A specialized thyroid surgeon will be recognized in the hospital where he operates, he will be a member of the scientific thyroid societies both in Greece and abroad. A general surgeon who does not specialize exclusively in thyroid surgery may not have advanced training and experience in this demanding surgery, nor may he be up-to-date on the latest developments worldwide in these conditions. Choose your thyroid surgeon wisely.

The area where the thyroid surgery is done is very small and requires very careful and delicate movements, it is not like the huge space of the abdomen, so the surgeon should be very familiar with operating safely in a very small field. Not only the difficult cases, which require removal of the lymph nodes of the neck, but also the simpler ones should be done by surgeons with advanced training, experience and expertise, since it is not pleasant for anyone to change the timbre of their voice after an operation.

The volume of patients operated on by a surgeon matters enormously! The experience of the surgeon is the number one predictor of the likelihood of complications. The American Thyroid Association states that low-volume surgeons, who perform more than 80% of thyroidectomies, have a complication rate as high as 24%. That’s too high! In contrast, he reports that surgeons with a large volume of patients have an average complication rate of 7.5% – which is again very high! When dividing surgeons by the number of thyroid procedures they perform, low-volume surgeons perform fewer than 10 thyroid surgeries per year – which clearly explains why nearly one in 4-5 patients have a complication.

In comparison, a surgeon with a high volume of patients performs over 100 thyroid surgeries per year and only 1 in 15 of his patients is likely to develop a complication (ATA Thyroid Nodule Guidelines).

For many surgeons, thyroidectomy represents the most delicate and difficult surgery they perform. For the thyroid surgeon, however, there is familiarity with these operations since he performs them every day. When the thyroid surgeon performs removal of the lymph nodes, many of which are located on the nerve responsible for speech, it means that he has daily contact with this area and is very familiar with it.

The results of this operation are seen daily by the patient, as for example the voice that permanently indicates the condition of the nerves exposed to danger during thyroidectomy. Or even worse when the surgeon, in order not to risk the patient having a problem with the nerves, leaves a large part of the thyroid out of reach and does not do a radical operation.

Unfortunately, it is not rare that patients come to us for surgery for the second or third time, after having previously undergone incomplete operations elsewhere. You need a surgeon who does a lot of delicate thyroid surgery every day and is comfortable performing procedures in the small spaces of the neck, which are not the same as the large spaces found in, say, abdominal organ procedures.

If you have cancer ask your surgeon if there is a possibility that you may have affected lymph nodes. Normally he will tell you that you need to check this possibility, by doing the mapping before the surgery. If he tells you that no mapping is needed and that he will see what happens to the lymph nodes at the time of surgery, you better find another surgeon. At the time of surgery, not all neck lymph nodes can be checked. This is something we need to know before surgery.

Ask before the operation how many lymph nodes will be removed if they are infiltrated by cancer. Normally it should tell you roughly the number.

When you see a surgeon feel comfortable and ask everything. Ask him about how big your incision will be, what residue it will leave you with, since the existence of malignancy can never be ruled out before the operation and also about the complication rates. But ask him to tell you about his own personal complication rates, not what is written in the books.

Complication rates have been shown in many studies and research worldwide to be proportional to the volume of patients operated on by a surgeon. Surgeons performing fewer than 100 procedures per year had significantly higher rates of both temporary and permanent complications. High-volume surgeons performing more than 100 thyroid procedures per year had the lowest complication rates and the best outcomes. Repetition and practice of surgery make every surgeon better. This is not just the case with thyroid surgeons. Everywhere, someone who performs something expertly is much better than someone who performs it occasionally. Obviously, you want the best surgeon who has the most experience and the lowest complication rates!

Results are calculated in several ways. For some surgeons, results are calculated on the number of patients. A recent study examining the outcomes of thyroid operations focused on the death rate from thyroid cancer. While, this is important however it does not account for the patient’s quality of life which is a very critical element. Early detection means less extensive surgery and fewer additional treatments.

Young surgeons must learn. That’s how I and all of us learned. They have to learn by operating on real people. So it is necessary for the specialized surgeons to operate, so that they can learn. You should ask who will learn during your operation and how closely these specialized surgeons would be supervised. Each of the operations for my patients is performed by me personally. While I welcome interns or surgeons who want to specialize in this demanding surgery, I still perform every operation myself.

I also use the same associate surgeons for each of my patients. My surgical partners are also highly experienced thyroid surgeons who have been working together for more than 15 years. This means that, after so many years of working together, they know exactly what I want at every moment, without even speaking. This is the definition of a team. What’s the result? My complication rates are much lower than those of the high volume surgeons listed above.

