Thyroid Surgery

The Importance of Experience

There are some unique challenges in thyroid surgery, mostly related to the organs surrounding the thyroid. There is a fine nerve called pallindromic laryngeal nerve located behind the thyroid and this nerve is responsible for our speech.

If this nerve is stretched during thyroid removal, injured or damaged during surgery, hoarseness or change in voice timbre or, more rarely, loss of voice and even difficulty breathing can occur. The rate of injury to this nerve during thyroidectomy is directly related to the experience of the surgeon.

Recently, the American Thyroid Association (ATA) reported a problem that more than 80% of thyroid surgeries are performed by surgeons who operate on a small or moderate number of patients each year. What they noted was that surgeons who operate on a small or moderate number of patients per year had higher complication rates than surgeons who operate on a large number of patients.

So they ranked the experience of these surgeons according to the number of thyroid surgeries they performed each year. Low volume surgeons were considered to be those who perform fewer than 10 thyroid procedures per year, sometimes even 1 or 2 patients per year. A moderate patient volume surgeon is considered one who operates between 10 and 100 patients per year, while a high patient volume surgeon is considered one who performs more than 100 thyroid procedures in 1 year. Their data show that surgeons who operate on a large number of patients (who are clearly more experienced in performing this delicate surgery) have much lower complication rates.


Our particular patient was not taken care of by other Thyroid Centers. He was not being operated on because one vocal cord was not working and his thyroid problem was on the other side. His problem was on the side where the healthy nerve was and if some complication occurred the patient would not only never speak again but would be with a permanent tracheostomy. Thyroid Surgeon Stavros Tsirigotakis took care of this patient and operated on him with complete success. Mr. Stavros Tsirigotakis did not think for a single moment not to take it on… the result justified him! His testimony is moving!

Themistoklis Georgiou, businessman: The advantage of being a Man and a Doctor or a Doctor and a Man ….. I am very grateful to Mr. Tsirigotakis for undertaking such a difficult surgery. When one vocal chord does not work and the nodules are very close to the other chord it is a very difficult and sensitive situation!!! Thank you very much and I wish the best for you!!!!

They reported overall complication rates for experienced high-volume surgeons at 7.5%. This rate is an average and is much higher than our rates, but it’s not as surprising as what you see in relation to the complication rate for surgeons with a moderate patient volume, which is as high as 13.4 %. Even worse, surgeons who have a low patient volume have a complication rate as high as 18.9%. These rates come from a statistically significant study conducted by the Healthcare Utilization Project that included over 6,000 surgeons in the study.

The American Thyroid Association concluded from these data that patients should be referred to thyroid surgeons with a high patient volume, especially if the case is considered extensive or complex. In the US for various reasons (and economics), one lobe is often removed so that the nerve or parathyroid glands on the side of the thyroid that is not removed are not at risk. However, in the cases where a total thyroidectomy is performed, they noted that the complication rates increase greatly, compared to the operation in which only one lobe of the thyroid is removed.

However, what is clear is that experience matters immensely as it appears that surgeons with a small volume of patients saw their complication rates increase to 24% for all thyroid procedures they perform.

The bottom line from all this data is that the number of thyroid surgeries a surgeon performs is important in developing techniques that are meticulous and careful so that injuries to sensitive organs such as the pallidum laryngeal nerve and the parathyroid glands. The surgeon’s experience determines how likely you are to injure your speech nerve and parathyroids in the event you need thyroid surgery, so choose wisely!