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Always tired, sudden weight changes, heart racing for no reason… or a lump on your neck you’ve been ignoring? It might be more than just stress!
In this podcast, Tan Sri Dr Noor Hisham Abdullah breaks down the reality of thyroid disease in Malaysia, from hyperthyroidism and thyroid cancer to surgery, radioactive iodine treatment and why women are more likely to experience thyroid issues.
He also shares how doctors detect thyroid cancer early, what really happens after thyroid surgery and how AI could transform the future of treatment.
#Health #Thyroid #Healthcare #Cancer #Medical #SinarDaily
In this podcast, Tan Sri Dr Noor Hisham Abdullah breaks down the reality of thyroid disease in Malaysia, from hyperthyroidism and thyroid cancer to surgery, radioactive iodine treatment and why women are more likely to experience thyroid issues.
He also shares how doctors detect thyroid cancer early, what really happens after thyroid surgery and how AI could transform the future of treatment.
#Health #Thyroid #Healthcare #Cancer #Medical #SinarDaily
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LifestyleTranscript
00:00Assalamualaikum and welcome back to the Sina Daily Live and Star podcast with me, Dr. Nur Hamjah Zulkifli.
00:06And today we are so honoured to have the man himself, the former Health Director General of Malaysia, Tan Sri
00:13Dr. Nur Hisham bin Abdullah.
00:15Thank you so much Tan Sri for being here.
00:18Thank you for having me.
00:19Okay, Tan Sri, I'm sure he does not, I mean, doesn't need any introduction.
00:24I think all the audience at home has been seeing Tan Sri's face on the TV during the COVID pandemic,
00:31how we managed, Tan Sri and his team managed to curb the COVID pandemic during, in 2020, about six years
00:37ago.
00:37But other than COVID, he's also, he's a consultant of breast and endocrine surgeon.
00:43And that is in his clinical speciality.
00:47And also, he's also active in his administrative work as he is currently the UCSI Spring Hill Nilay Health Group
00:54Chairman.
00:55So he has such a very busy schedule and we are so honoured to have him, that he managed to
01:00squeeze us in his very, very super busy schedule.
01:03So our topic for today is voice, scars and also cancer, the truth about thyroid surgery.
01:10So for many who still don't know what is thyroid, thyroid is actually, it's a gland.
01:15It's very vascular, it's a lot of vessels around it and it lies in front, it's located in front of
01:22your windpipe, which is your trachea.
01:24So we have a model here.
01:26So mainly this is a, this is a normal shape of the trachea, sorry, thyroid.
01:33It looks like a butterfly shape in front of the trachea.
01:37So, so what we're going to talk further during this current discussion is not just about the benign diseases.
01:45We're also going to touch on thyroid cancer as well.
01:48So Tan Sri, thyroid disease is often like, it's being mentioned, it's quite common nowadays.
01:55I mean, I think people are a bit more aware, especially in amongst the women.
02:00Yes, right.
02:01Yeah.
02:01So it's prevalence in amongst the women.
02:03But from a public health perspective, how is the thyroid disease here in Malaysia?
02:09I mean, the incidence in terms of in Malaysia and also globally.
02:12Yeah.
02:13Thyroid cancer is actually very common in Malaysia and more so in Borneo, for example.
02:19One of the reasons why you get the enlargement of thyroid gland is because of iodine deficiency.
02:26And because of that, you know, the gland starts to compensate for the loss of iodine and because, and the
02:35thyroid starts to grow.
02:36Now, thyroid is like two perspectives that you have to look, whether it's a functional issue or growth issue.
02:44Functional, it can be hyper, that means a high hormone production.
02:47Then you get hypothyroidism, whereby high hormone will give you, you know, symptoms like tremor, palpitation, sweating, and etc.
02:57Or low hormone, that means a hypothyroidism.
03:01And it gives you the symptoms of very tired, you know, lethargy, basically you want to sleep all the time.
03:08And, you know, periorbital edema and etc.
03:11All these symptoms of hypothyroidism.
03:14So, it's basically looking into the function, hyper or hypo function.
03:20The gland may be normal in size.
03:23Second is, you know, in terms of growth.
03:25Growth is not related to the function, but it's related to whether it's a benign growth,
03:31it's a non-cancerous growth, or it's associated with a cancerous growth.
03:36So, that is where I think once you have a nodule, and the nodule can be benign or can be
03:44malignant.
03:44Our concern is malignancy.
03:47That means, you know, malignancy means it's not only growth, but it can spread,
03:52either spread to the blood vessel or to the lymphatic system,
03:56and you can spread elsewhere on the body.
03:59For example, to the brain, to the bone, and etc.
04:03So, these are our concerns in terms of the perspective of thyroid, you know,
04:10presentation in terms of hyper functioning or growth.
04:14Whether it's a benign or malignant growth.
04:17Okay, just now we mentioned that the prevalence is more amongst the women.
04:21Exactly.
04:22I mean, yeah.
04:22So, I think the audience would want to know whether, is it genetically, let me like,
04:27breast cancer is more genetics.
04:28That's right.
04:28How about the thyroid cancer?
04:30Now, thyroid, I think if you look into it, younger age group, majority,
04:35most of the time, actually, it will be in women,
04:38because there's actually influence by the hormonal changes,
04:42and you can see that the incidence, the gap between men and women is higher in the women
04:49during the reproductive age, and after the postmenopausal,
04:54then the incidence almost equal, both sides.
04:57But for aggressive cancer, for example, the incidence almost the same,
05:03men and women almost the same.
05:04But the growth in terms of the estrogen affecting, stimulating the thyroid to grow,
05:10so that is also incidence during the reproductive age.
05:14Okay.
05:15So, in terms of, you said that in Malaysia, the thyroid cancer are much more common nowadays.
05:20I mean, how about the presentation to us?
05:22I mean, do they still present, I mean, do they present to us early, in early stages?
05:26So, the presentation can be functional.
05:28That means they present with signs and symptoms of hyper,
05:33or signs and symptoms of hypo, as I explained earlier.
05:37Or they can present with thyroid enlargement.
05:40So, enlargement can be one side, solitary, or it can be both sides, you know,
05:45the left side and the right side, you know, or even in between,
05:50that's from the isthmus, between the right and left side.
05:54So, it's a growth.
05:55So, the growth can be benign, or it can be magnanimous.
05:58It may be a slow-growing tumour, benign-growing tumour.
06:03We call it, the most common, it will be a multi-nodular goiter.
06:07So, and the symptoms of presentation of thyroid enlargement,
06:12mainly, you can, they have neck discomfort,
06:16and also associated with breathlessness,
06:21and a compression to the trachea.
06:23Sometimes, they have snoring during sleep,
06:26and if compression to the esophagus,
06:30they have dysphagia or difficulty in swallowing.
06:33Each time they take a meal, for example,
06:37they need to drink water to push the food down.
06:39So, these are some of the symptoms that they may have in terms of growth.
06:45But, in terms of the hyper-functioning,
06:48then the whole spectrum of hyper-thyroidism,
06:51or the spectrum of hyper-thyroidism,
06:54will be seen in clinical presentation.
06:58Okay.
06:59So, we have actually touched in terms of the clinical presentation,
07:01per se, and the incidence.
07:02So, in the investigations,
07:04normally, we'll start off with the ultrasound of the neck.
07:06So, now, with the emergence of more and more healthcare screenings,
07:11so, I mean, health screenings,
07:13so, they would incorporate everything,
07:14screen their abdomen, screen their neck as well.
07:17So, but what are the suspicious features that,
07:21maybe the audience would want to know,
07:22even the GPs out there,
07:24what are the suspicious features that warrant this,
07:26this is not a normal nodule?
07:28Right.
07:28So, in terms of investigation,
07:30the first investigation that's important is to do a thyroid function test,
07:34to look into whether it's hyper-functioning,
07:36or hyper-functioning.
07:38So, we look into the thyroid simulating hormone.
07:40That is the key.
07:42If it's normal,
07:43then we proceed to look into the enlargement of the thyroid gland.
07:48The most common, I think, clinical presentation,
07:51we will feel the gland,
07:52whether it's moving swallowing, for example,
07:55and then any limb nodes enlargement on each side of the growth.
08:01And then comes investigation.
08:03The most common investigation that we do is ultrasound.
08:05So, ultrasound is a very important tool.
08:08It's just like a stethoscope for the surgeon now,
08:11because we can see the thyroid enlargement
08:14in terms of the characteristic of the growth.
08:19Can it be benign or macklenant?
08:21So, we can use ultrasound to differentiate between a benign or a macklenant growth.
08:27For example, a macklenant seed,
08:29they have limb node enlargement, for example.
08:31And then, you look into the features of the under-ultrasound.
08:36Benign, usually, there's a, you know,
08:39the very well-capsulated, you know.
08:41And in benign, I think, in macklenant,
08:45the vertical is more than the mass vertical size,
08:49is more than the horizontal size.
08:51And there's a halo in between,
08:54in surrounding the benign nodule.
08:57So, sometimes there's a loss of the halo.
09:00And sometimes there's micro-calcification.
09:02You can see specks of calcification that we see.
09:05We call it a samona body.
09:07It can actually reflect in terms of the ultrasound.
09:11You can see it very well.
09:12And we can see a ton of margin of the nodule,
09:15whether it's a smooth margin
09:17or whether there's actually a very blur margin with the intubation.
09:21So, that characteristic can tell us,
09:24suggest to us whether that is actually suspicious of malignancy
09:27or a benign growth.
09:30So, that is the first thing that we do under ultrasound.
09:33Sometimes it's a cyst.
09:34A cyst is actually a hypodense area
09:39with the posterior enhancement.
09:41We can see a cyst.
09:42Normally, it's a cyst, a small cyst.
09:44We leave it alone.
09:45If it's a big cyst,
09:47one or two or three centimetres,
09:49we can put a needle and aspirate the cyst
09:51under ultrasound guidance.
09:53But if it's a mass,
09:55an ultrasound can tell a solid or cystic.
09:57If it's a solid,
09:58then perhaps we need to move on to the next step
10:01is to do a FNAC,
10:03fine needle aspiration for cytology,
10:05getting the cells out.
10:07And then from there,
10:07we can tell whether it's the Magdalene cells or not.
10:11So, it's almost like mandatory after,
10:13I mean, the algorithm would be
10:14after like you mentioned,
10:16the thyroid function test,
10:17clinical examinations,
10:18ultrasound,
10:19and after that, FNAC.
10:20That's right.
10:21I mean, most of the cases,
10:22usually we have to do FNAC, right?
10:24Yes, but also there is actually exact,
10:27I mean, if both glands are involved,
10:29for example,
10:30right side and left side,
10:31eventually you need the surgery.
10:33So then I think sometimes FNAC is only one area,
10:38one nodule only.
10:39So, if multiple nodules are involved,
10:42then you are going to perform a total thyroidectomy,
10:46then I'll move on to suggest the surgery
10:49rather than to go for the FNAC.
10:51Okay, so mainly the FNAC,
10:53we want to see whether it's suspicious
10:55or like prolifer neoplasm.
10:57Then some of the thyroid cancer,
10:59we need to proceed with the neck dissection, right?
11:02That's right, that's right.
11:03Okay, so we are moving on to the surgery
11:06since we have already talked about the initial stages,
11:08how do we get to the diagnosis
11:09and also the signs and symptoms,
11:12the investigations.
11:13So, the most, the biggest fear
11:15when you have to,
11:16when you tell your patients that,
11:17oh, you need to remove your thyroid,
11:19it's either half or you have to,
11:21what we call total thyroidectomy
11:22or you have to remove entire thyroid.
11:24So, their fear would be,
11:26whether, how can I live without my thyroid?
11:29I mean, do I need to take any lifelong medications?
11:32That's right.
11:32And then what are the complications?
11:36So, can you maybe actually share
11:37a little bit of your experiences?
11:39How do you, I mean, approach a patient?
11:42Well, we have to talk to the patient
11:44in terms of why we need to remove
11:46and always say five reasons to remove.
11:50Number one, if the mass is growing progressively,
11:53you know, in the short period of time,
11:56enlarging very much during a short period of time,
11:59then I think it's about time to remove.
12:01The suspicious is, you know,
12:03it's fast growing mass,
12:05then we have to remove it.
12:06Most probably it can be a carcin magnanimous.
12:10Second is the compression symptoms.
12:13If they have compression symptoms,
12:15namely, you know, difficulty in swallowing,
12:19you know, and snoring during at night,
12:21and then, you know, this breathlessness and etc.
12:25So, it's also about time to remove that.
12:28And sometimes they may have hoarseness of voice as well.
12:32And if there's hoarseness of voice,
12:34it's very suspicious that they may have
12:36a malignancy in place.
12:37In fact, I have one patient that presented
12:39just hoarseness of voice.
12:41No swelling.
12:42No swelling at all.
12:43And obviously, when we do the ultrasound,
12:45we can see a lump,
12:47a small lump,
12:48about 1.5 centimetres posteriorly to a thyroid,
12:51compressing the recurrent lenogean nerve.
12:54So, that is also one presentation.
12:57And obviously, the size,
12:59if it's big,
12:59everyone can actually notice
13:02an enlargement of the thyroid gland,
13:04then I think,
13:06cosmetically,
13:06it's about time for the patient to go for surgery.
13:10Okay.
13:11So, those are the five questions
13:12that we need to ask
13:13and then to evaluate
13:14and whether it's indicative.
13:15So, size does matter in this case, right?
13:18That's right.
13:18That's right.
13:19Okay.
13:19Is there any room
13:21for watchful waiting?
13:23I mean,
13:23for the thyroid cancer,
13:24in the microcarcinoma,
13:25so the small ones,
13:26is there any room?
13:27If it's a micro papillary,
13:29for example,
13:30less than one centimetre,
13:31so I think surgery will be enough.
13:34Even hemithiroidectomy
13:35will be enough.
13:36But if it's a multi-nodule goiter
13:39involving both sides,
13:40then obviously,
13:41we will suggest,
13:42we have a compression symptoms,
13:44we will suggest a total thyroidectomy,
13:45meaning to remove
13:47both of the thyroid gland
13:49and then we send the specimen
13:51to the lab
13:51and the lab will confirm
13:5295% of the time
13:54will be a benign growth.
13:56But there will be 5% to 10%.
13:58Sometimes it can be a malignancy
14:01and the most common malignancy
14:03is a papillary thyroid cancer.
14:05So, there's four types of malignancy.
14:08Number one, papillary.
14:10Papillary usually spread to the limb nodes.
14:12So, limb nodes will be enlarged.
14:14That's the first spread
14:16to the cervical nodes.
14:17Level 2, level 3, level 4
14:19or even level 5.
14:22And second is follicular.
14:25Follicular usually spread
14:26through blood vessels.
14:27So, you know.
14:29And the third is medullary.
14:31Medullary,
14:32they have a strong family history
14:34of thyroid cancers and etc.
14:36Sometimes in young population,
14:40you know, C-cell hyperplasia,
14:42for example,
14:42a strong family history
14:43of medullary thyroid cancer.
14:45In children,
14:46we need to screen
14:48for C-cell hyperplasia
14:49before it becomes
14:50medullary thyroid cancer.
14:51And last but not least,
14:53I think the most difficult challenge
14:55until today
14:56is the anaplastic.
14:57Normally,
14:58in the older age group,
14:59more than 60, 70,
15:02you have thyroid swelling,
15:03very progressive enlargement
15:04of the gland
15:05and causing compression symptoms,
15:08difficulty in breathing,
15:09etc.
15:10That's where I think
15:12the anaplastic thyroid cancer
15:14we need to handle
15:15very carefully
15:16in terms of our treatment
15:18needs to free
15:20the trachea
15:21and airway,
15:21trachea or airway
15:23and also the esophagus
15:24from the compression
15:25and invasion.
