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suspicion, not confirmation, of thyroid cancer. In such cases, the team in the Thyroid Center compiles all pertinent information and discusses the case to determine the best approach. Along with history and exam, the thyroid's function and structure are important determinants in the decision to go to surgery. The thy roid 's abilit y to produce hormones is critically important to the body's function, and abnormally high or low production of the hormone can cause serious medical problems. A radioac- tive iodine test provides quantitative values pertaining to thyroid function. Twenty-four hours after ingesting a pill containing radioactive iodine, patients undergo a scan with a gamma camera that details thyroid function. After viewing results, the team may decide to initiate medical treatment to normalize thyroid function. The group next considers the size of the thyroid nodules. In some cases, the thyroid gland can expand into the chest. These abnormal growths may not cause symptoms and likely will not be noticed until a random imaging study picks them up. But sometimes, the thyroid can impinge upon the trachea and cause compressive symptoms. In either case, surgical excision is recommended to relieve or prevent compression associated with abnormal thyroid growth. Excision Explained Before patients at South Na ssau Communities Hospital undergo surgery for a thyroid condition, Dr. Datta meets with them to illustrate the procedure. "I sit with patients and draw diagrams to show them what will happen during surgery," Dr. Datta explains. "I show them exactly where the thyroid sits and which structures I will preserve — the parathyroid glands, recurrent laryngeal nerve and superior laryngeal nerve." In the operating room, Dr. Datta coordinates the operation with mul- tidisciplinary collaboration similar to what takes place in earlier stages of treatment. He works with anesthesiolo- gists who are familiar with the process. Dr. Datta monitors the recurrent laryn- gea l ner ve through a n e r v e m o n i t o r dev ice inser ted in the neck, bet ween t he v o c a l c hord s. Anesthesiologists must meticulously introduce the monitor to avoid injury to the nerve. After the surgery, removing the tube is as delicate a process as its introduc- tion. Coughing can cause hemorrhage, so removal must be gentle. Dr. Datta has explored various surgi- cal modalities, including endoscopic and robot-assisted laparoscopic approaches, but he says the benefits are too few to make a wholesale change. "For thyroids that aren't too large, I can use an endoscopic approach," Dr. Datta says. "Patient selection is critical for the success of this approach. Normal-sized thyroids (between 1–1.5 cm) with nodules can be excised endo- scopically. The robot, on the other hand, isn't a particularly great modality at this point. We don't use it. It doesn't make a whole lot of sense because you have to make 4–5 cm incisions in the armpit, and patients stay in the hospital for as many as three days, whereas they can sometimes go home the same night after endoscopic surgery. Additionally, it can cause brachial plexus injuries." Instead, Dr. Datta makes a 1.5–2 cm incision high in one of the neck's crease lines, excises the nodule and closes the site with a subcuticular suture he removes four days after the surgery. Radioactive Iodine Ablation One of the leading-edge treatments available from Douglas Silfen, MD, a radiologist in the Thyroid Center at South Nassau Communities Hospital with specialized training in nuclear radiology, is radioactive iodine ablation. This treatment, which involves much higher doses of radioactive iodine than the test used to assess thyroid function, Dr. Port diagnoses a thyroid scan. ATTENTION TO DETAIL TREATING THE HIGH patient volumes that enter South Nassau Communities Hospital's Thyroid Center has led the team there to develop a number of protocols to effectively manage typical occurrences during and after the surgical process, says Rajiv V. Datta, MD, FRCS, FACS, FICS, Medical Director, The Gertrude & Louis Feil Cancer Center; Chair, Department of Surgery; and Division Director, Surgical Oncology/ Head & Neck Surgery at South Nassau Communities Hospital. One of Dr. Datta's major priorities is effec- tively managing postoperative pain. Avoiding narcotics and their associated risks, the surgi- cal team uses intravenous acetaminophen to significantly reduce postoperative pain. Preventing Hypocalcemia Following total thyroidectomy, many patients become calcium-deficient. Dr. Datta found a simple remedy. "After this procedure, I give all patients postoperative calcium and vitamin D so they do not become hypocalcemic," Dr. Datta explains. "Transient hypocalcemia is an extremely common postoperative out- come — it's not really a complication — and vitamin supplements reduce its incidence. If patients don't get vitamins, they'll initially experience numbness around their lips, and then they'll begin having spasms in their hands and legs. This can cause readmission, which can be avoided with oral calcium and vitamin D supplements." M D N E W S . CO M ■ MD NEWS Long Island | 9

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