THYROID SURGERY EXPLAINED NAVIGATE YOUR HEALTH JOURNEY WITH CONFIDENCE: THYROID SURGERY BY DR SANDEEP Thyroid disorders demand serious attention, and when surgery is necessary, Dr Sandeep’s expertise ensures you’re in capable hands. With a clear focus on achieving the best health outcomes, Dr Sandeep’s surgical process is precise, patient-focused, and aimed at delivering effective results. THOROUGH EVALUATION AND PLANNING Your journey begins with a thorough consultation to understand your medical history, current health status, and specific thyroid issues. Dr Sandeep’s detailed preoperative evaluation includes ultrasound imaging, fine-needle aspiration biopsies if necessary, and a review of your hormonal status to tailor a surgical plan that addresses your unique health needs. IN-DEPTH INFORMED CONSENT Dr Sandeep dedicates time to discuss every facet of the proposed surgical intervention, providing a comprehensive view of what to expect during and after the procedure. His philosophy centres on informed patient decisions, ensuring that you are fully aware of the benefits and potential risks associated with thyroid surgery. RIGOROUS PRE-SURGICAL PREPARATION Preparation is key to the success of your surgery. Dr Sandeep’s team will guide you through the necessary pre-operative preparations, including dietary restrictions, medication adjustments, and any lifestyle modifications needed to ensure optimal surgical outcomes. Our seasoned anaesthesia team will conduct a thorough pre-anaesthetic evaluation to ensure you are in the best possible condition for your surgery. SURGICAL PROCEDURE: DETAILED AND DELIBERATE STEPS WELCOMING AND PREPARATION On the day of surgery, you will be welcomed into a facility where comfort and safety are of the utmost priority. The team will prepare you for surgery, providing reassurance and answering any last-minute questions. ANAESTHETIC ADMINISTRATION A highly experienced anaesthesiologist will carefully administer the anaesthesia, tailored to your specific needs for a painless and comfortable surgical experience. STRATEGIC INCISION MAKING Leveraging his expertise in facial plastic surgery, Dr Sandeep will make carefully planned incisions that provide optimal access to the thyroid while ensuring that resultant scarring is minimal and strategically placed to be as inconspicuous as possible. SURGICAL REMOVAL OF THYROID LUMP Dr Sandeep performs the necessary surgical procedure, whether it’s a hemithyroidectomy, total thyroidectomy, or removal of malignant nodules, with precision and care to maintain function and aesthetics. SAFETY FIRST Utilizing state-of-the-art techniques, which can include nerve monitoring and minimally invasive procedures, Dr Sandeep enhances patient outcomes and safety. He focuses on preserving the integrity of external and recurrent laryngeal nerves that move the muscles of the voice box, as well as the parathyroid glands which help maintain calcium levels in the blood.Drains are placed during the procedure to reduce the risk of hematoma, which could cause complications such as respiratory difficulties and infection. EXPERT WOUND CLOSURE Dr Sandeep’s proficiency in facial plastic surgery enhances his ability to close surgical incisions with exceptional skill, promoting healing and resulting in scars that are often barely perceptible. POST-SURGICAL SUPPORT AND MONITORING Your post-surgery journey is supported by Dr Sandeep’s comprehensive care, including pain management, wound care designed to promote healing, and hormonal therapy if needed. Regular follow-ups are scheduled to monitor healing and endocrine function, adjusting treatment as required for your optimal recovery to support your return to normalcy. THOROUGH POSTOPERATIVE CARE WITH AESTHETIC FOCUS Following surgery, you will receive individualized attention to facilitate a smooth recovery. Drains, placed to prevent fluid build-up, are generally removed within the first 1-2 days post-operation. Sutures, if non-dissolvable, are usually removed after 5-7 days, depending on the healing progress. To ensure scars remain barely visible, we may apply silicone gel or recommend TriLuma for post-inflammatory hyperpigmentation (PIH) management. Vigilant sun avoidance and the use of broad-spectrum sunscreen are crucial for protecting healing skin and enhancing the appearance of surgical sites. POTENTIAL RISKS AND COMPLICATIONS Thyroid surgery, while generally safe and effective when performed by experienced surgeons, does carry potential risks and complications, as with any surgical procedure. Here is a detailed look at the risks and potential complications associated with thyroid surgery: BLEEDING AND HEMATOMA Any surgery can result in bleeding during or after the procedure. In thyroid surgery, this can lead to a hematoma, which is a collection of blood that may accumulate near the surgical site. In some cases, it may require surgical drainage. INFECTION The risk of infection is present with any surgery. If an infection occurs at the site of the incision, it typically can be managed with antibiotics. HYPOCALCEMIA Since the parathyroid glands, which control calcium levels in the body, are located behind the thyroid gland, they can be inadvertently damaged or removed during surgery. This can lead to low calcium levels, or hypocalcaemia, which may require calcium supplementation or other treatments. VOCAL CORD PARALYSIS The nerves that