No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the...
Transcript of No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the...
![Page 1: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/1.jpg)
![Page 2: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/2.jpg)
Thyroid Literature
Thyroid disease 136,053
Thyroid tumors 33,554
Thyroid Google search 36 million
Medline
• New Paper on Thyroid Disease – Every 3 Hours
• New Paper on Thyroid Cancer – Every 8 Hours
Thyroid Cancer Google search 21 million
![Page 3: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/3.jpg)
The extirpation of
thyroid gland typifies
perhaps better than any
operation the supreme
triumph of the
surgeon’s art.
Halsted
![Page 4: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/4.jpg)
Charles Proye-Lille, France
![Page 5: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/5.jpg)
![Page 6: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/6.jpg)
Postoperative Complications
• Postoperative complications
infrequent in experienced hands
• Early recognition and prompt initial
management crucial for successful
outcome
• Best prevented by meticulous
surgical technique
![Page 7: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/7.jpg)
• When the surgeon talks about the surgical
series, divide it by 2 and then he talks about
the complications, multiply by 2.
![Page 8: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/8.jpg)
• Only 20 % of the people will remember
20% of what you said 20 minutes after the
presentation.
![Page 9: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/9.jpg)
• The surgeons are like politicians, they have
very short term memory.
![Page 10: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/10.jpg)
Complications of Thyroidectomy
Wound hematoma – airway obstruction
Seroma – collection
Infection
Hypertrophic scar
Keloid
Recurrent laryngeal nerve injury – unilateral
Bilateral – rare
Hypoparathyroidism – temporary
Permanent
Recurrent hyperthyroidism
Hypothyroidism
Superior laryngeal nerve injury
Chyle leak
Horner’s syndrome – injury to sympathetic trunk – very rare
![Page 11: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/11.jpg)
Complications in Thyroid Surgery
Increased incidence with
• Extent of disease (size)
• Extent of surgery
• Reoperative surgery
• Extrathyroid extension and malignancy
• Paratracheal dissection
• Neck dissection
• Substernal thyroid
• Reoperation for hematoma
• Less experienced surgeon
Bigger the operation, bigger the complications
![Page 12: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/12.jpg)
Good judgement comes
from experience;
and experience comes
from bad judgement!
![Page 13: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/13.jpg)
The risk of parathyroid injury is directly proportional to the extent of thyroidectomy and inversely proportional to the
surgeon’s experience.
Thyroid Surgery
![Page 14: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/14.jpg)
Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003.
• Jury verdict reviews from 1987-2000 were obtained from a
computerized database
• 30 suits from 9 states occurred
• Plaintiffs were women in 80% of the cases, with a mean
age of 41
• 50% of pts (15 of 30) had a bad outcome, (9 of 30 dead, 4
of 30 with neurologic deficits, 1 blind & 1 alive w/ cancer)
• 30% alleged surgical complications, most RLN injury, and
75% of cancer pts alleged a delay, either through falsely
negative biopsies or no biopsy taken
• Respiratory events occurred in 43% and frequently
resulted in large awards
![Page 15: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/15.jpg)
36 year old Head and Neck Surgeon undergoes total
thyroidectomy and central neck dissection. Status of the
parathyroid; unknown. Upper PTH, not seen. Lower PTH,
not sure due to CND.
• Questions:
– Drain
– Same day discharge
– Post-Op PTH assay
– When to check calcium level
– Calcium & Vit. D supplement at discharge
• Routinely
• Selectively
– How much calcium and Vit. D
– Iatrogenic hypercalcaemia
![Page 16: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/16.jpg)
39 year old baseball coach undergoing
total thyroidectomy. Pre-Op vocal cord
evaluation, intra-op nerve monitor.
Post-op: pt is markedly hoarse with mild
stridor in the recovery room.
![Page 17: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/17.jpg)
44 year old litigation attorney undergoes
uneventful total thyroidectomy.
6 hours after surgery: c/o throat
discomfort with mild neck swelling.
8 hours after surgery: Considerable
swelling, mild stridor
![Page 18: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/18.jpg)
29 year old opera singer presents with 2.5 cm
Pap Ca. To be scheduled for thyroid surgery:
– Extent of surgery
– Pre-Op Evaluation
– Pre-Op discussion
– Intra-Op Decisions
– Sup laryngeal nerve
– Post-Op voice therapy
![Page 19: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/19.jpg)
29 year old opera singer presents with 2.5 cm
Pap Ca. Scheduled for thyroid surgery:
– Intra-Op
• The nerve totally encased by tumor
• Shave
• Resect
• Reconstruct
![Page 20: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/20.jpg)
Prospective Functional Voice
Assessment in Patients Undergoing
Thyroid Surgery
Stojadinovic/Shaha, et al.
