在甲状腺手术之前,您应该询问10个问题
If you havethyroid cancer, problematic nodules or goiter, or less commonly Graves’ disease/hyperthyroidism or Hashimoto’s thyroiditis, your doctor may recommend thyroid surgery — known as a thyroidectomy. There are 10 questions you should ask before scheduling the surgery to remove all or part of your thyroid gland. Let’s take a look at these important questions.
是否有甲状腺手术的替代品给我的结节或甲状腺肿?
有时建议在几种情况下为甲状腺结节推荐甲状腺手术:
- 当结节的细针抽吸(FNA)活组织检查是不确定的或不确定的时,不能排除甲状腺癌
- When nodules are interfering with breathing or swallowing
- When nodules or goiter are cosmetically unsightly
如果你有不确定的结节,你也许可以to avoid surgery by having the specializedVeracyte基因测试作为活组织检查的一部分。
您还可以通过放射性碘(RAI),经皮乙醇注射(PEI),或高强度聚焦超声烧蚀,以非手术治疗治疗良性结节。
是否有甲状腺手术的替代品,用于我的甲状腺癌?
如果您有低风险,小(尺寸1厘米或更小),生长缓慢的乳头状甲状腺癌,专家现在推荐积极监测 - 也称为“注意等待” - 而不是手术。John C. Morris,III,M.D.,是Mayo Clinic划分的明尼苏达州内分泌学家罗切斯特Endocrinology, Diabetes, Metabolism, and Nutrition。He has said that “If the thyroid cancer is not dangerous and won’t cause a problem, we can argue that any treatment is more than is actually needed.”
外科医生有多经历?
研究表明经验丰富的甲状腺外科医生,你的并发症风险越低。您应该选择每年执行至少26种甲状腺手术的经验丰富的外科医生。哥伦比亚大学纽约叙事中心建议,理想情况下,您应该选择每年至少进行50种甲状腺手术的外科医生,并迄今为止已经进行了至少500种甲状腺手术。另外,请问外科医生他/她的个人并发症率。
How much of my thyroid will be removed?
您应该询问外科医生您需要删除多少甲状腺。虽然大多数甲状腺手术是全甲状腺切除术 - 虽然可以去除整个腺体 - 如果乳腺切除术 - 去除甲状腺的一半 - 是一种选择。如果您患有甲状腺癌,您的外科医生也可能进行淋巴结解剖,从而在甲状腺周围除去一些一些淋巴结。
What type of surgery will be performed?
询问您的外科医生将如何进行手术。传统的甲状腺手术涉及颈部切口 - 注意将切口放在颈部折叠中以最小化瘢痕的可见性。然而,如果您的手术不适用于甲状腺癌,您可能是机器人腋窝(腋下)手术的候选者。根据Duke Health endocrine surgeon Michael Stang, M.D.: “Some patients are candidates for this procedure, as long as the thyroid isn’t too big.”
这将是门诊手术,还是我会住院?
根据手术和健康状况的程度,您可以将甲状腺手术作为门诊,或者您可以在手术后一天或多天住院。门诊甲状腺切除术如何与住院病一样安全有争议的,并与您的外科医生讨论。特别是,如果您在手术后立即出院,则有计划处理任何术后并发症,如出血,感染或嗜甲状腺功能亢进。
我该如何为手术做准备?
You should ask your surgeon what specific preparations you should make before surgery. For example, you will typically be told not to eat or drink anything after midnight the night before your surgery.
此外,请务必询问您正在采取的任何补充和处方药,以及如果您应该继续服用他们的手术。(例如,您通常会被告知,以便在手术前一周或更长时间停止服用香豆素,Plavix或Eliquis等阿司匹林或血液稀释剂。)
手术后,我应该看什么症状或并发症?
You should review with your surgeon any signs or symptoms of complications that may arise after your surgery, and what you should do. For example:
- 应立即评估出血,发热和显着的疼痛。
- Voice changes and hoarseness are common after surgery and usually resolve on their own.
- Numbness and tingling in the fingers and mouth and muscle cramps can be signs of hypoparathyroidism, a complication of thyroid surgery. Your doctor should instruct you on a plan of action, including the appropriate dose of calcium and vitamin D to take in the event this occurs.
What follow-up is needed after my surgery?
Before surgery, you should schedule a follow-up visit to remove any stitches or staples after your thyroidectomy.
你的外科医生应该建议你对你的recuperationafter thyroid surgery, including when you can go back to work, exercise, sports, and regular activities, including driving. You should also ask about protecting your scar after surgery, and how to care for your scar to minimize the appearance.
如果您患有甲状腺癌,您还想在提供详细的病理学评估时找出答案,因此您的癌症可以进行阶段,并概述了进一步治疗的计划。
What is the plan for thyroid hormone replacement?
After thyroid surgery,你很可能是甲状腺功能次甲状腺功能率,需要寿命处方甲状腺激素替代药物,如左甲苯胺或天然干燥的甲状腺。在手术前,您应该与您的医生讨论该计划,何时开始药物,这些药物将被规定,以及定期验血和监测计划,以确保您获得的最佳剂量。
玛丽肖蒙是一个病人的倡导者和New York Timesbestselling author who empowers readers with information on thyroid and autoimmune disease, diabetes, weight loss and hormonal health from an integrative perspective. Mary has been a leading force advocating for more effective, patient-centered hormonal healthcare. Mary also co-stars in PBS’ Healthy Hormones TV series. Mary also serves on HealthCentral’s Health Advocates Advisory Board.