgery.