Our program emphasizes recognizing and treating the whole person and all of the structures and functions that are associated with their thyroid and parathyroid glands. The diagnosis is confirmed when subsequent testing shows a high level of parathyroid hormone (PTH), a hormone secreted by the parathyroid glands, in their blood. Goiter tends to occur randomly, but it can also be associated with some medications and/or with other thyroid conditions or family trends. We take a collaborative approach in consultation with the patient’s medical endocrinologist, as well as sometimes with multidisciplinary experts at the Stanford Thyroid Tumor Board, help to shape a surgical plan. Maxwell P. Kligerman, Division of Head and Neck Surgery, Stanford University, Palo Alto, California, USA. Standard external beam radiation therapy and chemotherapy are rarely needed and generally only in cases of more aggressive cancers. In the era of the COVID‐19 pandemic caused by the SARS‐CoV‐2 virus, which has a high viral load in the upper airways, these examinations and procedures of the upper aerodigestive tract must be approached with caution. Fax: 650-320-9443 When the presence of thyroid cancer is confirmed, further evaluation is made with radiographic studies that include high-resolution ultrasound of the thyroid and entire neck, if not done already, and sometimes CT or MRI scanning of the neck and upper chest area. If you take aspirin or nonsteroidal anti-inflammatory agents (such as ibuprofen), you should stop taking these one week before surgery. There is no medication to cure hyperparathyroidism, and the curative treatment is surgical removal of the abnormal gland(s). The site facilitates research and collaboration in academic endeavors. This broader anatomy of the neck is incorporated into the Stanford Endocrine Head and Neck Surgery team's diagnostic and technical expertise in head and neck surgery. The 3 small incisions inside the mouth are closed with dissolvable stitches that do not need to be removed. We present a case of an unanticipated difficult airway in a 40-year-old male scheduled for elective middle ear surgery. Head and neck examinations are commonly performed by all physicians. Because the complete head and neck examination is lengthy, it is usually tailored to the patient's history and presenting complaint. If you notice any redness or drainage from the incision contact your surgeon. Shoulder pain is one of the most common complaints in the outpatient setting. Sometimes beta-blockers are also prescribed to initially control the symptoms related to hyperthyroidism. The physician will first want to identify where the enlarged gland(s) are located in the neck through imaging studies prior to surgery. This is a limited therapy with minimal side effects. The spread of tumors cells occurs in a predictable pattern that begins in the central neck and progresses to the lymph nodes of the lateral neck compartments and the upper central chest. Examination of the head . Only through pre- and post-operative evaluation and feedback can surgeons truly know and use what techniques are most successful at preserving and maximizing nerve function. Some thyroid nodules with cancer cannot be felt on exam and are detected by radiologic studies done for other purposes (ultrasound, CT scan, MRI scan, PET/CT scan). High definition cameras provide sharp and magnified images that permit the surgeon to work with the utmost precision and protect vital structures. Patients can generally speak, eat and breathe normally right after surgery. There is no tissue removed during radiofrequency ablation. Please fax the Medical Record Release Form to your new patient coordinator. Once this has taken effect, the radiofrequency probe is inserted into the target nodule. Continuation of 111A/211A. You will be provided with a dressing to wear under the chin and instructions on neck exercises to prevent stiffness. The incidence rates of thyroid cancer in both women and men have been increasing in recent years, and Stanford researchers are working to figure out why. Mouth. He is also a skilled bedside examiner and has wonderful tips for examining the spleen and lymph nodes. Overview. A throat and neck exam is an examination in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas. A mild burning sensation may occur as the ethanol is injected, but this dissipates quickly. Examination of the head and neck is a fundamental part of the standard physical examination.It is typically one of the first parts of the physical examination and is performed with the patient in a seated position. In most cases, 2 or more treatments are needed to see a notable response. A comprehensive newborn examination involves a systematic inspection. The incision is stitched closed and is then covered with steri-strips (tapes) and a dry gauze dressing. Support Lucile Packard Children's Hospital Stanford and child and maternal health. Email: maxwell3@stanford.edu. Hyperthyroidism means overactivity