15:27Okay.
15:28So, basically,
15:28thyroid cancer mainly is,
15:30surgery is number one.
15:31There's no such thing
15:32that we can actually
15:33offer them to,
15:34why don't we monitor
15:34your thyroid first
15:36because since it's
15:37a slow growing,
15:38so, I mean,
15:39surgery is number one.
15:40Yeah.
15:41For benign,
15:42obviously,
15:42we can monitor,
15:44you know,
15:45from close follow-up
15:47but then,
15:47if it's medullary
15:49then the best
15:50is still to remove
15:51unless it is an anaplastic.
15:54Anaplastic,
15:54we have a few options now.
15:56There's new adjuvant
15:57chemotherapy to be given
15:59and the response,
16:01I just recently
16:03looked into the latest
16:04using latest chemo,
16:06subalternib and etc.
16:08Then, probably,
16:10the response is
16:11life,
16:12you know,
16:13survival is about
16:15one year
16:16rather than we proceed
16:18jump into surgery.
16:19Okay.
16:20So, subsequently,
16:21normally,
16:22the patients
16:22after they have done
16:23their surgery,
16:24especially in thyroid cancer,
16:25I mean,
16:26benign,
16:26of course,
16:26we don't talk about
16:27radioactive iodine.
16:28So, if it's a cancer,
16:30I mean,
16:31the HP,
16:32the histopathology
16:32examination shows,
16:34I mean,
16:34reported as it's a cancer.
16:36So, when we talk about
16:37radioactive iodine
16:38because when we
16:38counsel the patient,
16:39of course,
16:39you have to tell all this
16:40in advance.
16:42When we say
16:43radioactive iodine,
16:44it sounds very,
16:45very scary.
16:45Yeah.
16:46So, the moment
16:47the patient hear
16:48the word radioactive,
16:49they immediately,
16:50they're going to be panicked.
16:51So, what is actually
16:52radioactive iodine therapy?
16:54And when,
16:55does all cancer cases
16:58need to go through
16:59this RAI?
16:59All cancers need
17:01radioactive iodine
17:02ablation
17:03because we know
17:04thyroid,
17:05they'll take up
17:06iodine.
17:07That's the function
17:08of the thyroid,
17:09taking up iodine
17:10to form
17:10thyroid hormone.
17:13But,
17:15because they have
17:16the affinity
17:16to take up
17:17iodine,
17:18so,
17:18we provide
17:20radioactive iodine.
17:22and once we have
17:23done the surgery
17:24and most of,
17:2598% of the
17:27iodine
17:28will be
17:28concentrated
17:29in the thyroid.
17:30Once we have
17:30removed the thyroid
17:31and the remnants
17:32of the thyroid cell
17:34or even cancer cell
17:35will take up
17:36the radioactive iodine
17:37and then,
17:38over a period
17:39of a few months,
17:40the thyroid cell
17:41will be ablated
17:41and we kill
17:43the thyroid cells.
17:44So,
17:44that is one treatment
17:46after surgery
17:48that we can offer
17:48to our patient
17:50but not necessarily
17:51all patient
17:52like a micropupillary
17:54thyroid cancer
17:54less than one centimeter
17:55normally,
17:57we do not
17:57in a subject
17:58of a patient
17:59for iodine
18:01ablation
18:01and then,
18:02furthermore,
18:03in thyroid,
18:04very rarely
18:05we use
18:06chemotherapy
18:07or radiotherapy
18:08except for
18:09anaplastic
18:10thyroid cancer
18:12then,
18:13you know,
18:13there's a role
18:14of chemotherapy
18:15as well as
18:16radiotherapy
18:17if there's
18:18no iodine
18:19uptake
18:19so if there's
18:20no iodine
18:21uptake
18:21meaning
18:22the cancer
18:23is not
18:23taking up
18:25the radioactive iodine
18:26and then,
18:26you cannot use
18:27radioactive iodine
18:28to ablate
18:29the cancer
18:29then,
18:30we need to
18:31look into
18:32other option
18:32perhaps a
18:33radiotherapy
18:34and etc.
18:35Okay,
18:36we have a question
18:37just from
18:38our previous guest
18:39who was asking
18:39about radiofrequency
18:41ablation.
18:42Is it
18:42commonly practiced?
18:43Well,
18:44there are many
18:46modalities
18:46been used
18:48to manage
18:49thyroid
18:50nodule
18:51for example.
18:52Many years ago,
18:54I think they
18:54used alcohol
18:55inject into
18:56the thyroid
18:57you know,
18:57use
18:59substance now
19:00radiofrequency
19:01and etc.
19:03For thyroid
19:03benign nodule,
19:04I think you
19:05can use
19:05small nodule
19:07perhaps there's
19:08a role
19:09but when
19:10the best
19:11is still
19:11to remove
19:12the whole
19:13capsulated
19:14thyroid
19:14nodule
19:15and send
19:15to the lab.
19:16So,
19:16because if
19:17there is
19:17a malignancy
19:18then,
19:19our fear
19:19is that
19:20you may
19:21not be able
19:22to ablate
19:22the whole
19:23entire
19:23gland.
19:25So,
19:25there is
19:25issues and
19:26challenges
19:26with regards
19:27to the
19:27long-term
19:28follow-up
19:28following
19:29the radio
19:30frequency
19:30or radio
19:32alcohol
19:33injection
19:33etc.
19:34Okay,
19:35so especially
19:35in those
19:36suspicious
19:36lesions,
19:37so it's
19:37better for
19:38us to
19:38do,
19:38I mean,
19:39if it's
19:39only half
19:40a thyroid,
19:40you can
19:41do a
19:41diagnostic
19:41hemothyroidotimate
19:42and remove
19:42NC under
19:43the microscope.
19:45When you
19:45talk about
19:46RAI,
19:47radioactive
19:47idin,
19:48the one
19:49that post
19:49surgery,
19:50some patients
19:51they still
19:52have this
19:52misconception,
19:53I mean,
19:53like when
19:53you take
19:53this RAI,
19:54you need
19:55to be
19:55isolated,
19:56you have
19:56to live,
19:57you know,
19:57like underground,
19:57I mean,
19:58those days
19:58they say
19:59they need
19:59to be
19:59isolated,
19:59cannot be
20:00with their
20:00kids,
20:01so how
20:02do we
20:02go about
20:02that?
20:03I mean,
20:03it's still
20:03like old
20:04days?
20:05I think
20:05we still
20:05advise our
20:06patient,
20:06you know,
20:07in terms
20:07of which
20:08group of
20:08a patient,
20:09if for
20:10example,
20:12in hyperthyroidism,
20:13sometimes we
20:14also advise
20:15them to go
20:16for radioactive
20:16idin instead
20:18of surgery,
20:19but the
20:19dosage that
20:21we use for
20:21radioactive idin
20:22is very low,
20:23maybe 15
20:24to 20
20:26MCG.
20:27So,
20:28but in
20:30terms of
20:30radioactive
20:31ablation,
20:33normally we
20:33use about
20:3380 to
20:34100,
20:35and before
20:36we use
20:36the radioactive
20:37idin
20:38ablation,
20:39we always
20:39advise the
20:40patient some
20:42of the
20:42side effect,
20:43because it's
20:44not only
20:44thyroid gland
20:45that's going
20:45or the
20:46remnants of
20:47thyroid gland
20:47is going to
20:48absorb the
20:49radioactive
20:49idin,
20:50sometimes
20:50slavery gland
20:51also will
20:52absorb little
20:53of radioactive
20:54idin,
20:55and because
20:55subsequently
20:56patient have
20:57a dry mouth
20:58and etc.,
20:58so we need
20:59to encourage
21:00them to
21:01take
21:02sour
21:02plum and
21:02etc.,
21:03to still
21:03make the
21:04salivary gland,
21:05and obviously
21:06if you are
21:06giving 80
21:07to 100
21:09mercury,
21:09then perhaps
21:10we need
21:11to isolate
21:12the patient
21:12because they
21:13are ready
21:14thing,
21:14and more
21:15so,
21:16during
21:17ready thing,
21:18we do not
21:18want them
21:18to be
21:19close to
21:20the children
21:21because they
21:22are growing,
21:23so we
21:23protect them,
21:24and then
21:25we confine
21:25them in
21:26the room,
21:26maybe within
21:2948 hours
21:29to 72
21:30hours to
21:31look into
21:31their
21:32radiation,
21:33the half-life,
21:34and then
21:34once within
21:35the acceptable
21:36limit,
21:37then only
21:37we can
21:37discharge
21:38them.
