This case takes place in New York and involves a patient who was diagnosed by his otolaryngologist with thyroid cancer. As a result of these findings, the physician performed a thyroidectomy on the patient. However, the physician failed to perform lymphatic mapping of the patient’s neck, nor did he perform an ultrasound in order to ensure that the cancer had not metastasized to surrounding tissues. A few months after the thyroidectomy was performed, the cancer had spread to the patient’s lymph nodes. This required the patient to undergo a number of highly invasive surgeries in order to remove the remaining cancerous tissue, and has substantially reduced the patient’s quality of life and long-term prognosis.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. Have you ever had a patient develop the outcome described in the case?
- 3. Do you believe there may have been a deviation in the standard of care that contributed to this patient's outcome?
Expert Witness Response E-001733
I am a fellowship trained head and neck oncologic surgeon, practicing in an academic setting. Total thyroidectomy with or without central neck dissection is the treatment of choice for the majority of well differentiated thyroid cancers. Lateral neck disease can be present at either initial presentation or present at a later date. In addition to physical exam, ultrasound of the thyroid gland, thyroid bed (central neck) and lateral neck is generally the best initial medical imaging modality to assess the extent of disease and plan the initial surgery. The fact that these studies were not used prior to surgery would indicate a deviation from the standard of care. I routinely perform thyroid surgery for both benign and malignant indications. I have seen patients treated with thyroidectomy develop lateral neck metastasis following initial surgical treatment of the primary tumor in the thyroid.
Expert Witness Response E-000324
I am a board certified otolaryngologist with over 35 years of experience including treatment of thyroid cancers. I have treated numerous patients with thyroid cancer including those requiring neck disection for lymph node metastasis. Based on the information available I feel there potentially may have been a deviation from the standard of care. All patients undergoing surgery for thyroid cancer should have a US and FNA. The US should include the neck nodes, however, if the cancer was less than 1cm some would argue it does not.