of the thyroid gland, resulting in too much thyroid hormone in the bloodstream. What to Expect During and After the Procedure? Get the iPhone MyHealth app » For the right patient, radiofrequency ablation has some advantages over surgery. Our team participates in leading-edge clinical research as well as research into tumor biology, cancer stem cells, and radiation therapy. The head of your bed will be raised to help minimize swelling. Since parathyroid glands can sometimes be ectopic, or located away from the usual position adjacent to the thyroid gland, it is ideal for the parathyroid surgeon to have as good an idea as possible of the location of the suspected abnormal parathyroid gland(s) before proceeding with surgery to remove these gland(s). In the era of the COVID-19 pandemic caused by the SARS-CoV-2 virus, which has a high viral load in the upper airways, these examinations and procedures of the upper aerodigestive tract must be approached with caution. We take a collaborative approach in consultation with the patient’s medical endocrinologist, as well as sometimes with multidisciplinary experts at the Stanford Thyroid Tumor Board, help to shape a surgical plan. Central neck dissection (also known as level 6 neck dissection) is recommended for patients with central compartment lymph node metastasis detected either preoperatively or intraoperatively (during surgery.) Topics include radiation therapy physics, radiobiology, treatment and simulation equipment, principles of patient care, clinical components of cancer care, and cancers of the brain, head and neck region, and respiratory, digestive, urinary, and male and female reproductive systems. It is important to keep your mouth clean between meals. There are several types of thyroid cancer and a spectrum of aggressiveness. If the red reflex findings are abnormal or the patient has a family history of pertinent eye disorder… If thyroid hormone levels are deficient, a supplement of thyroid hormone may be prescribed. In general, a thyroid nodule is considered “significant” if it is 1 cm or larger and/or has suspicious features on ultrasound. Radioactive iodine therapy is used to destroy thyroid tissue and can be effective in achieving a cure for some patients with hyperthyroidism. Head & Neck and Thyroid Cancers ... HEAD AND NECK CANCER SURGERY AT STANFORD At Stanford’s Division of Head and Neck Surgery, we aim to invent and deliver curative treatments that minimize harmful side effects and ... and identify positive margins during specimen examination by the surgeon. It has often spread to other parts of the body by the time it is detected, and is very hard to treat effectively. Lectures, practicals, and applications. They may also have difficulty breathing due to compression of the windpipe. Patients with goiter may notice a visible distortion of the neck, the sensation of a lump in the throat when swallowing and/or actual difficulty swallowing. Stanford is currently accepting patients for this trial. Neelaysh Vukkadala MD. Surgery may also protect the airway. Ideal candidates usually have one of the following: We want you to have the best possible outcome, and are very thoughtful in offering this approach to our patients. Topics include head, neck, and trunk injuries, bleeding and shock, burn emergencies, and environmental emergencies. The presence of lymph node metastasis increases the risk of thyroid cancer persistence or recurrence. Roof of the mouth (palate), tongue, throat. However, it may occur in people without any known risk factors. The endocrinologist will often prescribe medication to help control the hyperthyroidism, while helping determine the best long-term plan of action. Search for more papers by this author. The result is hypercalcemia (high calcium levels in the blood). Radiofrequency ablation is a treatment that relies on heat to eliminate tissue. STANFORD LIBRARIES; Lane Medical Library. If the nodule cannot be felt during the office physical exam, an ultrasound-guided fine needle biopsy will be performed by the surgeon, endocrinologist, or radiologist who will localize the nodule and obtain a sample of the nodule using a thin needle. Many nodules do not require intervention, but when they are causing discomfort or pressure, distorting appearance, or exhibiting growth, treatment may be indicated. 