21:38Even when
21:39we discharge
21:39them,
21:40you always
21:40tell them
21:41to stay
21:41away from
21:41children
21:42because they
21:43are growing,
21:43so avoid
21:44radiation,
21:45for example,
21:46for at least
21:46two or
21:47three weeks,
21:47so this
21:48is some
21:48of the
21:49advice that
21:49we have
21:50for our
21:50patient.
21:50Okay,
21:52so we
21:52still follow
21:53all these
21:53advices like
21:54has been
21:54mentioned,
21:55and I'm
21:55sure that
21:56they will
21:56emphasize
21:57this before
21:58a patient
21:58undergo the
21:59radioactive
22:00iodine or
22:01ablation.
22:02So when
22:03we talk about
22:03surgery,
22:04so we're
22:04going back
22:05a little bit
22:05to the
22:05surgery,
22:06the most
22:07common
22:07questions
22:08other than
22:09this RAI,
22:10and then the
22:10next question
22:11they will
22:11ask,
22:11will I
22:12lose my
22:13voice,
22:13or what
22:14will happen,
22:15can you
22:15tell me
22:16about the
22:16complications?
22:17So these
22:18are the
22:18fear and
22:18also the
22:19worries of
22:20our
22:20patients.
22:21So how
22:22do we,
22:23in our
22:23current era,
22:24how do we
22:24avoid the
22:25injury to
22:26the nerves,
22:27and what
22:28are the
22:28incidents
22:28actually?
22:29Yeah,
22:30incidents
22:30depends on
22:31the surgeon.
22:31I think
22:32the training
22:33is important.
22:34I think
22:34those days,
22:36Prelo has
22:37one mention,
22:37when the
22:38nerve is
22:38seen,
22:39the nerve
22:39is injured.
22:40This is
22:40in fact a
22:41statement
22:42made more
22:44than 100
22:44years ago.
22:45But now I
22:46think
22:47technique has
22:48changed.
22:49Those days,
22:49100 years
22:50ago,
22:51100 people
22:51go for
22:52surgery,
22:5240 will
22:53die from
22:53bleeding.
22:54You know,
22:55die.
22:55I mean,
22:56now we
22:56don't,
22:58you know,
22:59we don't see
23:00any cases
23:01of death
23:02after
23:03tyrodectomy.
23:04Very rarely,
23:05but in my
23:07life,
23:08I mean,
23:08my lifetime
23:09in terms of
23:10as a surgeon,
23:11I don't think
23:12I've seen
23:12any death.
23:13but more
23:15importantly is
23:15that,
23:16you know,
23:17we need to
23:18basically be
23:19trained,
23:20well trained
23:20to do the
23:22surgery.
23:23And now I
23:23think if you
23:24compare 100
23:25years ago,
23:2640% of them
23:27would die.
23:28And when
23:28Korker actually
23:29introduced the
23:30technique,
23:30a good
23:31technique,
23:31he won the
23:33Nobel Prize.
23:33That's the only
23:34time a surgeon
23:35won a Nobel
23:36Prize,
23:36whereby
23:37reducing the
23:38mortality from
23:3940%
23:40right down to
23:41less than
23:4110%.
23:42So now I
23:43think mortality
23:43is very low.
23:44More important
23:45is the
23:46technique,
23:47technique of
23:47surgery.
23:48Now I
23:49think
23:49tyroid surgery,
23:51hemityrodectomy
23:51for example,
23:52can be done
23:53bloodless,
23:54you know,
23:54bleeding probably
23:55less than
23:565 mils or
23:5710 mils,
23:57you know,
23:58even one gauze
23:58cannot be soaked
24:00actually during
24:01the operation.
24:02Identifying
24:03the external
24:04laryngeal nerve,
24:05you know,
24:05you take
24:06a technique
24:07of identifying
24:08the cricothyroid
24:09space,
24:10or we call it
24:10space of
24:11rift,
24:12and then
24:12classification
24:13of the
24:14external
24:14laryngeal nerve,
24:15individual
24:16ligation of
24:17the blood
24:18vessel,
24:18superior thyroid
24:19artery,
24:19for example,
24:20anterior and
24:21posterior,
24:21then when
24:22we dislocate
24:23the gland,
24:23we must
24:24identify the
24:25recurrent
24:25laryngeal nerve
24:26because that's
24:27the nerve
24:28to your
24:29voice box,
24:29so you
24:30need to
24:31protect.
24:32So this
24:32is again,
24:33there are
24:34variation in
24:35terms of
24:35the nerve,
24:36anterior
24:37branch,
24:37you know,
24:38it can be
24:39posterior
24:40branch or
24:41lateral
24:41branch as
24:42well.
24:43Sometimes
24:43there are
24:44two branches
24:44or three
24:45branches,
24:45so all
24:46this needs
24:47to be
24:48trained in
24:49terms of
24:49the technique
24:50of doing
24:50the operation
24:51right,
24:52identifying the
24:53nerve first,
24:53and also
24:54identifying the
24:55parathyroid
24:56glands because
24:56otherwise you
24:58may have
25:01hypokalcemia
25:01after the
25:02surgery for
25:03example,
25:03so very
25:04important to
25:05identify and
25:06preserve the
25:07gland,
25:07but sometimes
25:08the blood
25:09vessel is
25:10affected and
25:11you have no
25:11choice to
25:12remove the
25:12parathyroid
25:13gland and
25:14then you
25:14need to do
25:14some
25:15auto-transplantation
25:16to the
25:16muscle.
25:17Right,
25:17because when
25:18I met
25:18Tan Sri,
25:19I think early
25:20part of
25:20April,
25:21I mean I
25:22was being
25:22told that
25:22Tan Sri's
25:23technique is
25:25not more
25:26than one
25:26gosso,
25:26not even
25:27one gosso.
25:28So,
25:29so that
25:30there's an
25:30important thing,
25:31important key
25:32point for
25:32the surgeons
25:33out there that
25:34technique is
25:35very,
25:35very important.
25:37In regards
25:38of the
25:38recurrent
25:38laryngeal
25:39nerve,
25:39now we
25:40also have
25:40a new
25:41technique,
25:41not a new
25:41technique,
25:42a new
25:42adjunct,
25:43I would say,
25:43the IONM,
25:44intraoperative
25:44nerve monitoring.
25:45In your
25:46practice,
25:47do you
25:47routinely use
25:48this IONM?
25:49I don't
25:49use routinely.
25:50I think we
25:50started way
25:51back 20 years
25:52ago,
25:52we use
25:54nerve monitoring
25:54for external
25:55laryngeal nerve
25:56to identify
25:57the nerve,
25:58and then
25:58once you've
25:59seen the
25:59nerve,
25:59it stimulate
26:00the nerve,
26:00and then
26:01you can see
26:01contraction
26:02of
26:02critero
26:02thyroid muscle.
26:03The point
26:04I'm trying
26:04to make
26:05is that
26:05for you
26:06to use
26:07a nerve
26:07simulator,
26:08you must
26:09be able
26:09to identify
26:10the nerve
26:11first.
26:11Once you
26:12identify
26:12the nerve,
26:13then only
26:13you can
26:14stimulate
26:14the nerve.
26:15If you
26:15are not
26:16able,
26:16or you
26:16don't have
26:17the skill
26:17to identify
26:18the nerve,
26:19nerve simulator
26:19would not
26:20be helpful.
