Thyroid surgery, known as a thyroidectomy, is employed to treat a host of thyroid conditions including: thyroid nodules, compressive thyroid mass, thyroid cancer, and hyperthyroidism. The process involves removing all or part of the thyroid gland.

About one in five Americans has some type of thyroid disease; and women are five to eight times more likely than men to develop thyroid problems.

Thyroid surgery is performed by otolaryngologists or general surgeons. So, what are the differences between the two specialties of general surgery and otolaryngology with regards to thyroid surgery?

According to Henry N. Ho, M.D., board certified otolaryngologist, specializing in head and neck cancer, president of The Ear, Nose, Throat and Plastic Surgery Associates and co-director of the Head and Neck Program at the Florida Hospital Cancer Institute, there are some differences in training and expertise.

Managing The Voice

The last portion of the word “otolaryngologist” is “laryngologist”, an expert in laryngology from the root word,” larynx” or voice box. The residency training lasts 5 or 6 years beyond the MD degree, a significant portion of which is dedicated to the study of the larynx and its functions, including the voice. Training includes the evaluation of voice disorders and how to manage them. This includes a close working relationship with speech pathologists who often work in the otolaryngologist’s office. Speech pathologists are trained in the evaluation and treatment of vocal disorders. This team, along with special expertise in treatment, both surgical and non-surgical, provides the best scenario for good voice outcomes with regards to thyroid surgery.

“Don’t get me wrong, there are some excellent general surgeons that do a great job at thyroidectomy and have great results,” says Dr. Ho. “But, it’s a little more involved than simply performing the operation. One of the risks of thyroid surgery is changing the voice. If we get a voice problem because of injury to the nerve that moves the vocal cord, the otolaryngologist is trained to manage it, as we are “phonosurgeons”, or voice surgeons, as well.”

Indeed many otolaryngologists have in-house speech pathologists and special diagnostic equipment to manage voice disorders and most general surgeons lack both.

“We have in our offices the benefit of academic-level speech pathologists who can analyze the exact difficulty with the voice,” says Dr. Ho. “Preoperative and postoperative voice assessment is something that we do routinely. Most general surgeons, or non-ENT surgeons don’t have that background or facilities to do that.”

There are treatments to rehabilitate hoarseness due to an immobile vocal cord following injury to the nerve that provides movement to the affected vocal cord. Surgical interventions are designed to move the static vocal cord closer to the mobile vocal cord to tighten the closure between the two, thus improving the voice quality. These procedures are aptly named, “medialization” techniques or moving the position of the weak or immobile vocal cord toward the midline and the opposite, mobile vocal cord.

“There are various techniques that we use to do that (move the vocal cord),” says Dr. Ho. “From placement of an injectable implant through the mouth to push the vocal cord towards the mobile side, or an open procedure, where we actually implant a small shim-type device into the side of the larynx, to move the vocal cord.”

Treating the Lymph Nodes

Another key difference between general surgeons and otolaryngologists, with regards to thyroid surgery, is the management of at-risk lymph nodes in the neck.

There are hundreds of lymph nodes in the body that form a complex network. They are part of the immune system involved with fighting infection and cancer.

“Lymph nodes are small structures that sometimes become involved with (thyroid) cancer,” says Dr. Ho. “And if the lymph nodes are harboring cancerous cells, in general, they need to be removed to completely eradicate the cancer and provide the best cure rate. Lymph node removal is done with what’s known as a “neck dissection” operation. It’s best for the patient if this neck dissection is done at the time of the thyroidectomy.”

In other words, if there is clinically evident lymph node involvement, the thyroidectomy should be coupled with the appropriate neck dissection for removal of those nodes, and most general surgeons are not trained to do this procedure unless they have had extra training, beyond the standard general surgery residency. All board-certified otolaryngologists are trained to perform neck dissections, however.