2019;8(6):644-647. doi:10.21037/gs.2019.10.13, The Thyroid Book: Medical and Surgical Treatment of Thyroid Problems, Recurrent Thyroid Cancer & Revision Surgery, Parathyroid Disorders/Hyperparathyroidism, Otolaryngology⁠ — Head & Neck Surgery (OHNS), ENT Clinic: Pediatrics (Pediatrics Otolaryngology), Multidisciplinary Head & Neck Cancer Care, 2020 Swallowing Disorders Awareness Symposium, 2020 Head and Neck Cancer Patient and Caregiver Education Symposium, Endoscopic Sinus Surgery - A Patient's Guide, Skeletal Surgery (MMA) Post-Op Instructions, Distraction Osteogenesis Maxillary Expansion, Upper Airway (Hypoglossal Nerve) Stimulation, Pediatric Otolaryngology Fellowship Program Alumni, For African-American, Latinx, and Native American Students, Thyroid RFA (Radiofrequency Ablation) Procedure, the Endocrine Head and Neck Surgery Program, Thyroid Cancer Survivor Association (ThyCa), An American Head and Neck Society consensus statement, Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement, Lucile Packard Children's Hospital Stanford, Indications and patient selection for thyroid RFA, Thyroid/neck ultrasonography and RFA-relevant findings, The consent process: expected outcomes and potential risks, Anesthetic and ablative techniques under ultrasound guidance, vocal cord and airway evaluation before and after surgery, ultrasound guided biopsies and procedures in the office, minimally invasive or remote access techniques, incorporation of dynamically-acquired data (such as ultrasound information, laryngoscopy, nerve monitoring, parathyroid hormone testing) and. Chief of Comprehensive Otolaryngology. The vocal cords move during speech, swallowing, and breathing. Try to keep the neck area as dry as possible and pat dry after showering. Head and Neck Cancer Survivor Videos HNCA honors all head and neck cancer survivors from the newly-diagnosed, those navigating through their cancer journey as well as individuals who are post-cancer treatment. Your stitches will be removed in the office about a week after surgery. In some cases additional surgery will involve removal of lymph nodes and other structures. A thin probe the size of a needle is inserted through the skin and into the target nodule. The Stanford Comprehensive Cancer Network is part of the Stanford Comprehensive Cancer Care Institute, an NCI-designated comprehensive cancer center. These patients may require short-term supplementation with calcium pills until the function of these glands recovers. A throat and neck exam is an examination in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas. Since a functioning vocal cord also serves to protect the airway, coughing can also occur when saliva mistakenly travels into the airway, even when the patient is not eating. 2020;162(1):50-55. doi:10.1177/0194599819886123, Chan JYK, Koh YW, Richmon J, et al. The infant above has swelling over the left clavicle … Director of Head & Neck Cancer Research, Chris Holsinger, MD, FACS The diagnosis of thyroid cancer is usually made by fine needle biopsy, performed without or with ultrasound guidance. Thyroid cancer occurs more commonly in woman than in men and can occur at any age. Neck ultrasound, often performed as an office- based examination, is the primary imaging modality for the initial assessment as well as the postoperative surveillance of patients with papillary thyroid cancer. Another risk of surgery is a potential compromise of parathyroid function. Email or fax a cancer referral form with supporting documentation to ReferralCenter@stanfordhealthcare.org or 650-320-9443. After surgery, you will stay in the recovery room for several hours. It is an examination for swollen lymph nodes in the neck, and abnormal areas in the throat. (Stanford Cancer Center), Fred Baik, MD This is done to destroy any remaining thyroid tissue. International Patients Seminar series designed to expose students to the field, including its subspecialties and commonly performed procedures. The endocrinologist may order additional testing for hyperthyroidism, which may include a nuclear medicine scan. Eyes, ears, nose, cheeks. Usually patients or their physicians first notice thyroid nodules during a routine exam of the neck area; sometimes they are found incidentally during a radiologic examination of the neck (such as a CT scan, X-ray, MRI or ultrasound) ordered to investigate another condition— such as a carotid artery ultrasound or perhaps a CT scan of the spine for neck pain or car accident. This results in complete removal of the nodule and some of the surrounding thyroid tissue. If the red reflex findings are abnormal or the patient has a family history of pertinent eye disorder… Mouth. Lastly, some thyroid nodules are atypical enough that standard diagnostic measures are notable to eliminate of the possibility of cancer; such nodules may need to be surgically removed to reach a diagnosis. If neck dissection (lymph node removal) is required, additional itme will be needed. You will likely undergo a nuclear medicine study called a Sestamibi scan, as well as a neck ultrasound. Goiters found in the United States today are most often a result of the gradual and progressive growth and overlap of benign thyroid nodules. Division of Head and Neck Surgery, Stanford University, Palo Alto, California, USA. Minimally invasive surgery and reconstructive surgery options are carefully integrated into overall treatment recommendations. The night before surgery, do not have anything to eat or drink after midnight. An innovative, surgical procedure offers cancer patients and survivors a greater quality of life. Very rarely (in 1% of cases), enlargement