26:22Once you
26:23identify the
26:24nerve,
26:24you know
26:24very sure
26:25it's
26:25the nerve,
26:25you can
26:25protect
26:26the nerve,
26:26and you
26:27can use
26:28a nerve
26:28simulator
26:28definitely
26:29to confirm
26:30it's not
26:31injured,
26:32etc.
26:34In terms
26:35of the
26:35other
26:37complication
26:37side
26:37effects
26:38is
26:38if they
26:39remove
26:40the
26:40entire
26:40thyroid,
26:40they
26:40have
26:41to
26:41be
26:41on
26:41long
26:41term
26:42L-thyroxine
26:42medication.
26:44Again,
26:45one of
26:45our
26:45guests
26:46has been
26:47asking
26:47that
26:47her main
26:48concern
26:48that
26:49she
26:49has
26:49to
26:49be
26:50on
26:50lifelong
26:51thyroxine.
26:52Is there
26:53a role
26:53of preserving
26:54little bit
26:55of the
26:55thyroid?
26:55If it's
26:56suspicious,
26:57can we?
26:57In those
26:58days,
26:58for example,
26:59in
26:59hypothyroidism,
27:00we don't
27:00remove the
27:01entire
27:01gland.
27:01We do
27:02a
27:02subtotal
27:02tyrodectomy.
27:03So,
27:04in the
27:04hope that
27:05the
27:05remnants
27:06of the
27:06gland
27:06will
27:08produce
27:08enough
27:08hormone
27:09for
27:09the
27:09body.
27:10But
27:10over
27:10the
27:11years,
27:11the
27:11gland
27:12will
27:12enlarge
27:13again,
27:13and
27:14then
27:14you
27:14need
27:14a
27:14second
27:15operation.
27:16For
27:16example,
27:17then
27:17the
27:17second
27:17operation
27:18is
27:18much
27:18more
27:18difficult.
27:19So,
27:21now,
27:21I
27:21think
27:22we
27:22have
27:22moved
27:23on
27:23to
27:23do
27:23a
27:23total
27:24tyrodectomy
27:25rather
27:25than
27:25a
27:25subtotal
27:27tyrodectomy
27:27for
27:31hyper-functioning
27:32gland.
27:32So,
27:33I
27:33think
27:34if
27:35in
27:35the
27:35thyroid
27:36cancer,
27:36for
27:36example,
27:37leaving
27:39the
27:39gland
27:40behind
27:40is
27:41sometimes
27:41a
27:42very
27:42futile
27:42operation
27:43because
27:44sometimes
27:44the
27:45gland
27:45leaving
27:45behind
27:46the
27:46posterior
27:46component
27:47that's
27:47where
27:47it
27:48gives,
27:49I mean,
27:49it
27:50causes
27:50the
27:50compression
27:51to
27:51the
27:52trachea
27:52and
27:52even
27:53to
27:53the
27:53esophagus.
27:54This
27:55is
27:55where
27:55we
27:55call
27:55the
27:56Zucca
27:56Candle
27:56Tubercle
27:57at
27:57the
27:57mid
27:57point
27:58of
27:58the
27:58posterior
28:00side
28:01gland.
28:01You
28:01can
28:01see
28:02the
28:02enlargement
28:03of
28:03the
28:03Zucca
28:04Candle
28:04Tubercle
28:05and
28:05embryologically
28:07I
28:07think
28:07it's
28:08different
28:08from
28:09the
28:09component
28:09of
28:09thyroid
28:10gland.
28:10So,
28:11sometimes
28:11it's
28:11important
28:12to
28:12do
28:12a
28:14completeness
28:14of
28:15surgery.
28:16And
28:16one
28:17important
28:18surgery
28:19for
28:20medlenancy
28:21is
28:21a
28:21complete
28:22removal.
28:23If
28:24you
28:24were
28:24to
28:24look
28:24into
28:25the
28:25prognostic
28:26scoring
28:26system
28:27MECI
28:27score
28:27MECI
28:28score
28:29look at
28:29metastasis
28:30age
28:31and
28:31C
28:31is
28:31the
28:32completeness
28:32of
28:33surgery
28:33and
28:34then
28:34I
28:34is
28:35the
28:35invasion
28:35and
28:36S
28:36is
28:36actually
28:36the
28:37size
28:37of
28:37tumour.
28:37So
28:38completeness
28:39of
28:39surgery
28:39is
28:39important
28:41embryologically
28:41that
28:42means
28:42we
28:42are
28:42not
28:42only
28:43looking
28:43at
28:43completeness
28:44from
28:44the
28:44point
28:45of
28:45view
28:45of
28:46the
28:46normal
28:46thyroid
28:47but
28:47also
28:47embryologically
28:48meaning
28:49to
28:49remove
28:50the
28:50zucca
28:51candle
28:51tubercle
28:51as
28:51well.
28:52Okay
28:53so
28:53I
28:53mean
28:54having
28:55said
28:55that
28:55mainly
28:56it's
28:57better
28:57to
28:57just
28:57not
28:58to
28:58leave
28:58any
28:59parts
28:59of
28:59the
28:59thyroid
29:00behind
29:00because
29:00even
29:01if
29:01it's
29:01a
29:01benign
29:02condition
29:02it
29:02will
29:03grow
29:03back
29:03again
29:03if
29:04it's
29:04a
29:04cancer
29:04that
29:04is
29:04where
29:05it
29:05might
29:06harbour
29:06the
29:07main
29:07bulk
29:07of
29:07the
29:08tumour
29:08and
29:08it
29:08will
29:08grow
29:08and
29:09compress
29:09And
29:09once
29:10you
29:10leave
29:10behind
29:10you
29:11cannot
29:11use
29:11radioactive
29:12iodine
29:12in terms
29:13of
29:13ablation
29:14because
29:14all the
29:15radioactive
29:16iodine
29:16will be
29:17concentrated
29:17in
29:18the area
29:20that's
29:20left
29:20behind
29:21Okay
29:22just
29:22Tan
29:23did
29:23mention
29:23regarding
29:24the
29:24caucous
29:24I mean
29:25like
29:25he won
29:27the
29:27Nobel
29:27Prize
29:27and
29:28then
29:28also
29:28the
29:28incision
29:29and
29:29the
29:29collar
29:29incision
29:29also
29:30was
29:30made
29:30by
29:31his
29:32name
29:32on
29:32his
29:32name
29:32caucous
29:33incision
29:33which
29:33is
29:34about
29:34two
29:35finger
29:35breadth
29:35above
29:35your
29:36sternal
29:36notch
29:37right
29:37that
29:38is
29:38the
29:39we
29:39have
29:39been
29:41a junior
29:41surgeon
29:42that's
29:42what
29:42we've
29:43been
29:43trained
29:43but
29:44now
29:44with
29:46other
29:48organs
29:48we have
29:49seen
29:49the
29:50laparoscopy
29:51the
29:51minimally
29:51invasive
29:52and
29:52robotic
29:54so
29:56the
29:56next
29:57future
29:58of
29:58thyroid
29:59surgery
29:59would
29:59it
29:59still
30:00be
30:00the
30:00caucous
30:00incision
30:01I mean
30:01I have
30:02actually
30:02modified
30:02from
30:03the
30:03caucous
30:03incision
30:04to
30:04spinal
30:04breath
30:05now
30:05I
30:05follow
30:06the
30:06skin
30:06crease
30:06incision
30:07right
30:07so
30:08you
30:08look
30:08at
30:08the
30:08skin
30:09crease
30:09and
30:10then
30:10from
30:11middle
30:11border
30:12of
30:12the
30:12steloconial
30:13mastoid
30:13to
30:13middle
30:13border
30:14steloconial
30:14mastoid
30:14so
30:15once
30:16it heals
30:17you cannot
30:18even see
30:18the scar
30:18so
30:19regardless
30:20maybe
30:20sometimes
30:21the
30:21skin
30:21crease
30:21is
30:22higher
30:22or
30:23lower
30:23so
30:23depending
30:24on
30:24the
30:24skin
30:24crease
30:24rather
30:25than
30:25two
30:25finger
30:26breath
30:26and
30:27obviously
30:27many
30:27techniques
30:28can be
30:28done
30:28in terms
30:29of
30:29intraoral
30:30in terms
30:31of
30:32endoscopic
30:33or
30:33surgery
30:34and etc
30:35but
30:36the
30:36simple
