MedStar Health Blog

Doctors are seeing more patients with thyroid cancer in the last 30 years, as data from the American Cancer Society show. Thyroid cancer is the fastest-growing cancer diagnosis in the United States. The vast majority of these cases are papillary thyroid cancers, which are more common in adults between the ages of 30 and 50 and more common in women than men.

For many years, we’ve handled these cases the same way:

• A growth, or nodule, appears on a patient’s thyroid
• We perform a biopsy, which involves taking a sample of the nodule’s tissue
• If the biopsy confirms that the nodule is cancerous, we recommend surgery, which can involve removing either part or all of the thyroid

But in the last five to 10 years, we’ve found that patients whose thyroid nodules aren’t considered aggressive both clinically and cytologically tend to have a low risk of symptoms or death over long periods of time. As we find more of these small, slow-growing thyroid nodules, researchers have begun to study whether it’s better in these cases to practice active surveillance, also known as watchful waiting.

As of August 2017, there are several clinical studies measuring outcomes for patients with low-risk thyroid cancer who decide to closely monitor their cancer instead of having surgery. But prospective, controlled trials will take years or decades to show their full results. In the meantime, I recommend surgery for the majority of my patients who have low-risk thyroid cancer.

Active surveillance involves regular monitoring of thyroid nodules. Patients with small nodules can come back every three to six months for a thyroid ultrasound, and the doctor can track that nodule’s growth over time. If the nodule has grown at least 20 or 30 percent in six months, the surgeon and patient can re-evaluate whether surgery is a good option. A thyroid fine needle aspiration (FNA) is recommended for thyroid nodules at least about 1-1.5 cm or larger.

A potential reason to wait on surgery is if the patient has other health conditions that could make surgery and recovery more challenging. For example, a patient in their 80s who has heart disease is likely to have more trouble recuperating after thyroid surgery than an otherwise healthy patient in their 30s.

These are valid considerations, and doctors should discuss them with their patients. Though I tend to recommend surgery for my patients with low-risk thyroid cancer (e.g., thyroid nodules larger than 1-1.5 cm and/or that have an FNA suspicious or diagnostic of thyroid cancer it’s a decision both the patient and their doctor should weigh carefully. Make sure to discuss the advantages and disadvantages of surgery, as well as your risks if you decide to wait. Ask about the surgeon’s experience performing this kind of procedure. And don’t be afraid to ask for a second opinion.

When you see the words “plastic surgery,” your first thought probably doesn’t involve the eyes. Or you may think about cosmetic procedures to remove wrinkles or bags under the eyes.

I’m an oculoplastic surgeon, and I specialize in surgery of the area around the eyes. And while there is value to cosmetic procedures in the eye area, that’s not my area of focus, though many oculoplastic surgeons do perform cosmetic procedures.

I’ve encountered a lot of confusion from patients who are curious about how an oculoplastic surgeon could help them. Let’s go through what an oculoplastic surgeon does, what conditions we treat and answers to some of the most common questions patients ask.

What does an oculoplastic surgeon do?

An oculoplastic surgeon is an ophthalmologist, or eye doctor, with specialized training in plastic surgery around the eyes. Oculoplastic surgeons work exclusively with the eyes and the structures in the eye area, including the:

• Eye sockets
• Eyelids
• Tear ducts

Contrast this with a general plastic surgeon, whose experience is much broader because they work with many other parts of the body. Some plastic surgeons have experience with eye-related issues, and are indeed very good at working around the eye, but that may not be enough. Plastic surgeons’ overall training is less eye-focused, and they see fewer patients with eye-related problems.

It’s similar to the difference between a general car mechanic and one who specializes in transmissions. For many jobs, the general mechanic is the better choice. But for difficult jobs involving a transmission, the specialist may be the better option.

When you see an oculoplastic surgeon, you get the advantage of our narrower focus, as well as our greater familiarity with the anatomy and how everything works together in the eye area.

What conditions do oculoplastic surgeons treat?

My practice, like that of many other oculoplastic surgeons, deals with functional surgeries. Functional surgeries of the eye are procedures that improve either a patient’s vision or some other symptom related to a medical condition that affects the eye. Because these are medically necessary procedures, patients’ insurance plans usually cover some or all of the cost.

I personally don’t do many cosmetic procedures, which are primarily related to improving a patient’s appearance.

Some of the many procedures I perform include:

• Blepharoplasty, removal of eyelid lesions, drooping eyelid repair (ptosis repair), malpositioned eyelid repair (entropion or ectropion repair)
• Removal of blind, painful, disfigured eyes and insertion of orbital implants, so that people can obtain a natural-appearing prosthetic “glass eye”
• Surgery to treat lesions/tumors or disorders of the eye socket, such as thyroid eye disease, which can cause bulging of the eye
• Tear duct surgery, such as correcting a blocked tear duct

I also evaluate and treat patients for neurological conditions that affect their vision. This field of medicine is called neuro-ophthalmology. Some of the conditions that affect vision include:

• Bell’s palsy, a weakening or paralysis of one side of the face
• Blepharospasm, an involuntary blinking or twitching of the eyelid
• Cranial nerve disorders, which affect eye movements and can cause double vision
• Optic neuropathies, or diseases of the optic nerve

Related reading: What your eyes can tell you about your health beyond how well you see

Questions and concerns about oculoplastic surgery

The main question patients should ask before any surgery—eye surgery included—is whether the surgeon has experience with the procedure and condition. Ask your surgeon if they’ve treated other patients with your condition before, and if so, what the outcomes were.

There’s also benefit to asking how many of the particular procedure your surgeon has done. The more often a surgeon does a procedure, the more likely they are to be better at it. Your surgeon should be able to share the number of surgeries like yours they’ve done previously and how many of those had good results for their patients.

Pay attention to the surgeon’s responses to your questions. Don’t be afraid to ask for a second opinion if the surgeon doesn’t have experience with your condition, if you don’t feel confident that you’re getting the best possible answers to your questions or if you just think you could benefit from another perspective.

My patients often ask me what they can expect during their surgeries. Most people are nervous about any type of surgery, and surgery around the eyes can be even more intimidating. I perform many of my procedures in the office on an outpatient basis. Patients usually are awake during these procedures, but I give them local anesthesia so they don’t feel pain. After surgery, patients can go home, and their recovery is quick in most cases.

Your eyes are too important to trust to just anyone. An oculoplastic surgeon understands the eye’s intricate details and is specially trained to treat conditions that affect the tissues around this delicate organ.