Hernia and 
General Surgeon  
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Zero nerve injury and Zero PoSH are the glass ceiling of endocrine surgery. We are using surgical innovation to reach it

Risks of Thyroid and Parathyroid surgery

Advise from Consultant Surgeon Mr James Kirkby-Bott 

Voice change can occur after any neck operation, not just from nerve injury in thyroid and parathyroid surgery

Voice Change from nerve damage.

Damage to the recurrent laryngeal nerve makes the voice weak and difficult to project. It will also tire quicker than usual so that towards the end of your day it can be harder to speak audibly. In addition to voice change recurrent laryngeal nerve injury can make swallowing feel abnormal and this increases the risk of recurrent chest infection. New research has shown that a recurrent laryngeal nerve injury can reduce life span by up to 10 years through the increased risk of chronic chest infection. By using cIONM we can have reduced this risk to less 0.7% - compared to 1.3% nationally and this risk is falling as more of our cases are performed using cIONM. If both recurrent laryngeal nerves are injured more severe disability can be caused - weaker voice, difficulty swallowing safely and even difficulty breathing requiring a tracheostomy. Bilateral nerve injury can only occur after a total thyroidectomy or bilateral neck exploration for parathyroid disease. Because we use use cIONM we can avoid bilateral injuries by not operating on the second side. Our injury rate is reducing and now down to 0.7%

If you are affected by this complication please try these voice strengthening exercises when you feel ready to help strengthen your voice again

Surgical Hypoparathyroidism - Causing low calcium

This happens because the 4 glands controlling calcium levels in the blood are attached to the thyroid gland and have to be carefully dissected off during thyroidectomy. They are very small. A normal gland is 6x4x2mm in size so their blood supply is very delicate. Normal function of 1 of these 4 glands is enough to maintain normal calcium levels. It is fairly common after total thyroidectomy or completion thyroidectomy for the glands to be bruised and not work normally for a few weeks, 7.5% of my patients go home with temporary supplements in case they need them compared to 16.2% nationally. 

Permanent damage is rare and affects about 1% of patients.

Advice on medication, how to take it and how to maintain calcium levels


This complication is rare but important. It is why we advise some patients having thyroid or parathyroid surgery to stay in hospital the night after surgery in case we need to re-operate urgently. While I have not had to do this in 13 years as a Consultant. The national benchmark is 1 in 500 cases return to theatre for bleeding. 

Click here to see Mr Kirkby-Bott's outcomes reported on national database

Click here for The British Association of Endocrine & Thyroid Surgeons (BAETS) patient information leaflets

All of Mr Kirkby-Bott's outcomes are recorded on a National Database of Endocrine surgery outcomes run by the British Association of Endocrine and Thyroid Surgery (BAETS)

Click here to see Mr Kirkby-Bott's outcomes reported on national database
Parathyroidectomy patient - 60 years old

Patient Feedback

Parathyroidectomy patient - 60 years old
I feel so much better now. I wish all patients with hyperparathyroidism could be diagnosed and operated on as quickly as my experience. It is a dreadful disease that impacts people's bodies and lives in so many negative and frightening ways.

I chose due to his knowledge of hyperparathyroidism and experience of performing parathyroidectomies.

I was pleased with the quick and thorough diagnosis and how smoothly all scans and tests were done. Mr Kirkby-Bott was caring and his secretary was efficient and pleasant. The operation was as I expected and the scar healed well and is fading nicely.