Which Types of Surgeon do Thyroid Surgery?

One of the things that I didn't understand before I became a surgeon is that many different types of surgical specialties can do a single surgery, like a thyroidectomy or a parathyroidectomy. Back in the old days, a general surgeon would have done pretty much everything. Nowadays, there are a seemingly endless number of surgical subspecialties, and there is sometimes some overlap. So if you're looking for a surgeon, and want to know which kind does thyroid surgery best, then this article is for you.

Most thyroid surgeries in the United States are done by ENTs. An Ear Nose and Throat surgeon is also known as an otolaryngologist. When they do additional training in head and neck cancer, they are then often referred to as a Head and Neck Surgeon, or sometimes abbreviated as an OLHNS (otolaryngology head and neck surgeon). It's a mouthful, and truly a branding problem for the specialty (full disclosure, I'm a head and neck surgeon). The reason that ENTs do most thyroid surgery is because thyroid nodules are very common, and primary care doctors usually find nodules first and then send them to the local ENT. Just because the local ENT is the most likely to do it doesn't mean that they do the most individually. In fact, most thyroid surgeries in the US are done by a surgeon who does fewer than 5 thyroid surgeries each year. It goes without saying that surgical outcomes are worse if you don't do lots of thyroid surgeries, despite the fact that ENT surgical training (known as residency, which is a 5 year period for most surgeons) exposes these surgeons to a near constant flow of thyroid and neck surgery.

A special note about OLHNS surgeons: there are about 3 fellowships in the United States that take dedicated ENT trainees and give them thyroid cancer specific training. That means, in the US, only a very small handful of trainees spend their entire surgical training doing neck surgery and then do a dedicated extra 1-2 years of surgical training focusing on thyroid and parathyroid surgery. These people usually have done hundreds of thyroid and neck dissection cases before they leave training, and are generally considered the "Thyroid Unicorns," because they have the most training of anyone (by a lot). There's only a few of us in the world, and I talk about the advantages of this elsewhere (check out other news and my IG channel).

The next group of docs who do thyroid surgeries are general surgeons. Like ENTs, general surgeons have some exposure to thyroid surgery during training in the middle of their other chest and abdominal surgery. For most general surgery training programs, however, that exposure to thyroid and neck surgery is much more limited (usually just a few months). There may be wide variability within programs, however, and so some general surgeons will feel comfortable offering thyroid surgery as part of their practice after training. Again, volume affects outcomes, and so some general surgeons do a dedicated one year fellowship in thyroid and parathyroid and adrenal surgery, at which point they often call themselves Endocrine Surgeons. This type of surgeon is more common in academic hospitals, and they are increasing in number because they are training an increasing number of these surgeons.

Another subtype of general surgeon who does thyroid surgery is the Oncology Surgeon. They have done general surgery training and then a general cancer fellowship training, that likely includes some thyroid. The numbers of thyroid and parathyroid surgeries are usually fairly limited, however.

Other docs who thyroid surgery include vascular surgeons (rare) and some plastic surgeons (also rare because, hey, plastic surgery pays more than cancer surgery).

A special word about pediatric thyroid surgery: general pediatric surgeons and general pediatric ENT surgeons do pediatric thyroid surgery. Because pediatric thyroid surgery is rare, they usually do orders of magnitude fewer thyroid and parathyroid surgeries than the average adult surgeon (think 5-10 per year is normal, while 50-100 per year is normal for a busy pediatric thyroid surgeon, while a busy adult surgeon does more than 300 thyroid and parathyroid cases each year). Because volume matters, it's important to choose wisely when you are picking a surgeon, and sometimes (often) an adult surgeon will have better outcomes even if they aren't always treating kids.

To help with all of this confusion, the American College of Surgeons set up a new certification known as the Focused Practice Designation, which helps patients know how to find a surgeon who specializes in thyroid and parathyroid surgery. As such, it would be expected that these surgeons would have the best outcomes (again, full disclosure, I was in the first group of surgeons to achieve this designation).

Now that you know which surgeons do thyroid surgery, happy hunting! And please let us know if we can help!