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Doctor insights on: Thyroidectomy Electronic Nerve Monitoring

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Should all hospitals use/have a instrument-intraoperative nerve monitor , used to safeguard the recurrent laryngeal nerves during thyroid surgery?

Should all hospitals  use/have a instrument-intraoperative nerve monitor , used  to safeguard the recurrent laryngeal nerves  during  thyroid surgery?

Nerve monitoring: At the present time this is not considered standard of care for routine initial thyroidectomy. Operative technique is more important. Nerve monitoring is an adjunct for primary surgery. In repeat surgery or very complicated cases it would be expected that the surgeon use it. It can be very helpful under those conditions. ...Read more

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Nerve (Definition)

The brain and spinal cord communicates with what is occurring in the internal organs and limbs by nerve fibers where are like electrical wires with insulation (myelin) and the "copper" (axon). Within brain and spinal cord these nerves connect to other nerves via synapses on both axons and dendrites. A nerve can carry information regarding sensations, and ...Read more


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Should all hospitals use/have a instrument-intraoperative nerve monitor , used to safeguard the recurrent laryngeal nerves during thyroid surgery?

Should all hospitals  use/have a instrument-intraoperative nerve monitor , used  to safeguard the recurrent laryngeal nerves  during  thyroid surgery?

No proof: I agree with dr. Wing. Although I use a nerve monitor in all of my thyroid surgeries, there is no proof that it's use decreases the risk of recurrent nerve injury. ...Read more

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Vagus nerve stimulator implant follow up?

Vagus nerve stimulator implant follow up?

Please resubmit: Can you please be more specific with your question? It's not clear if you are asking whether you need a followup, or with whom, or have other questions. Please contact the doctor who implanted the stimulator if you have specific questions about your procedure, and YES, you need followup afterwards. ...Read more

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What's the continuous glucose monitoring system (cgms) benefit?

What's the continuous glucose monitoring system (cgms) benefit?

Excellent: For people who are in intensive Insulin regimens like the Insulin pump, it has been very helpful to fine tune Insulin delivery. For people who are still in injections it has helped me to convince them they need to proceed to the next step, because it shows them how unreliable giving Insulin in bursts through the skin ...Read more

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Nsclc/bones/brain now pressing on l main stem bronchus. 70yr/low levels mag./rbc/protoenetc.Chemo, radio ceased 5 month. Suggestions?

Nsclc/bones/brain now pressing on l main stem bronchus. 70yr/low levels mag./rbc/protoenetc.Chemo, radio ceased 5 month. Suggestions?

Limited: It sounds like all therapeutic options have been used except surgery, and that is clearly not an option. If there are serious breathing issues, a bronchial stent may be an option. Otherwise, this may be the time to think about hospice or comfort care. ...Read more

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What percentage of epilepsy patients are good candidates for vagus nerve stimulation (vns) therapy?

What percentage of epilepsy patients are good candidates for vagus nerve stimulation (vns) therapy?

VNS candidates: must be at least 12 years old (in the US) and have seizures that are known to respond to VNS ( eg. focal seizures, secondarily generalized seizures ) and have failed to achieve adequate seizure control with at least two anticonvulsants (with documented therapeutic levels) or a combination of medications. Typically they are not good epilepsy surgery candidates. In my practice: about 1/3 patients. ...Read more

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Tinel sign(electric shock) on tapping lesion site again developed 2 months after excision of radial nerve schwannoma of arm, does this mean recurrence?

Tinel sign(electric shock) on tapping lesion site again developed 2 months after excision of radial nerve schwannoma of arm, does this mean recurrence?

Not at all: Tinel's sign is indicative of chronicity, and typically is present due to nerve re-innervation and peripheral sprouting, a sign of partial recovery. Hopefully the Schwannoma has been fully excised. ...Read more

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Are APPS for Afib detection with finger on light Abnormal Afib result of ShE 0.81 rMMSD 0.25 although at ER room ECG explained Sinus Tachycardia?

 Are APPS for Afib detection with finger on light Abnormal Afib result of ShE 0.81 rMMSD 0.25 although at ER room ECG explained Sinus Tachycardia?