30:36operation
30:37is still
30:37it can
30:38be done
30:38there's
30:38no doubt
30:39about that
30:39but
30:40question
30:40is
30:40should
30:41we
30:41do
30:41it
30:41in terms
30:41of
30:42the
30:42cost
30:43simple
30:44operation
30:44makes
30:44difficult
30:45I would
30:45say
30:47tyrant
30:47operation
30:48normally
30:48patient
30:49comes in
30:49the same
30:49day
30:50you do
30:50the
30:50operation
30:50tomorrow
30:51with
30:51discharge
30:51and the
30:52operation
30:52takes
30:53about
30:53one
30:53hour
30:54or
30:54less
30:54than
30:54one
30:55hour
30:55but
30:56with
30:56this
30:56technique
30:57cost
30:57will
30:57escalate
30:58as well
30:59as
30:59prolong
31:00the
31:00surgery
31:01and
31:02sometimes
31:02discharge
31:02will be
31:03longer
31:03I think
31:04we have
31:05to look
31:05into
31:05high
31:05impact
31:06good
31:06outcome
31:06at
31:07reasonable
31:07cost
31:07it
31:08can be
31:08done
31:08no doubt
31:09about that
31:09but
31:10whether
31:10it should
31:10be done
31:11at the
31:12regular
31:12in terms
31:13of
31:14in our
31:16setup
31:16is left
31:17to the
31:18surgeon
31:18to make
31:19the decision
31:20in terms
31:20of high
31:21impact
31:21good
31:21outcome
31:22at
31:22reasonable
31:22cost
31:23okay
31:23so
31:23from
31:24currently
31:25that
31:25you're
31:25practicing
31:25you're
31:26still
31:26practicing
31:26the
31:27normal
31:28open
31:28surgery
31:29rather than
31:29all this
31:2920 years
31:30ago
31:30I think
31:31many
31:31surgeons
31:32from
31:32Japan
31:33and
31:33Korea
31:34they
31:34were
31:34doing
31:34endoscopic
31:35approach
31:36or
31:36remote
31:37thyroid
31:37surgery
31:38I was
31:38doing
31:39thyroid
31:39on the
31:39local
31:40right
31:40so
31:41in
31:42thyroid
31:42on the
31:42local
31:42you know
31:43you know
31:44how to
31:44block
31:44the
31:47nerve
31:48and you
31:49can actually
31:49proceed to
31:49do the
31:50surgery
31:50and
31:51cost
31:51effective
31:52so
31:52I
31:52looked
31:52into
31:53high
31:53impact
31:53good
31:54outcome
31:54and
31:54reasonable
31:55cost
31:55for
31:56us
31:56to
31:56adapt
31:57the
31:58good
31:58technique
31:58obviously
31:59there's
32:00no
32:00doubt
32:00you
32:00can
32:00do
32:01using
32:01remote
32:02surgery
32:03there's
32:03no doubt
32:04about that
32:04but you
32:05also
32:05create
32:05scars
32:06elsewhere
32:06not
32:07in your
32:08neck
32:09on your
32:10neck
32:10but
32:10elsewhere
32:11in your
32:11body
32:11okay
32:12okay
32:13so in
32:14Malaysia
32:15just to
32:16educate
32:17the
32:17viewers
32:18we do
32:19have all
32:19these other
32:20techniques
32:20I mean
32:21like
32:21robotic
32:21I mean
32:22here in
32:23Klang Valley
32:23itself
32:23but
32:24Tanshri
32:25is
32:26still using
32:27the
32:28I mean
32:28I wouldn't
32:29say the
32:29old-fashioned
32:30way
32:30it's a
32:30conventional
32:31but it
32:31is like
32:32he said
32:32it's still
32:33having good
32:34outcome
32:34okay
32:35for high
32:35impact
32:35and good
32:36outcome
32:37so what
32:38do you
32:38think
32:38what would
32:40you say
32:40for the
32:40future
32:41in terms
32:41of
32:42endocrine
32:42I mean
32:42not in
32:43terms of
32:43surgical
32:43technique
32:44maybe AI
32:45in terms
32:46of molecular
32:46diagnostic
32:47would it
32:47are we
32:48going
32:48towards
32:48that
32:49direction
32:49AI
32:50I think
32:50in all
32:51our
32:51areas
32:51of
32:51practice
32:52in
32:52medicine
32:53going to
32:53change
32:54the way
32:54we
32:55practice
32:55medicine
32:56from the
32:57way we
32:57run our
32:58consultation
32:59you know
33:00you don't
33:00need to
33:00type
33:01the
33:01computer
33:01anymore
33:02just talk
33:02to the
33:03patient
33:03and then
33:03AI will
33:04summarize
33:05everything
33:05and then
33:06also
33:06give
33:09advice
33:09in terms
33:10of what
33:10to do
33:11in terms
33:11of
33:11investigation
33:12and give
33:13you
33:13a
33:14differential
33:15diagnosis
33:16for example
33:17and AI
33:18also will
33:18play a
33:19role
33:20in ultrasound
33:21because
33:21the
33:21normal
33:22AI
33:23can be
33:23used
33:23to
33:23diagnose
33:24this
33:24is
33:24my
33:25leniency
33:25or this
33:26is
33:26not
33:26and
33:27also
33:27AI
33:27I think
33:29it will
33:29come
33:30a day
33:31that
33:31even
33:31to
33:32read
33:32the
33:32slides
33:33FNHC
33:34reports
33:34and
33:34AI
33:35can
33:36help
33:36to
33:37read
33:37that
33:37report
33:37once
33:38we
33:38have
33:38stained
33:39the
33:39slides
33:40and
33:40do
33:40FNHC
33:41and stained
33:41it
33:41and then
33:42AI
33:42can
33:42do
33:43the
33:43reading
33:43so
33:44I
33:44think
33:44AI
33:45is
33:45going
33:45to
33:45play
33:46a
33:46big
33:46role
33:46and
33:47robotic
33:48surgery
33:48is
33:48still
33:49coming
33:49to
33:49play
33:49in
33:50terms
33:50of
33:50thyroid
33:51surgery
33:52and
33:52etc
33:52but
33:55we need
33:56to see
33:56how best
33:57it can
33:57improve
33:58further
33:58in
33:59time
33:59to
33:59come
34:00and
34:00always
34:01in
34:01surgery
34:02we
34:02want
34:02to
34:02know
34:02how
34:03can
34:03we
34:03do
34:03things
34:03better
34:04faster
34:04cheaper
34:05smarter
34:06and
34:07most
34:07important
34:07safer
34:08high
34:09impact
34:09good
34:09outcome
34:10at
34:10a
34:10reasonable
34:11cost
34:11practicality
34:12surgeons
34:13are very
34:13practical
34:14people
34:14you know
34:15sometimes
34:15we need
34:16to
34:16look
34:16into
34:17all
34:17this
34:17angle
34:18before
34:18we
34:18commit
34:19to
34:19use
34:19a
34:20technique
34:20for
34:21our
34:21patient
34:21because
34:22someone
34:22is
34:23paying
34:23not
34:23the
34:24patient
34:24or
34:24insurance
34:25company
34:25if
34:26we
34:26continue
34:27to
34:27use
34:27robotic
34:28for
34:28example
34:29it
34:29can
34:29be
34:29done
34:30there's
34:30no
34:30doubt
34:30but
34:31the
34:31cost
34:31will
34:32escalate
34:33and
34:33insurance
34:34company
34:34will
34:35actually
34:35increase
34:36the
34:36premium
34:36and
34:37etc
34:37so
34:38I
34:38think
34:38these
34:38are
34:38the
34:38challenges
34:39that
34:39we
34:39face
34:40how
34:40do
34:40we
34:40strike
34:41the
34:41balance
34:41between
34:42technology
34:42and
34:43the
34:43reasonable
34:44technology
34:44for us
34:45to
34:45adapt
34:45but
34:46more
34:46important
34:47is
34:47the
34:48safety
34:49of
34:49that
34:49procedure
34:50yeah
34:50because
34:51like
34:51no
34:51point
34:51of you
34:52going
