Thyroid surgery for Grave’s disease is more complicated and must be handled properly for good results. In Grave’s disease, the gland is typically much more vascular and is frequently partially scarred from chronic inflammation.
Risks of bleeding, metabolic fluctuations and calcium fluctuations are higher with Grave’s disease. These risks can be dramatically decreased with proper management.
To reduce the vascular and metabolic activity of the gland, patients are treated with a 10-day course of high-dose iodine drops in the days prior to surgery. During the operation, blood pressure and heart rate are meticulously monitored and controlled with medications. In patients who have significant hyperthyroidism, post-operative monitoring in an ICU setting will be done.
Thyroid Storm—an exuberant post-operative hypermetabolic response—can occur following surgery for hyperthyroidism. However, with modern peri-operative management strategies, this very rarely occurs.
Pediatric thyroid surgery
The same conditions that may require adults to undergo thyroid surgery can occur in children. While the surgical procedure for adults and children is similar, the overall management of pediatric vs. adult thyroid disease can be very different.
The details of surgery can be quite different and for this reason, only an experienced pediatric thyroid surgeon should perform thyroid surgery for children. Research studies repeatedly show that the experience of the surgeon is the best indicator of a good outcome from surgery, and Dr. Wright feels that this is especially true in the case of pediatric thyroid surgery, where the anatomy is quite small and delicate.
Dr. Wright has performed hundreds of thyroid surgeries for both cancer and non-cancer indications. He is among the most experienced minimally invasive pediatric thyroid surgeons in the world.
Pediatric thyroid nodules
Occasionally, a nodule will develop in a child. This can occur as a solid mass or a fluid-filled cyst. While thyroid nodules are less common in children, they are more likely to be malignant. For this reason, thyroid nodules in children must undergo appropriate work-up, including fine-needle aspiration. If a nodule cannot be convincingly determined to be benign, it must be removed to be certain whether or not the nodule is cancerous.
Pediatric thyroid cancer
Thankfully, cure rates for pediatric thyroid cancer are extremely high. Dr. Wright is very experienced with pediatric thyroid surgery, having performed hundreds of these procedures. The single most important predictor of safety for thyroidectomy is the experience of the surgeon; for this reason, pediatric thyroidectomy should always performed by a surgeon well-experienced with pediatric thyroid surgery.