See cardiologist: if only sinus tachycardia found on ecg this is more definitive , noit a.fib.,but see cardiologist to find out why sinus tachycardia ...Read more

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Is my cardiac output too high? Results from echo:stroke volume 100ml, by 70 bpm, that means cardiac out:7l/min; cardiac index would be 3, 57l/min*m2.

Is my cardiac output too high? Results from echo:stroke volume 100ml, by 70 bpm, that means cardiac out:7l/min; cardiac index would be 3, 57l/min*m2.

Cardiac output: Your measured cardiac output is high for someone at rest, but not at all if you do any exertion or are under stress. Co can reach 15 l/min in healthy men without any difficulty. ...Read more

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Would a TSH lab reading of 4.680 require thyroid medication?

It might,,: This is at the upper limit of normal for most lab reference ranges, so it depends on whether or not you have symptoms of hypothyroidism, and your other thyroid readings like freet4, etc.. It would be smart to see your doctor to get these tests of you haven't and to discuss therapy. Good luck. ...Read more

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120bpm, breathing shallow & heavy, with both arms trembling post 3 BMs in succession. It has since normalized. Vagus nerve stimulation?

120bpm, breathing shallow & heavy, with both arms trembling post 3 BMs in succession. It has since normalized.
Vagus nerve stimulation?

VNS ?: Vagal Nerve Stimulation is used in the management of medically refractory epilepsy and depression. Perhapse you are thinking of Vaso vagal syndrome due to valsalva can occur when straining to have BM. Make sure you are not constipated from the Tylenol (acetaminophen) with codeine. Keep well hydrated. Consider using a stool softener. Be sure to tell your doctor about this. ...Read more

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Tt(2 mos. Ago) due to pap carc. Tumor only 3mm., no rai. Tsh now 33, tgab 70(140% jump post-op), tg <0.2 - why would tgab increase so much post-op?

Tt(2 mos. Ago) due to pap carc. Tumor only 3mm., no rai. Tsh now 33, tgab 70(140% jump post-op), tg <0.2 - why would tgab increase so much post-op?

Go see your doctor: Two issues here. It seems that your hypothyroidism is not well controlled but most importantly your tg ab's is elevated. 25% of patients with thyroid cancer have tgab making follow-up with tg alone insensitive which means you should have other imaging modalities to monitor for disease recurrence. ...Read more

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Is electrical muscle stimulation dangerous for your heart?

Is electrical muscle stimulation dangerous for your heart?

It could be: It could be if you have a pacemaker or electricaldefibrillator , since the muscle stimulation could induce falsely icd firings. ...Read more

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On levothynxine .025 mcg. Normal thyroid. 433.8urine calcium- 1800 ml urine sample.Bd -0.9rt hip/neck. -0.8 lumbar. -0.4 forearm. Meaning? Recommendat

On levothynxine .025 mcg. Normal thyroid. 433.8urine calcium- 1800 ml urine sample.Bd -0.9rt hip/neck. -0.8 lumbar. -0.4 forearm. Meaning? Recommendat

Questions: http://www.jbc.org/content/28/1/237.full.pdf to better understand that urinary calcium levels vary. It is best to do a creatinine clearance and a 24 hour urinary calcium level. Whoever ordered it should review it with you. The thyroid function is ok so you should stay on that dose. The bone density is more accurate in hips and lumbar spine and should be reviewed with your doc. ...Read more

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Tt(2mo. Ago, pap carc.), 3mm tumor, no rai, TSH 33, tgab 70(140% jump post-op), tg <.02. Endo waiting 2mo. To eval. Is onocologist warranted?

Tt(2mo. Ago, pap carc.), 3mm tumor, no rai, TSH 33, tgab 70(140% jump post-op),  tg <.02. Endo waiting 2mo. To eval. Is onocologist warranted?

Wait.: Doesn't sound like you need oncologist as your tumor has been removed - it was really very tiny. 3 mm? A micro carcinoma. How did one find this? I wonder if this was just an incidental finding. Tumors of this size are not uncommon and their clinical significance is not well understood. ...Read more

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Dr. Brendan Stack Jr.
371 doctors shared insights

Thyroidectomy (Definition)

is the surgical removal ...Read more