Ann Surg 2002.
• To analyze voice before & after thyroid surgery
• Prospective study of 50 pts – functional voice testing
• Acoustic/aerodynamic/glottographic/videostroboscopic testing
• 30% pts reported early subjective voice changes
• 14% reported late subjective voice changes
• 84% had significant objective change in at least
one voice parameter
• 12% had significant alterations in more than 3 voice measures
• Early maximum phonational frequency range and
vocal jitter changes from baseline were significantly
associated with voice symptoms at 3 months
![Page 21: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/21.jpg)
Post Thyroidectomy Central
Compartment Syndrome
• Submental anesthesia/paresthesia
• Vague voice changes
• Chronic throat discomfort
• Swallowing difficulties
• Feeling of choking
(Shaha)
![Page 22: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/22.jpg)
Special Clinical Issues
• Superior laryngeal nerve
• Intraoperative nerve stimulation & monitoring
• Drains
• Management of substernal goiter
• Management of post-op hypocalcemia
• Tracheomalacia
![Page 23: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/23.jpg)
SLN Injury
• Early vocal symptoms after thyroid surgery in 1/3 even if
no obvious evidence of RLN injury
• Half of these will have persistent symptoms 3 months
later
• Usual symptoms indicative of SLN injury lowered tone
vocal fatigue
difficulty in high-pitch phonation or
projection of voice
• Videostroboscopy and laryngeal electromyography may
be needed to confirm diagnosis of SLN palsy
• Speech pathology input for severe symptoms
![Page 24: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/24.jpg)
RLN Injury
• Temporary nerve palsy may occur in up to 5% of
cases
• Permanent RLN injury and vocal cord paralysis
occurs in less than 2% to 3%
• Causes of transient nerve palsy include significant
manipulation & dissection along RLN
thermal injury
traction injury
![Page 25: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/25.jpg)
RLN Injury
• Most permanent RLN injuries are due to transaction of
nerve during surgery
• May cause hoarseness, although voice can be normal
• Pre and Post op Larynx exam CRUCIAL
• Symptomatic patients may suffer from dysphagia and
aspiration
• Recovery of a temporarily paralyzed nerve that is
anatomically intact can take several months
• Consider vocal cord medialization if severe symptoms or
permanent paralysis
![Page 26: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/26.jpg)
![Page 27: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/27.jpg)
SB 35298453 (Dr. Shaha)
• 36 yo woman with recurrent thyroid cancer
• Jan 2011: presented with T4N1bM0 (stage I)
papillary thyroid carcinoma, classical type – Total thyroidectomy, central neck dissection, right MRND
– Right lobe primary tumor; 2.8cm, with extrathyroidal
extension into fibroadipose tissue
– 5 positive lymph nodes (levels 2, 6, & 7)
![Page 28: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/28.jpg)
SB 35298453 (Dr. Shaha)
• Received 140 mCi RAI; post-treatment stimulated Tg 29.
• October 2011: presented with recurrent disease in right neck (levels 4 and 6), underwent revision neck dissection.
• Tg dropped to 15 (stable since, between 15 and 20).
![Page 29: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/29.jpg)
SB 35298453 (Dr. Shaha)
• PET-CT July 2012:
– 2cm right retropharyngeal node (SUV 15)
– 1.5cm right level 2 node (SUV 3)
– 1.5cm left level 2 node (SUV 5)
• Cross-sectional imaging (for review)
![Page 30: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/30.jpg)
SB 35298453 (Dr. Shaha)
![Page 31: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/31.jpg)
![Page 32: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/32.jpg)
50 year old female had total thyroidectomy in
Russia 18 months back. 3 positive nodes.
Received post-op RAI. Presented with
rising thyroglobulin and follow up
suggestive of local recurrence.
![Page 33: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/33.jpg)
![Page 34: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/34.jpg)
![Page 35: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/35.jpg)
![Page 36: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/36.jpg)
![Page 37: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/37.jpg)
58 year old patient comes in with Pap Ca R
side with palpable R neck nodes
![Page 38: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/38.jpg)
![Page 39: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/39.jpg)
![Page 40: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/40.jpg)
• 64 year old U.S. Senator had undergone a total
thyroidectomy for 2.6 cm papillary ca
6 positive nodes. Received 100 mCi. RAI 3 years back.