One of the things I go to great lengths to ensure is that each of my patients and their environment understand both their diagnosis and their treatment options. What a patient of mine might say on his first contact with me is that I told him a lot of detail about his problem! But I strongly believe that patients make the best decisions for themselves when they are fully informed and their questions are answered in such a way that they can fully understand their problem. I always see my patients the same day after the operation and I have open communication with them constantly and for as long as they need me. Trust relationships are built but last forever.

My care remains consistent through every phase of treatment – even after surgery. I do not assign my patients to another doctor once I have finished the operation. Usually most of my patients ask my opinion about other health issues in the future and I always treat them as if they were my own people.

I am personally interested not only in the thyroid of each of my patients but also in my patient as a whole as a person! Several of my family and friends have thyroid nodules, so thyroid care and overall health is a personal matter for me. Choose your thyroid surgeon wisely.

Good relationships are based on honesty. I’m not very good at hiding my thoughts and feelings, so I don’t try to. I hope that my interest and honesty win the trust of every patient. I never change after the operation, what I have that I have told my patient before operating on him. This happens in all fields, even in finance. In fact, this website reflects who I am and my core values. As a Christian, my calling goes beyond just a job or a career – I strive every day to walk in the shoes of the great physician, Jesus Christ! If you know Him, then you know very well what I mean, if you don’t know Him…I would like and be interested in talking about Him!

I think a second opinion is valuable. If I’m doing my job right, an honest and scientifically based second opinion will make me look pretty good.

If a surgeon is offended by your interest in another opinion, go elsewhere! We all welcome questions from our patients as we want our patients to be informed.

We never exaggerate our abilities or speak disparagingly of other colleagues. If you see this happening, you better leave and go to another colleague. You need to be comfortable with your decision making process, as you will live with the consequences of that decision much longer than you will with the surgeon you choose. Don’t feel uncomfortable telling a surgeon that you will get a second opinion. keep you from the peace of mind that a second opinion can bring!

You should ask your surgeon before the operation to tell you what residue you will have.

Before surgery, ask your surgeon how big your incision will be.

This is the testimony of one of our many patients:

The operation I perform on my patient with thyroid cancer is always individualized. Depending on the type of cancer and the result of the mapping I may perform total thyroidectomy or total thyroidectomy and central lymph node dissection or total thyroidectomy with central and lateral lymph node dissection.

All patients who are going to undergo a thyroidectomy for thyroid cancer or a strong suspicion of thyroid cancer, I screen them with mapping for the possibility of having infiltrated cervical lymph nodes.

If the mapping shows that there are infiltrated lymph nodes in the central compartment I will usually remove more than 10 lymph nodes. If there is an infiltrated lymph node in the lateral compartment, I will remove both the lymph nodes in the central compartment and those from the side. Usually over 30. This is one of our patient histology tests, read it:

HISTOLOGY
D/A: 7… / 2021
DATE OF INTERVENTION : 10/4/2021 DATE OF DAKT/SEOS : 22/04/2021
DATE OF DIAGNOSIS : 18/4/2021
T.E.R.: 3/4/21 DOCTOR: TSIRIGOTAKIS STAVROS
MATERIAL : 7… -21: THYROID GLAND
7…-21: CENTRAL CERVICAL LYMPHATIC CLEANSING
7…-21: LATERAL CERVICAL LYMPHATIC CLEANSING
No. sections :
No. paraffin blocks: 18(total embedding)/7…-21, 3(total embedding)/7…-21, 11(total embedding)/7…-21
ICDO:
We received:
7…-21: Thyroid gland weighing 16.05g. and dimensions according to
right lobe 4x2x2cm, while left lobe 5x2x1.5cm. and with
isthmus 2cm long On the outer surface of the left lobe,
about the middle and the lower pole of it, it is recognized as a raccoon
view. The surgical margins were colored with blue ink. At
cross-sections, throughout the length of the parenchyma are recognized
white-grey confluent areas. Corresponding to the one described
raccoon area, in the middle of the left lobe is recognized
of a white-grey tumor that touches the surgical margins n.d. 1m, while
in the lower pole, another whitish tumor is recognized n.d. 1cm
(sections 1-6: right lobe, 7-8: isthmus, 9-16: left lobe).
Three irregular whitish pieces of tissue were included, incl. diam.
2×1.5x1cm. in the sections of which two (2) lymph nodes were found
n.d. 0.4cm and 0.8 cm. (volumes 17&18).
7…-21: With the indication “central lymph node cleansing
of neck”, fat pieces total diam. 2.5x2x0.5cm, in cross-sections
of which eleven (11) lymph nodes were found n.d. from 0.1 to 0.6 cm.
(sections LN1:1lymph., LN2:7lymph., LN3:3lymph.).
7758-21: Labeled “lateral lymph node cleansing
of neck”, oblong fat piece diam. 8x2x1.5cm At one end
has a seam marked “upper level” and correspondingly on it
sixteen (16) lymph nodes were found in the area. from 0.1 to
0.3cm (sections LN1:1lymph., LN2:1lymph., LN3:9lymph., LN4:5lymph.).
Seventeen (17) lymph nodes were found in the remaining tissue.
from 0.1cm up to 0.7 cm. (sections LN5:2lymph., LN6:2lymph., LN7:3lymph.,
LN8:adipose tissue, LN9:7lymph, LN10:2lymph, LN11:1lymph).
Page 1 of 3

