Should my Thyroid Surgeon do an Ultrasound?

In addition to being a thyroid and parathyroid surgeon, I'm also a dad and husband. When my own family members need to have medical tests, you had better believe that I am 100% checked in to what happens and how they are treated. Especially when it comes to ultrasound- because that's the world that I live in.

Recently, a family member had an ultrasound for a routine checkup (don't worry, not the thyroid!). As I was reviewing the report from the sonogram, it became obvious that the ultrasonographer had reversed the side of the thing that was being followed!!! Fortunately, it wasn't a big deal because we had previously been following this up, but still... terrifying.

As I talked to my family, I realized how grateful I am that I do my own ultrasound on every. Single. Patient. It's easy. It's quick. And that patient relies on me knowing what is going on BEFORE I start the surgery. Yes, I still collaborate with radiologists and read their reports. And yes, I still get CT scans and PET scans or MRIs from time to time... but the ultrasound is the backbone of thyroid and parathyroid surgery. And the fact that a surgeon would cut without confirming what another doctor has reported makes me nervous.

The beauty of having your surgeon ALSO do an ultrasound is that we, the surgeons, also get almost immediate feedback. We make estimates of how bad a tumor will be or where the parathyroid gland will be and then we go right in and do the surgery. And so we get to learn quickly if we were right or wrong. No radiologist gets to do that! We also know exactly where to look on ultrasound, and you feel a significant ownership of the ultrasound if you know that you will be relying on what you see as you go in. In fact, for about half of my cases I will do another ultrasound as the last thing before I start the surgery (depending on what the surgery is for).

I've also worked with great surgeons who don't do an ultrasound before they start surgery. They are still fantastic surgeons, but at least a few times I have watched them struggle to find thing that would have been obvious on an ultrasound- but only if the radiologist knew what a surgeon was specifically looking for.

But why is it REALLY important for a surgeon to do their own ultrasound? Because all of the new therapies, like radiofrequency ablation (RFA), microwave ablation (MWA) and nano pulse (nsPFA) all require that a surgeon not only read an ultrasound, but they actually have to be very experienced with an ultrasound. In other words, if you want your surgeon to know when there are other options that could be used to treat your thyroid condition, your surgeon needs to know how to do them. And that means they need to be doing an ultrasound on you. i