Questions to ask before selecting an Endocrine Surgeon
And our Answers
What percentage of the operations that you perform are either thyroid or parathyroid?
Over 90% of our patients are thyroid or parathyroid with the remainder requiring surgery for benign or malignant diseases of the breast.
How many thyroid or parathyroid cases do you perform a year and for how many years?
Approximately 600 a year since 2007
Do you primarily work in an outpatient setting or do you admit patients to a hospital after surgery?
Unless there is a specific reason to admit to the hospital because of pathologic process or significant patient co-morbidity, most patients have their surgery as an outpatient through an ambulatory surgery center.
Are you fellowship trained?
Yes. There are only a total of 26 programs in the United States and Canada that specialize in the training of endocrine surgeons.
Are you a member of any specific organizations dedicated to thyroid or parathyroid surgery?
Yes. The most critical is the American Association of Endocrine Surgeons.
Which team members or assistants in the operating room are constant, and which are variable?
Dr. Garner has the same physician assistant, surgical technician, and circulating nurse for all operations. These members of the team are extremely familiar with the surgical flow. The anesthesia group is the same but a different member of the group may be assigned on a daily basis. All are in network for insurances.
Does surgery involve general anesthesia?
Yes.
Do you perform your own ultrasound examination?
Yes.
If fine needle aspiration is necessary for diagnosis, do you do it yourself?
Yes.
Do you have a working relationship with your pathologist and how familiar are you with them?
Absolutely. We speak on a weekly basis and have each other’s cell phones in the event that further or most in-depth discussion is necessary.
How certain are you of my diagnosis and need for surgery?
Will be explained to the satisfaction of each patient.
What is your rate of recurrent laryngeal nerve injury?
<0.5% of cases
In the event there is a nerve injury, what is your referral pathway afterwards?
It depends on the nature of the injury. In the event of suspected traction or thermal injury, sometimes these injuries will heal spontaneously. In the event that there is non healing or in the event in which the nerve was cut, referral in made to ENT voice experts. We are partnered with voice clinics through Baylor Scott & White and UT Southwestern.
What is the incidence of patients requiring ED or hospitalization for hypocalcemia following surgery?
Very rare. Perhaps one patient a year. We try to prevent this with in depth patient education regarding symptoms of hypocalcemia to avoid exacerbation of symptoms.
In the event that hospitalization for hypocalcemia is necessary, will the surgeon care for me or someone else?
Yes. We try to encourage patients to seek care at a hospital in which Dr. Garner has admitting privileges, but in the event that it is not possible, Dr. Garner will consult and direct your treating physician.
Will the surgeon manage post operative thyroid medication or will referral to someone else be necessary?
We have an entire aspect of the clinic devoted to the management of thyroid medication, regardless if the patient has had surgery or not. The ultimate decision of who the provider will be—surgeon, endocrinologist, PCP, etc. is up to the patient.
Will I have a choice of which thyroid medication to take?
Absolutely. Dr. Garner asks that the medication be FDA approved and commercially available. Compounded prescriptions can be done if Dr. Garner is able to communicate with the compounding pharmacist.
What is the typical length of the scar?
Except in the case of very large goiter or very large neck, incisions are uniformly 4 cm.
How will the incision be closed?
There will be dissolving vicryl sutures underneath the incision with dermabond and steri-strips covering the skin. Patient will advise if they have any allergy to those components.
How likely is infection or hematoma?
Infection is extremely rare such that preoperative antibiotics are not necessary. Hematoma will likely happen in the first hour following surgery. Patients will be educated about the need to come off of blood thinners for surgery and how long they must be off of them.
Describe a typical recovery time following surgery.
Patients have a sore throat for about 2 days and then report feelings of fatigue. Typically, patients benefit from about a week off from work.
What happens if I have a problem or question after surgery?
Call! Even after hours, the message is transcribed and sent to the doctor or physician assistant.
For thyroid cysts, is ethanol ablation an option instead of surgery?
Absolutely. Dr. Garner will discuss expectations with the patient.
For benign thyroid nodules, is radiofrequency ablation an option instead of surgery?
Absolutely. Dr. Garner will discuss expectations with the patient.
For either ablation, are those procedures done in the office or operating room?
Ablations are done in an office-based procedure room and do not require general anesthesia.
In the event cancer is diagnosed, what is the next step?
Most cancer patients will require surgery so that is the next step. Then, depending on final pathology, the decision is made to refer the patient for radioactive iodine. Rarely, very aggressive cancers will require external beam radiation.
Do you follow your own cancer patients for recurrence or refer elsewhere?
Thyroid cancer patients will be followed for a total of 5 years from surgery with ultrasound. This is usually done in conjunction with a treating endocrinologist or radiation oncologist.