control the vocal cords, particularly the recurrent laryngeal nerve, run very close to the thyroid gland and can be injured during surgery. This can lead to vocal cord paralysis, hoarseness, voice changes, or difficulty breathing. THYROID STORM This is a rare but life-threatening complication that can occur if a patient with hyperthyroidism (overactive thyroid) undergoes surgery without proper preoperative treatment to control thyroid hormone levels. THYROID HORMONE IMBALANCE After thyroid surgery, particularly if most or all of the thyroid is removed, patients may require lifelong supplementation with thyroid hormones to maintain normal metabolic function. SCARRING While surgeons make an effort to minimize and conceal incisions, there will be some form of scarring after thyroid surgery. The severity of scarring can vary based on the individual’s healing process. CHANGES TO VOICE AND SWALLOWING Some patients may experience temporary or, less commonly, permanent changes to their voice or swallowing ability after thyroid surgery due to nerve irritation or damage. LYMPHOEDEMA In cases where lymph nodes are removed during surgery, there can be a risk of lymphoedema, which is swelling due to lymph fluid build-up in the tissues. NEED FOR ADDITIONAL SURGERY If not all the diseased thyroid tissue is removed during the initial surgery, or if there are postoperative complications, additional surgery may be needed. ANAESTHETIC COMPLICATIONS Risks of general anaesthesia in thyroid surgery include respiratory complications, such as airway obstruction

MANAGEMENT OF THYROID LUMPS Dr Sandeep Uppal and his team at The ENT Clinic understand that a thorough diagnostic process is crucial for addressing thyroid lumps effectively and follow the following steps for effective management of this condition. DIAGNOSTIC METHODS DETAILED PATIENT HISTORY Before any physical examinations or tests, a detailed history is taken to understand the patient’s symptoms, lifestyle, and any potential risk factors. Questions may include when the lump was first noticed, any changes in size or texture, associated symptoms, family history of thyroid disorders or cancers, and any previous radiation exposure. CLINICAL EXAMINATION A comprehensive clinical examination involves palpating the neck area to assess the size, texture, and location of the lump. Dr Sandeep will also check for enlarged lymph nodes in the neck and other signs that could indicate a more systemic issue. An endoscopic examination of the larynx (voice box) will also be performed to rule out any abnormality of the nerve supplying the muscles that help to produce voice. ULTRASOUND IMAGING An ultrasound is typically the first-line imaging study used to visualize the thyroid gland and any nodules present. This technique can discern whether the lump is solid, cystic, or a mixture of both, and can also identify suspicious characteristics like irregular borders or internal calcifications. FINE-NEEDLE ASPIRATION (FNA) BIOPSY An FNA biopsy is often crucial for determining the nature of the thyroid lump. A thin, hollow needle is used to extract a small sample of cells from the nodule. Local anaesthesia may be used to numb the area. The extracted cells are then examined under a microscope for characteristics that may indicate cancer or other thyroid conditions. BLOOD TESTS Thyroid-Stimulating Hormone (TSH), Free T4 and sometimes Free T3 levels are checked, and in some cases, additional tests like thyroid antibodies may be done to rule out autoimmune conditions. ADDITIONAL IMAGING For complex cases, further imaging studies like CT scans or MRIs may be performed. These additional imaging studies can provide a more detailed view of the thyroid gland and surrounding structures. MOLECULAR TESTING Molecular testing looks at the cellular makeup of the thyroid nodule, specifically focusing on the genes and proteins that are expressed. This kind of testing is particularly useful for nodules where the Fine-Needle Aspiration (FNA) biopsy results are indeterminate or suspicious but not definitively cancerous. By examining the molecular markers, our team can better understand the behaviour of the nodule, such as its potential for malignancy or aggressiveness. Types of molecular tests for thyroid nodules include ThyroSeq, Afirma, and RosettaGX Reveal, among others. These tests analyse the presence or absence of various gene mutations and rearrangements to offer a more nuanced diagnosis. GENETIC TESTING Genetic testing takes a broader look at an individual’s genetic makeup to understand the risk factors for developing thyroid nodules or thyroid cancer. With his background of research and PhD in ‘Genetic Studies on Inherited Diseases Presenting with Unusual ENT Problems’ Dr Sandeep in well placed to recommend genetic tests for patients with a strong family history of thyroid disorders or other endocrine cancers. Types of Genetic Tests Germline Testing: This test examines a blood or saliva sample to identify inherited mutations that increase the risk of developing thyroid nodules or cancer. This is especially useful for individuals with a strong family history of thyroid or other endocrine disorders. Somatic Mutation Testing: Conducted on the tissue sample obtained from the thyroid nodule, this test looks for mutations that have occurred after birth and may contribute to the nodule’s growth or malignancy. Commonly Tested Genes