Pathology Laboratory: e-mail [email protected] – tel. 210-6185221
Scientific Advisors: Om. Professor K. Pavlakis, Assistant Professor A. Nonni
Curators: P.Yiannou, D.Chrysanthaki, E.Messini, T.Gavresea, E.Kavoura
On histological examination:
7756-21: A papilloma is identified in the middle of the left lobe
microcarcinoma n.d. 10 thousand, which is tangent to it
surgical margin of resection presenting at least microscopic
extrathyroidal extension. In the lower pole of the left lobe
another papillary carcinoma is recognized n.d. 12 mm which also
abuts on the operative margin of the presenting resection
at least microscopic extrathyroidal extension.
Both papillary carcinomas of the left lobe present in
small area (less than 30% of the total area of the tumor)
morphology of tall cells (tall cells).
Two papillary microcarcinomas are identified in the right lobe.
4 mm and 2 thousand with intrathyroid growth.
Fibrosis is recognized in all papillary carcinomas and
vitrification of the substrate with the presence of sandy particles and
coarse calcifications.
Alterations are recognized in the rest of the thyroid parenchyma
subacute granulomatous thyroiditis with areas of fibrosis
and follicular atrophy. Microscopic colloids coexist
nodules, while remains of a telobrachial apparatus are recognized.
With the left lobe, a parathyroid body has been excised.
4mm, without significant changes as well as two lymph nodes n.d. 2
and 5 thousand showing metastatic infiltration from the carcinoma,
with maximum metastatic focus n.d. 0.3mm
A tiny lymph node is identified in the isthmus area
n.d. 6 mm negative for metastatic infiltration.
In the included tissue sections, the two lymph nodes found
are negative for metastatic infiltration from carcinoma.
7757-21: One (1) of a total of eleven (11) found
of lymph nodes labeled “central lymph node cleansing.”
Cervix”, shows metastatic infiltration from carcinoma with
presence of gritty particles and a metastatic focus 0.5 mm in diameter.
7758-21: The total of thirty-three (33) lymph nodes found with
the indication “lateral lymph node cleansing of the neck” is
negative for metastatic infiltration from carcinoma.
Page 2 of 3
Pathology Laboratory: e-mail [email protected] – tel. 210-6185221
Scientific Advisors: Om. Professor K. Pavlakis, Assistant Professor A. Nonni
Curators: P.Yiannou, D.Chrysanthaki, E.Messini, T.Gavresea, E.Kavoura
CONCLUSION:
· Four (4) papillary carcinomas of the thyroid gland (two
in the left lobe and two in the right lobe), the largest
of which it is located in the left lobe and has m.d.
12 mm, while two of them, in the left lobe, present
at least microscopic extrathyroidal extension and
they touch the surgical margin of resection.
· Papillary carcinomas in the left lobe present in
small area (<30%) tall cell morphology (tall
cells).
· Three (3) “central lymph nodes” out of a total of forty
nine (49) lymph nodes found, indicated
“central and lateral lymph node cleansing”
present with metastasis from metastatic carcinoma
hearth n.d. 0.5 mm

KAVOURA EVAGGELIA
PATHOLOGIST DOCTOR

Sometimes the mapping may not show that there is an infiltrated lymph node but a suspicious lymph node is found during the operation. In this case I will remove the suspicious lymph node and send it for a rapid biopsy. If the answer is yes then I will perform a lymph node cleansing.