Thyroid surgery: Your questions answered

The thyroid gland, located in the front of the neck, is responsible for the secretion of hormones like the thyroid hormone, that regulate key body functions. When a disease develops in this gland, surgery for its removal may be recommended. Here, Mr Anurag Jain, esteemed consultant ENT surgeon, provides an expert insight into thyroid surgery. He explains what thyroid surgery involves, how painful is it and how the voice box is protected during the surgery, among other important points. When is thyroid surgery required? There are several reasons for having thyroid surgery, which are as under: The presence of a large thyroid lump or nodules that causes either pressure symptoms or cosmetic concerns. The presence of thyroid lumps, whereby the needle biopsy has raised a concern for thyroid cancer. Patients with overactive thyroid cases of thyrotoxicosis who either cannot tolerate, do not wish to take or whose symptoms are not controlled by anti-thyroid medicine. What does thyroid surgery involve? Thyroid surgery is undertaken under general anaesthetic and typically requires one or a two night’s stay in the hospital. Surgery may involve either: removing half of the thyroid gland (which usually takes around two to three hours) or removing the whole of the gland (which takes around three to four hours including the anaesthetic and the surgical time). After the procedure, patients will have a drain coming out of the neck, which typically is removed in the next one to two days. How painful is it? Thyroid surgery is not very painful and patients are prescribed adequate analgesia post-operatively to keep them comfortable. What is included in the aftercare? If only half of the gland is removed, then typically patients stay overnight and are usually discharged the next day following the removal of the drain. If the whole gland is removed, then two drains are placed. Usually, they would come out in the next two days, but this duration can vary. After the removal of the total thyroid gland, patients will need to take a thyroid supplement in the form of a tablet for the rest of their lives. It is likely that they may also require calcium or Vitamin D supplements, either temporarily or (rarely) for life. How is the voice protected during thyroid surgery? The nerve supplying the voice box runs very close to the thyroid gland and is potentially at risk of damage during the thyroid surgery. This is prevented by using a nerve monitor to identify and preserve the nerve. In some occasions, however, the nerve can either be bruised (causing temporary hoarseness) or rarely damaged (causing permanent hoarseness), which can be improved by speech therapy and vocal cord injection. Side effects are rare but may include, bleeding, scarring, infection, the return to the theatre to stop bleeding and seldom, the need for blood transfusion.

How are swallowing disorders diagnosed? - Anurag JainHow are swallowing disorders diagnosed?

There are many different reasons why a person may experience difficulty swallowing. It is important to determine the cause and get treatment promptly, to avoid more serious health conditions from developing. Highly esteemed and expert otolaryngologist, Mr Anurag Jain, practising in Buckhurst Hill, London, and Brentwood, discusses some of the main causes, who is most affected, and how the cause is determined to ensure the correct treatment is used. What health conditions can cause swallowing problems? Swallowing problems can be caused by a variety of health conditions such as infective conditions like throat infection, neurological conditions like stroke, a motor neuron disease, aging, or a condition such as pharyngeal pouch where there is a pouch at the back of your throat making swallowing difficult. A more sinister pathology, like throat cancer, could also cause swallowing problems so it is essential for you to get it checked as soon as possible. Early detection and correct management of such a pathology make a big difference to the outcome. Who is mainly affected by swallowing disorders? Swallowing disorders can affect any age group but it’s usually more common in elderly people. It also very commonly affects people with neurological disorders or neurologic conditions like motor neuron disease or cerebral palsy. It can also be an issue for patients with cancer of the throat or oesophagus, for example. What are the main symptoms of swallowing problems? The main symptom is difficulty in swallowing. Patients with swallowing problems could be limited to liquids only, or they could have difficulty even getting liquids down. Swallowing disorders are associated with painful swallowing, fever, lumps in the neck, and even loss of weight due to the inability to get adequate nutrition. What further problems can swallowing disorders lead to? If there is some kind of obstruction in the food pipe, the food can often be aspirated, meaning it can go down the wrong way or through the wrong pipe into the lungs causing chest infection. This is also seen in a condition called pharyngeal pouch, where there is a pouch bulging from the food pipe, the food collects there and can be regurgitated. When this happens, it can go down the wrong way. Again, it can cause chest infection, but it can also cause weight loss, lack of nutrition, cachexia, or anaemia. How are swallowing disorders diagnosed? It begins with finding out the cause of the swallowing problem, so whether it is neurological, anatomical like a pharyngeal pouch, age-related, or if it is a more sinister pathology such as cancer. Diagnosing a swallowing disorder involves a thorough clinical examination including a nasal endoscopic examination, where a camera is placed in a patient’s throat to visualise the voice box directly to make sure there is nothing there. Patients might require scans, such as the barium swallow and even an upper GI endoscopy. Once the cause has been determined, then the treatment is carried out appropriately.

Tongue Tie in babies: Should it be corrected?

We might think that tongue-tie is when we can’t speak due to nerves or embarrassment. However, in babies, it is another term for ankyloglossia, a condition where the tongue is anchored to the bottom of the mouth and can’t be moved freely. Expert London-based consultant otolaryngologist, Mr Anurag Jain, shares his expertise on the condition, how it presents and when it should be treated. What is meant by tongue-tie? Tongue-tie is seen in one in ten childbirths and refers to a condition whereby the tongue is stuck to the floor of the mouth, usually by a membrane. It is more commonly seen in boys but it can also be seen in girls. There are two types of tongue tie, anterior tongue tie, and posterior tongue tie. It can be divided into mild, moderate, and severe cases. What causes babies to be tongue-tied? Tongue-tie is a developmental abnormality, there is no clear cause. What are the symptoms of tongue-tie? Common symptoms of tongue-tie are: failure to latch onto the breast, causing difficulty in breastfeeding clicking sounds from the baby while feeding wind and bloating the child may take a long time to feed but always seems hungry and not getting enough milk inability to gain weight painful nipples for the mother It may also cause problems with the pronunciation of certain words when the child grows up. Is tongue-tie a serious condition? Is correction always required? Tongue-tie is not serious. Of the children presenting with a tongue tie, excision (treatment) is necessary for only around half of the children. How is tongue-tie corrected? Tongue-tie is corrected by a short surgical procedure, which can be undertaken during the same appointment as the diagnosis in the clinic and without any anaesthetic for children under nine months old. It is like a haircut and hence does not hurt the child. The mother can then breastfeed the child straightaway, and improvement is often observed immediately. For a child older than nine months, a general anaesthetic may be required to perform a tongue tie excision, so if your child is encountering any feeding problems, it is better to get them assessed as soon as possible. It is a very safe procedure with very few complications or risks in expert hands, therefore it is very important to get your child assessed and treated by an expert.