RET Gene: Mutations in this gene are often associated with medullary thyroid cancer and are a cornerstone of genetic testing for individuals with a family history of this condition. BRAF and RAS Genes: These are often tested in somatic mutation panels to identify the likelihood of papillary or follicular thyroid cancer. PTC and FTC Genes: Sometimes, tests may include genes specifically associated with papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC). When is Genetic Testing Recommended? Family History: When multiple family members have had thyroid nodules or cancer, genetic testing may be advised. Multiple Endocrine Neoplasia (MEN) Syndromes: For families with a history of MEN syndromes, which involve tumours in multiple endocrine glands, genetic testing is highly recommended. Young Age: The presence of thyroid nodules or cancer at a young age can also be an indicator for genetic testing. Pre- and Post-Test Counselling Pre-test Counselling: Before undergoing genetic testing, it’s often recommended to speak with a genetic counsellor to understand what the test can and cannot tell you. Post-test Counselling: After the results are available, another session with a genetic counsellor helps interpret the results, understand the implications for treatment and future screening, and discuss the potential impact on family members. Genetic testing can provide valuable insights into the diagnosis and management of thyroid conditions, but it’s important to interpret the results in the context of each patient’s unique medical history and symptoms. Dr Sandeep Uppal and his team at The ENT Clinic offer a thorough, evidence-based approach, incorporating genetic testing as part of their comprehensive care for thyroid disorders. TREATMENT AND PROGNOSIS IN THYROID CANCERS Dr Sandeep Uppal and his team at The ENT Clinic emphasize the importance of a comprehensive approach to understanding the prognosis of thyroid cancer, which can be influenced by several factors such as the stage of the cancer, the patient’s age, and any relevant genetic markers. It’s worth noting that survival rates are general estimates, and the prognosis can vary from patient to patient based on a variety of factors, including overall health, response to treatment, and other individual characteristics. In general, younger patients (<45 years) often have a better prognosis across all types of thyroid cancer. PAPILLARY THYROID CANCER Stage I Younger than 45: Almost 100% 5-year survival. 45 Years and Older: 80-90% 5-year survival if localized. Stage II Younger than 45: Almost 100% 5-year survival. 45 Years and Older: 70-80% 5-year survival if localized. Stages III & IV Younger than 45: 90-95%

MALFUNCTION OF THYROID GLAND AND ITS MANAGEMENT WHAT HAPPENS WHEN THE THYROID GLAND MALFUNCTIONS? A malfunctioning thyroid can lead to various health issues. The conditions generally fall under two categories: HYPOTHYROIDISM Dr Sandeep Uppal and his team at The ENT Clinic specialise in the comprehensive care of thyroid disorders, including hypothyroidism, an underactive thyroid condition that results in reduced production of crucial hormones T4 and T3. Common causes These range from autoimmune diseases like Hashimoto’s thyroiditis to surgical removal of the thyroid gland and certain medications. Symptoms Often include fatigue, unexplained weight gain, and sensitivity to cold. Left untreated, the condition can lead to complications such as cardiovascular issues and infertility. Diagnosis Typically involves blood tests and ultrasounds. Treatment Options include hormone replacement therapy with Levothyroxine and lifestyle modifications, such as a diet rich in iodine and selenium. Ongoing monitoring through regular blood tests and symptom evaluations is crucial for effective management. HYPERTHYROIDISM Hyperthyroidism is characterised by an overactive thyroid gland that produces excess amounts of the hormones T3 and T4. Common causes Include Graves’ disease, thyroid nodules, and excessive iodine intake. Symptoms Patients may experience symptoms such as weight loss, heat intolerance, and anxiety. If left untreated, hyperthyroidism can lead to serious complications like heart disease and osteoporosis. Diagnostic measures Typically include blood tests to measure hormone levels and imaging studies like ultrasounds or radioactive iodine uptake tests. Treatment approaches These vary from antithyroid medications and beta-blockers to more invasive options like radioactive iodine therapy or surgical removal of the thyroid gland. Ongoing monitoring is essential for adjusting treatment and preventing complications. TAKE CHARGE OF YOUR HEALTH: MANAGE YOUR THYROID DISORDER TODAY! Are you constantly feeling tired, experiencing weight changes, or having trouble with temperature regulation? Thyroid gland malfunction can disrupt much more than just your metabolism—it may affect your energy levels, mood, and overall vitality. Both adults and children might suffer the consequences of this disorder, which, if neglected, can lead to serious health complications, including heart problems and mental health issues. Don’t allow thyroid dysfunction to control your life. Now is the moment to act! Seek professional thyroid management. Collaborate with Dr Sandeep to navigate towards a balanced and healthier state. Secure your consultation with Dr Sandeep for expert advice and personalized treatment options.

