Vaninder Dhillon

#ahnschat Thank you to all of our patients, and for the questions tonight!

#ahnschat Look for a surgeon and a team who will commit to working with you as you navigate this terrain, and keep you informed, offer all options and provide guidance every step of the way

#ahnschat We have been fortunate to evaluate responses with our ThyCa members of patients who have undergone recurrence. Having the support before, during and after thyroid cancer surgery and reoperative surgery is a lifelong commitment.

@mcmullen_dr Yes! the patient-physician relationship with strong communication and offered resources for patients to feel educated and well informed is so important!

A5: In addition, find someone that communicates clearly with you and builds a strong patient-physician relationship so you can feel educated, empowered and supported #AHNSchat

#ahnschat A5. An experienced, trained endocrine surgeon who has not only experience in thyroid and parathyroid surgery, but reoperative thyroid cancer surgery (for recurrence). Also, a surgeon who works with a multidisciplinary team with other specialists in a high volume center

#ahnschat patient preference is also very important, if this is a choice and the non surgical option can provide oncologic benefit!

#ahnschat A4. additional surgery may not be a good idea for any patient with any co-morbidities or medical issues that doesn't allow them to undergo surgery, where the risks of surgery outweigh any benefit of providing increased survival.

#ahnschat 'watch and wait' is supported by the guideline recommendations, but is dependent on each individual patient, their type of thyroid cancer and the location of their cancer. it is important as a patient to discuss this with your surgeon and team, including the pro/ con

#ahnschat I am in agreement with Dr. Chen. Prior to any reoperative surgery it is important to confirm vocal fold mobility by directly looking at the vocal folds through a laryngoscopy or videostroboscopy in the office (camera examination)

@zemkai @allenhomd Yes, @zemkai. In any type of surgery, whether for primary thyroid cancer or cancer, parathyroid glands can be 'autotransplanted' which means they can be reimplanted in another part of the part and still function as glands that irrespective of location can secrete hormone

@allenhomd #ahnschat - okay, silly / urban legend type question… I’ve heard that during these surgeries, parathyroids would be. … relocated? Into the arm and such? Really? #ImASoftwareGuy #ThisSeems…Odd.

Yes agreed. The parathyroids may be in unpredictable locations and hard to find amongst the scar. #AHNSchat

#ahnschat @elliebenya Great question. good objective imaging like CT with contrast and ultrasound are my choice for guiding surgery for recurrence.

@AHNSEndo Great to be here

Welcome back Vinny! #ahnschat

#ahnschat A1. Recurrent thyroid surgery is challenging given need to identify surgical landmarks altered by scar tissue. Strong imaging is important in preoperative planning

Vaninder Dhillon, endocrine surgeon. Johns Hopkins University #ahnschat

Thank you all for your answers. Very stimulating! And thank you to @ThyCaInc and #AHNSChat. Goodnight everyone.

@AHNSEndo @PSkerl @ThyCaInc There is a paper within the voice literature on the benefits of early injection laryngoplasty. metroatlantaotolaryngology.org/journal/nov10/… #ahnschat

@VaninderD @PSkerl @ThyCaInc Vinny, as a voice specialist as well as thyroid surgeon, do you have a protocol for someone diagnosed with vocal cord paralysis after thyroidectomy? at 1mo, 3mo, 6mo? when do you inject vs perform thyroplasty? #AHNSChat

A5. As a voice and swallow specialist as well as an endocrine surgeon, I am curious to know, for those who had nerve injury or voice concerns after surgery, how fast were you diagnosed, and treated.. #ahnschat

@AHNSEndo @PSkerl @ThyCaInc I then see patients back within 6-8 weeks after injection, or within 4 weeks post op (if no injection) to follow up and see how they are improving. I'm an advocate for early injection (which fortunately I can do in office).

@AHNSEndo @PSkerl @ThyCaInc If there is inherent knowledge that a vocal fold is paralyzed during surgery, I like to have patients seen speech therapy before discharge to prevent risk for aspiration. I see them back within 1-2 weeks and we plan on an in office injection if there is continued aspiration

A7. Every patient should have a discussion with their surgeons as to whether it will add value to the surgery decision making process #ahnschat

A7. Gene testing involves a host of assays, which all have different values in whether they help in ruling IN or OUT the risk for cancer. #ahnschat