34:52to
34:52all
34:52this
34:53high
34:53technology
34:53and
34:54then
34:54at the
34:54end
34:54of the
34:55day
34:55the
34:55patient
34:55will
34:56I
34:56mean
34:56not
34:56bear
34:56the
34:57cost
34:57in
34:57terms
34:57of
34:57the
34:58ringgit
34:58but
34:58it's
34:59the
34:59bare
34:59cost
34:59of
34:59the
34:59complications
35:00and
35:00also
35:01the
35:01side
35:02effects
35:02okay
35:04okay
35:05this is
35:05something
35:05not
35:06really
35:06related
35:06to
35:07thyroid
35:07but
35:08it's
35:08about
35:09mainly
35:09for
35:10the
35:10future
35:11surgeons
35:11out
35:11there
35:13last
35:13I
35:14mean
35:14in
35:14April
35:14I
35:14did
35:14actually
35:15met
35:15Tansri
35:16and
35:16this
35:16is
35:16because
35:17I
35:17went
35:17through
35:18on
35:18online
35:18looking
35:19into
35:19the
35:22subspecialty
35:22of
35:23breast
35:23and
35:23endocrine
35:24training
35:24and
35:25USSI
35:26healthcare
35:26is now
35:27developing
35:27fellowship
35:28pathways
35:28I
35:29understand
35:29about
35:29that
35:30in
35:30breast
35:30and
35:31endocrine
35:31surgery
35:31what
35:32is
35:32the
35:32long-term
35:32vision
35:33behind
35:33these
35:33programs
35:34is it
35:35like
35:35equivalent
35:36to
35:36the
35:36conventional
35:38the
35:38three
35:38years
35:39subspecialty
35:40training
35:40yeah
35:40it's
35:41still
35:41new
35:41for
35:41UCSI
35:42to
35:43excel
35:43in
35:44breast
35:44and
35:44endocrine
35:44surgery
35:45so
35:45our
35:46bread
35:47and
35:47butter
35:47is
35:47mainly
35:48thyroid
35:48so
35:49we
35:49are
35:50beginning
35:50to
35:51accept
35:51patients
35:52for
35:53renal
35:53hypopir
35:54thyroid
35:54as
35:54well
35:54as
35:55primary
35:55hypopir
35:56thyroid
35:56and
35:57last
35:58week
35:59I
35:59started
36:00receiving
36:01patient
36:01for
36:03pheochromocytoma
36:03so adrenal
36:04surgery
36:05will be
36:05coming into
36:06play
36:06and
36:07adrenal
36:07surgery
36:08mainly
36:08we use
36:09posterior
36:10retroperitoneal
36:11approach
36:11and
36:12we
36:13started
36:14with
36:14open
36:15posterior
36:16approach
36:16and
36:16then
36:17now
36:18we have
36:18laparoscopic
36:19approach
36:20so that
36:21is another
36:22technique
36:23that we
36:24hope
36:24that we
36:25can
36:25enhance
36:25over
36:26over the
36:26next
36:26couple
36:27of
36:27years
36:27five
36:27years
36:28we
36:28hope
36:28that
36:28we
36:28can
36:29increase
36:29the
36:30pool
36:30of
36:30patients
36:31and
36:31now
36:32we
36:32are
36:32receiving
36:33many
36:33difficult
36:34cases
36:34for
36:35thyroid
36:35for
36:35example
36:36retrosenogoitus
36:37from other
36:38private
36:38hospital
36:39and public
36:39hospital
36:40as well
36:40and
36:41hopefully
36:41we
36:42become
36:42a
36:42center
36:43hub
36:43for
36:44breast
36:44and
36:45endocrine
36:45surgery
36:46and
36:46we
36:47need
36:47to
36:47complement
36:47the
36:48treatment
36:49with
36:49other
36:50modalities
36:50for
36:50example
36:52oncology
36:52services
36:53radioactive
36:54ID
36:54all
36:55in
36:55one
36:56place
36:56a
36:56one
36:56stop
36:57center
36:57so
36:57this
36:58is
36:58where
36:58we
36:58are
36:58moving
36:59last
37:00two
37:00days
37:00ago
37:00we
37:01discussed
37:01with
37:01the
37:01nephrologist
37:02to
37:03look
37:03into
37:03to
37:03become
37:04a
37:04center
37:04of
37:05excellence
37:05for
37:06treatment
37:06of
37:07renal
37:07bone
37:08disease
37:08for
37:08example
37:09renal
37:09hyperparethoridism
37:10that
37:11is
37:11something
37:11that
37:12we
37:12I
37:12think
37:14skill
37:15to
37:15develop
37:16the
37:16center
37:16to
37:17be
37:17a
37:17center
37:17of
37:17excellence
37:18and
37:20when
37:20I
37:20came
37:21back
37:21from
37:21Australia
37:21for
37:22example
37:22in
37:231999
37:24so
37:25I
37:26have
37:26the
37:26intention
37:27of
37:27plan
37:28A
37:28and
37:28plan
37:28B
37:29plan
37:29A
37:30is
37:30to
37:30establish
37:31a
37:32breast
37:32and
37:32endocrine
37:33department
37:34in
37:35the
37:35Ministry
37:35of
37:35Health
37:36in
37:36the
37:36public
37:36sector
37:37otherwise
37:38plan
37:38B
37:39you
37:39know
37:39then
37:40I
37:40would
37:40establish
37:41in
37:42a
37:42private
37:42sector
37:43like
37:43manual
37:44cleaning
37:44like
37:44John
37:45Hopkins
37:45cleaning
37:45they
37:46are
37:46all
37:46private
37:46centers
37:46so
37:47there
37:47was
37:48the
37:48intention
37:48but
37:49I
37:50was
37:50supported
37:50by
37:51the
37:51Ministry
37:51of
37:52Health
37:52they
37:52provide
37:53the
37:53space
37:54even
37:54the
37:55hospital
37:55the
37:55whole
37:56entire
37:56hospital
37:56to
37:57develop
37:57as
37:58endocrine
37:58center
37:59in
37:59Putrajaya
38:00and
38:01certainly
38:01now
38:01that
38:02with
38:02the
38:02experience
38:03that
38:03we
38:03have
38:03gone
38:04through
38:04we
38:04can
38:04set
38:05up
38:05this
38:05in
38:06private
38:06entity
38:07and
38:07you
38:07can
38:07see
38:08UCSI
38:09is
38:09not
38:09a
38:10short
38:10lot
38:10hospital
38:11is
38:11the
38:11proper
38:11private
38:12university
38:12hospital
38:13we
38:14have
38:14the
38:14capacity
38:15to
38:15develop
38:15the
38:16services
38:17also
38:18we
38:18talk
38:18about
38:19clinical
38:19center
38:20of
38:21medical
38:21education
38:21and
38:22training
38:22fellowship
38:23training
38:24and
38:24we
38:25are
38:25also
38:25moving
38:25towards
38:26research
38:26publication
38:27and
38:28looking
38:29into
38:29our
38:29cases
38:30so
38:30I
38:31have
38:31updated
38:32for
38:32example
38:32recently
38:33in
38:33terms
38:33of
38:34retrosenogoitus
38:35the
38:35numbers
38:35add
38:36on
38:36the
38:37cases
38:37that
38:37have
38:37done
38:37in
38:38UCSI
38:38and
38:39then
38:39become
38:39one
38:40of
38:40largest
38:40series
38:40in
38:41the
38:41world
38:41and
38:42we
38:43have
38:43our
38:43own
38:43classification
38:44of
38:45retrosenogoitus
38:46as well
38:46based
38:47on
38:47the
38:47experience
38:48that
38:48we
38:48have
38:49based
38:49on
38:50the
38:50cases
38:50that
38:51we
38:51have
38:51and
38:52we
38:52can
38:52explain
38:53and
38:53then
38:53our
38:53classification
38:54is
38:54much
38:55better
38:55than
38:56the
38:56assisting
38:57classification
38:57elsewhere
38:59because
38:59we are
39:00looking
39:00into
39:00three
39:01dimension
39:01classification
39:02and
39:03the
39:03variation
39:03of
39:04the
39:04retrosenol
39:05component
39:05I
39:06think