HYPOTHYROIDISM Dr Sandeep Uppal and his team at The ENT Clinic appreciate the importance of understanding hypothyroidism in depth. Below is a more detailed breakdown of the condition: Definition and Physiology Hypothyroidism is characterised by an underactive thyroid gland which results in reduced production of essential thyroid hormones Thyroxine (T4) and Triiodothyronine (T3). These hormones are critical for metabolic functions and energy regulation in the body. CAUSES Autoimmune diseases like Hashimoto’s thyroiditis. Surgical removal of the thyroid gland. Radiation therapy for cancer. Certain medications like lithium. Iodine deficiency (rare in developed countries). COMMON SYMPTOMS Fatigue and lethargy. Unexplained weight gain. Sensitivity to cold temperatures. Depression and mood swings. Dry skin and hair. Muscle aches and weakness. Cognitive issues like poor memory and concentration. POTENTIAL COMPLICATIONS Cardiovascular issues: Elevated cholesterol levels, increased risk of heart disease. Infertility: Problems with ovulation and reproductive health. Myxoedema: A severe, life-threatening form of hypothyroidism that can lead to coma. Mental Health: Prolonged untreated hypothyroidism can exacerbate depression and cognitive issues. DIAGNOSTIC METHODS Blood Tests: Measuring levels of Thyroid-Stimulating Hormone (TSH), Free T4, and sometimes Free T3. Ultrasound: To examine the size and condition of the thyroid gland. Additional tests may be performed to identify underlying causes, such as autoimmunity tests. TREATMENT OPTIONS Hormone Replacement Therapy: Levothyroxine is the standard treatment to replace insufficient hormone levels. Lifestyle Changes: Diet rich in iodine and selenium, regular exercise. Selenium is a key component of enzymes that help convert T4 into T3, the active form of thyroid hormone. Foods rich in Selenium include seafood, meat, eggs, nuts and seeds, whole grains, dairy products, spinach and mushroom. Monitoring: Frequent blood tests to adjust medication dosages. FOLLOW-UP AND MONITORING Regular check-ups to monitor hormone levels. Adjustments in medication dosage based on test results and symptoms. Patients who exhibit symptoms of hypothyroidism should not hesitate to seek professional medical advice for proper diagnosis and treatment. Dr Sandeep Uppal and his dedicated team at The ENT Clinic are equipped with the expertise and technology to provide comprehensive, evidence-based care for thyroid disorders. We work closely with our endocrinology colleagues to provide comprehensive care for thyroid disorders.

HYPERTHYROIDISM DEFINITION AND PHYSIOLOGY Hyperthyroidism is marked by an overactive thyroid gland, resulting in excessive production of the thyroid hormones Thyroxine (T4) and Triiodothyronine (T3). These hormones are vital for metabolic functions and energy regulation in the body. CAUSES Graves’ disease, an autoimmune disorder. Toxic multinodular goitre Excessive iodine intake. Thyroiditis, inflammation of the thyroid. COMMON SYMPTOMS Weight loss. Heat intolerance. Rapid or irregular heartbeat. Anxiety and irritability. Tremors. Diarrhoea. POTENTIAL COMPLICATIONS Heart issues: Tachycardia, atrial fibrillation, and increased risk of heart disease. Osteoporosis: Weakening of the bones due to prolonged elevated hormone levels. Thyroid storm: A severe, life-threatening form of hyperthyroidism. Mental health: Anxiety and irritability can be exacerbated. DIAGNOSTIC METHODS Blood Tests: Measuring levels of Thyroid-Stimulating Hormone (TSH), Free T4, and Free T3. Ultrasound: To assess the size and condition of the thyroid gland. Radioactive Iodine Uptake Test: To identify the cause of hyperthyroidism. TREATMENT OPTIONS Antithyroid medications: Methimazole or Propylthiouracil to reduce hormone production. Beta-blockers: To manage symptoms like rapid heartbeat. Radioactive Iodine Therapy: To destroy part of the thyroid gland. Surgical Removal: In severe cases, the thyroid gland may be partially or completely removed. FOLLOW-UP AND MONITORING Regular check-ups to assess hormone levels. Adjustments in medication dosage based on test results and symptoms. Patients displaying symptoms of hyperthyroidism should consult healthcare professionals for accurate diagnosis and tailored treatment. Dr. Sandeep Uppal and his dedicated team at The ENT Clinic work in collaboration with our partner endocrinology experts to provide a comprehensive and evidence-based approach to managing thyroid disorders effectively.