of a parathyroid gland is due to cancer. Some patients will need to take thyroid replacement medication long-term after surgery. They occur in both women and men but are more common in women (50% of women ages 50 or older have had a thyroid nodule). Such surgery may be necessary, as over time, up to twenty percent of patients with initial thyroid cancer may subsequently develop recurrent disease in the form of neck lymph node metastases. Complete removal of lymph node clusters (“compartment-oriented lymph node dissection”) is recommended for its higher cure rates compared to “node plucking” or individual lymph node removal. This is the only thyroidectomy procedure that leaves no external scar – no one will know you had thyroid surgery! Surgeon experience and measures taken to preserve the nerves in this complex area are imperative to a good outcome. elr@stanford.edu. Head and neck: Appearance, shape, and shaping of the head from passage through the birth canal (molding) The open soft spots between the bones of the baby's skull (fontanels) Bones across the upper chest (clavicles) Face. You may experience soreness at the treatment site and can take over-the-counter pain medication. Anaplastic thyroid carcinoma is a rare but extremely aggressive form of cancer. This video is brought to you by the Stanford Medicine 25 to teach you the common causes of shoulder pain and how to diagnose them by the physical exam. most importantly with you and your family. If you take prescription blood thinners (anticoagulants such as Coumadin or Plavix) please discuss the discontinuation plan and possible “bridging” plan for anticoagulation with your prescribing doctor as well as your surgeon. Using magnifying lenses, the surgeon locates the thyroid gland and associated structures and all or part of the thyroid is removed. The considerations given to each approach will be reviewed with you during your visit. Injury to these nerves could affect your voice. In addition to the dominant recurrent laryngeal nerves, there are more minor superior laryngeal nerves, that are also susceptible to injury. We pride ourselves on offering the full complement of diagnostic and therapeutic techniques, including: We also collaborate with other specialists as needed, including: We develop a plan especially for you, that streamlines your care before, during, and after treatment. See a Stanford specialist to learn about your treatment options. Our extensive experience and use of laryngeal nerve monitoring has allowed us to perform these complex procedures with a low risk of complications. The presence of lymph node metastasis increases the risk of thyroid cancer persistence or recurrence. A priority of Stanford's Head and Neck Cancer program is to maximize the quality of life of our patients, and we have devoted many resources both to minimize the impact of cancer and to help cope with side effects of intervention. Stanford 25: Approach to Tremor; Congratulations to our ACP Winners! Noel JE, Kligerman MP, Megwalu UC. As a Stanford Health Care patient, you may have access to the latest, advanced clinical trials. Many patients are first diagnosed with primary hyperparathyroidism when routine blood tests show abnormally high levels of calcium in the bloodstream. Goiter is an abnormally enlarged thyroid gland. Using the latest surgical techniques including monitoring of the recurrent laryngeal nerve, surgeons can safely and thoroughly remove either the entire gland or a portion of the thyroid to achieve a permanent cure of hyperthyroidism. We evaluate each person thoroughly and will discuss candidacy with you during your appointment. A quick look at the latest developments from Stanford University Medical Center. Head and neck examinations are commonly performed by all physicians. This is accomplished through ultrasound evaluation and occasionally even by CT or MRI scanning of the neck and upper chest. Roof of the mouth (palate), tongue, throat. Stanford University School of Medicine 875 Blake Wilbur Drive, CC-2229-A Stanford University Medical Center Stanford, CA 94305-6564 (650) 725-5968 Vasu Divi, MD, FACS – Fellowship Director Tausha Richardson – Coordinator Program Website Number of Fellowships: 1 Duration (in years): 1-2 years Faculty: Head and Neck Surgery: Fred Baik, MD Vasu Divi, MD Chris Holsinger, […] The traditional treatment for a symptomatic thyroid nodule is a thyroid lobectomy. Consultative Opinions & Case Reviews Stanford’s Head & Neck Pathology service offers consultative opinions on challenging cases submitted from outside of the Stanford network. The prognosis for thyroid cancer is generally favorable, with surgery to remove part or all of the thyroid gland and any involved lymph node usually recommended. Administration of radioactive iodine Stanford's Chief of Head & Neck Surgery discusses the next generation of advances in surgery for head and neck cancers. ... Head and Neck Cancer Program. 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