Presents with slight increase in thyroglobulin
U/S shows 6 mm paratracheal node
• Work up
• Treatment
Case
![Page 41: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/41.jpg)
• 56 year old male noticed swelling in the left neck.
• FNA performed
• Surgical exploration showed multiple nodes in the neck.
• The disease in the thyroid was thought to be inoperable.
• Patient now presents 3 weeks after surgery
• Pathology – papillary carcinoma
Case #3
![Page 42: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/42.jpg)
![Page 43: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/43.jpg)
![Page 44: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/44.jpg)
![Page 45: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/45.jpg)
• 56 year old musician presents with repeated bouts of
hemoptysis.
• Chest x-ray shows thyroid mass with intratracheal
extension.
• FNA – Papillary carcinoma
•
Case #4
Treatment?
![Page 46: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/46.jpg)
![Page 47: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/47.jpg)
![Page 48: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/48.jpg)
![Page 49: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/49.jpg)
![Page 50: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/50.jpg)
![Page 51: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/51.jpg)
The staging system for papillary carcinoma of the
thyroid invading the trachea, based on the
histologic extent of invasion
![Page 52: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/52.jpg)
• 23 year old medical student undergoes total thyroidectomy
and right modified neck dissection for papillary carcinoma
• 7 positive nodes
• Receives 150 mc RAI postop
• 1 years later thyroglobulin rises from 1.5 to 3.5.
• Ultrasound shows 5 mm right paratracheal node and 1 cm
right retrojugular node
Case #4a
Further treatment?
![Page 53: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/53.jpg)
• 82 year old female presents with dysphagia and
shortness of breath
• Evaluation revealed submucosal mass in the
posterior pharyngeal area. Airway could not be
evaluated.
• Patient had total thyroidectomy and right MRD 19
years back with 2 courses of RAI
Case #5
![Page 54: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/54.jpg)
![Page 55: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/55.jpg)
![Page 56: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/56.jpg)
![Page 57: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/57.jpg)
• 39 year old marine biologist presents with right thyroid
mass – 4 cm, hard, fixed to the deeper structures.
No neck nodes.
• FNA – papillary ca
• Paralyzed right vocal cord
• Operative findings:
• Tumor involving the right RLN and constrictor muscles
• Right lobe removed with RLN
• Frozen section – poorly differentiated ca
• Left lobe – tumor involving posterior portion adherent to
the left RLN
Case
![Page 58: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/58.jpg)
Case Presentation
• 31 year old actress with locally aggressive thyroid
ca – total thyroidectomy
• Tumor adherent to RLN
• Received 2 courses of RAI without uptake
• 2 years later paratracheal disease
Surgical excision, nerve ****** recovered 3 months
![Page 59: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/59.jpg)
Case Presentation
• 2 years later – CXR
• PET also has 3 cm met tumor at level III
• PET positive – Chest and neck
Treatment for pulmonary metastasis and neck
![Page 60: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/60.jpg)
![Page 61: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/61.jpg)
![Page 62: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/62.jpg)
Case Presentation
• 80 year old female was diagnosed with left thyroid
cancer – Papillary Ca 8 months back.
•Total thyroidectomy and post-op RT
•Presented now with dysphagia and left thyroid mass.
•FNA positive for papillary Ca
![Page 63: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/63.jpg)
![Page 64: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/64.jpg)
![Page 65: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/65.jpg)
Case Presentation
• 34 year old female, very anxious
•Total thyroidectomy at age 18.
•Left modified neck dissection at age 28 with tumor stuck
to the nerve. Temporary paralysis post-op
•Now presents with mildly elevated TGB and U/S and CT
showing multifocal recurrent disease in thyroid bed and
central compartment of the neck
![Page 66: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/66.jpg)
![Page 67: No Slide Title - World Congress on Thyroid Cancer...2013/08/08 · Medical malpractice and the thyroid gland Lydiatt DD. Head Neck 25:429-431, 2003. • Jury verdict reviews from](https://reader034.fdocuments.in/reader034/viewer/2022050513/5f9da660fb03034f6e7a0a3e/html5/thumbnails/67.jpg)