HOW ARE THYROID CANCERS STAGED? Understanding the details of each stage of thyroid cancer is critical for both treatment planning and prognosis. Dr Sandeep Uppal and his team at The ENT Clinic adhere to the most current staging guidelines to offer tailored, evidence-based care for each patient. Below is a breakdown of what each stage generally entails: PAPILLARY AND FOLLICULAR THYROID CANCER STAGING STAGE I Tumour is 2 cm or smaller in size. No lymph node involvement. No distant metastasis. STAGE II Tumour is between 2 cm and 4 cm. No lymph node involvement. No distant metastasis. STAGE III Tumour is larger than 4 cm or any tumour with minimal extrathyroidal extension. May have spread to nearby lymph nodes. No distant metastasis. STAGE IV Divided into IVA, IVB, and IVC based on the extent of spread to tissues, lymph nodes, and distant metastasis. Stage IVA Tumour of any size that may extend beyond the thyroid capsule to invade subcutaneous soft tissue, larynx, trachea, oesophagus, or recurrent laryngeal nerve. Lymph node involvement may be present. No distant metastasis. Stage IVB Tumour invades prevertebral fascia or encases the carotid artery or mediastinal vessels. May or may not have lymph node involvement. No distant metastasis. Stage IVC Tumour of any size. May or may not have lymph node involvement. Distant metastasis is present. Reference: AJCC Cancer Staging Manual, 8th Edition. MEDULLARY THYROID CANCER STAGING: STAGE I Tumour is 2 cm or smaller. No lymph node involvement. No distant metastasis. STAGE II Tumour is between 2 cm and 4 cm. No lymph node involvement. No distant metastasis. STAGE III Tumour size varies. Spread to nearby lymph nodes. No distant metastasis. STAGE IV Stage 4 medullary thyroid cancer (MTC) represents a critical and challenging phase of the disease. The stage is generally broken down into sub-stages: IVA, IVB, and IVC, each with distinct characteristics. It is divided into IVA, IVB, and IVC, indicating more extensive local spread, lymph node involvement, or distant metastasis. Stage IVA Tumour of any size that extends beyond the thyroid. May involve adjacent structures such as the larynx, trachea, oesophagus, or recurrent laryngeal nerve. Lymph node involvement is common but limited to the central neck area. No distant metastasis. Stage IVB Tumour invades more distant structures such as the prevertebral fascia or encases the carotid artery or mediastinal vessels. Lymph node involvement can extend to lateral neck or mediastinal nodes. No distant metastasis. Stage IVC Tumour of any size and extent. May or may not involve lymph nodes. Distant metastasis is present, often involving the liver, lungs, or bones. Reference: AJCC Cancer Staging Manual, 8th Edition; Wells SA Jr, Asa SL, Dralle H, et al., Thyroid, 2015. ANAPLASTIC THYROID CANCER STAGING Unlike other forms, anaplastic thyroid cancer is always considered to be at an advanced stage when it is diagnosed. Due to its aggressive nature, rapid growth, and early spread to surrounding tissues and distant organs, it is not categorized into the earlier stages (1-3) that are typical for other forms of thyroid cancer. Stage IVA Tumour of any size, confined to the thyroid. May have lymph node involvement. No distant metastasis. Stage IVB Tumour of any size, extending beyond the thyroid. May have lymph node involvement. No distant metastasis. Stage IVC Tumour of any size. May have lymph node involvement. Distant metastasis present. Reference: AJCC Cancer Staging Manual, 8th Edition.   By understanding these stages in detail, Dr Sandeep Uppal and his team at The ENT Clinic are better equipped to offer comprehensive and individualized treatment plans. They collaborate closely with other specialists to provide the most effective care for each stage of thyroid cancer, enhancing the potential for successful outcomes.