39:06this
39:06is
39:06important
39:07I
39:07was
39:07given
39:07the
39:08honor
39:09actually
39:10deliver the
39:11Martin
39:12Agawa
39:12lecture
39:12after the
39:13presidential
39:14address
39:14in
39:15Krakow
39:16and
39:16whereby
39:16I
39:17shared
39:17this
39:18difficult
39:18thyroid
39:18surgery
39:19and
39:20focus
39:20mainly
39:20on
39:21retrosenogoitus
39:22in terms
39:23of
39:23our
39:23classification
39:24and
39:25now
39:25I
39:25think
39:26many
39:26countries
39:27are
39:27using
39:27our
39:27classification
39:28published
39:28in
39:29our
39:30textbook
39:30and
39:31principle
39:31and
39:32practice
39:32of
39:33endocrine
39:33surgery
39:34textbook
39:34and
39:35hopefully
39:35becomes
39:35a
39:36referral
39:36for the
39:37next
39:37generation
39:38to come
39:38Wow
39:39very
39:40inspiring
39:40I like
39:42the point
39:42that when
39:42you say
39:43you want
39:43to make
39:43UCSI
39:43like a
39:44hub
39:44of
39:44like a
39:45referral
39:45because
39:45nowadays
39:46as we
39:47know
39:47in
39:47our
39:48government
39:48sectors
39:49that
39:49sometimes
39:50you are
39:51operated at
39:51one
39:51center
39:52but when
39:52you need
39:53to go
39:53for your
39:53radioactive
39:54iodine
39:54you have
39:54to be
39:54sent to
39:55elsewhere
39:55where you
39:56have the
39:56nuclear
39:57medicine
39:57which is
39:58not available
39:58at all
39:59hospitals
39:59and your
40:00oncology
40:00might not
40:00be there
40:01at the
40:01hospital
40:01you have
40:02to do
40:02online
40:02referral
40:03so it's
40:04a bit
40:04troublesome
40:04for the
40:05patient
40:05right
40:06so you
40:07were talking
40:07about
40:07increasing
40:08the pool
40:08of patients
40:09I'm more
40:10interested in
40:10increasing the
40:11pool of
40:12endocrine surgeons
40:12in Malaysia
40:13so why do
40:16you think
40:16that a
40:16structured
40:17subspecialty
40:18is very
40:18important
40:18I know
40:19of course
40:19it's
40:19important
40:19but why
40:21do we
40:22emphasize
40:22on the
40:23subspecialty
40:23training
40:24and are
40:24we producing
40:25enough
40:25endocrine surgeons
40:26well the
40:27last 35
40:27years I
40:28think we
40:28have trained
40:28more than
40:2950
40:29endocrine surgeons
40:30and when I
40:32came back
40:32there was no
40:33trained
40:33endocrine surgeons
40:34but then we
40:35started the
40:35training fellowship
40:36program
40:37it's a three
40:38years program
40:38two plus one
40:39one year abroad
40:40and two years
40:41locally
40:41and then we
40:43have trained
40:43more than
40:4450 now
40:45I think the
40:46program is
40:46ongoing
40:47more important
40:48that we want
40:49every state
40:50and even
40:51every major
40:52hospital
40:52will have
40:53one
40:53endocrine
40:54surgeon
40:54in 1975
40:56the presidential
40:57address in
40:57the international
40:58association
40:59of endocrine
41:00surgeons
41:02IAS
41:03international
41:03association
41:04of endocrine
41:05surgery
41:05so make a
41:06statement
41:07and this is
41:07very important
41:08statement
41:08for us to
41:09excel and
41:11focus on
41:12endocrine surgery
41:13we need to
41:13let go other
41:14surgery like
41:15general surgery
41:16and etc
41:16so our
41:18bread and
41:18butter is
41:19endocrine surgery
41:20and we know
41:21for the fact
41:21the more you
41:22do the better
41:23you are
41:23so we have
41:24done a study
41:25I think
41:26internationally as
41:27well looking
41:27into if you
41:28do more than
41:29100 cases
41:30a year
41:31and then
41:31your
41:33efficiency
41:33in terms of
41:34cost effectiveness
41:35of doing
41:36the surgery
41:37is much
41:37better than
41:38those who
41:38have done
41:3910-20
41:39operations
41:40so the more
41:41you do
41:41the better
41:42you are
41:42and this
41:43is the same
41:43principle
41:44that we
41:44use during
41:46the pandemic
41:46week 19
41:47there's a
41:47backlog of
41:48cases
41:48and what
41:49we did
41:50for example
41:5030% of
41:51backlog of
41:51cases is
41:52cataract
41:53operation
41:53and what
41:54we did
41:55is you
41:55know we
41:56use the
41:56concept like
41:57in Jalan
41:57we have
41:58a center
41:58and then
41:59we realized
42:01that one
42:01operating
42:02theater can
42:03do 15
42:04surgery
42:05as compared
42:06in general
42:06OT in the
42:07government
42:08hospital about
42:09seven to
42:09eight cases
42:10so two
42:10theaters we
42:11can do
42:1130
42:12and for
42:12the last
42:1415 years
42:15we have done
42:15more than
42:1630,000
42:16operation
42:17and you
42:18can see
42:18the result
42:19we audit
42:19the result
42:20the more
42:20you do
42:21the better
42:21you are
42:22in terms
42:22of complication
42:23minimum complication
42:240.001%
42:26and outcome
42:27is one of
42:28the best
42:28in the
42:28country
42:29and this
42:29is a
42:29shop lot
42:30next to
42:30a kayak
42:31next to
42:31a coffee
42:32shop
42:32you know
42:33and this
42:33is in
42:34partnership
42:34with
42:36Majah Agama
42:37Islam
42:37so the
42:38concept now
42:39that we
42:39are trying
42:40to put
42:40is
42:41if you
42:41do
42:42more
42:42you are
42:43the more
42:44you do
42:44the better
42:45you are
42:45in one
42:46operation
42:46and that
42:47is the
42:47concept
42:48that we
42:48adopt
42:49in the
42:49center of
42:50excellent
42:50okay
42:51all right
42:51so
42:52I
42:53googled
42:55and I
42:55saw that
42:56you actually
42:56retired
42:57in 2023
42:58yes
42:58and after
42:59that you
42:59continued
43:00your journey
43:01in UCSI
43:02I mean
43:02continued
43:03serving
43:03in UCSI
43:04six months
43:05grace period
43:06so I did
43:06not involve
43:08in any
43:08activities
43:09for six
43:09months
43:09because
43:10grace period
43:11crossing over
43:12between
43:12public
43:13and private
43:14so
43:14then
43:15after six
43:16months
43:16I was
43:16actually
43:17offered
43:18a post
43:19in UCSI
43:20and I
43:21also
43:21appointed
43:22chairman
43:22of
43:23IJN
43:24and also
43:25the
43:25chancellor
43:25of the
43:25university
43:26of
43:26Samajaya
43:26all right
43:28actually I
43:28wanted to
43:28ask
43:29what is
43:30your
43:30motivation
43:31to continue
43:31to serve
43:32I mean
43:32that decades
43:33of service
43:34and then
43:34from surgery
43:35to leading
43:36the nation's
43:37healthcare
43:38system
43:38during the
43:38pandemic
43:39what
43:39keeps you
43:41motivated
43:42well
43:42Tun M
43:43did advise
43:43me
43:44when we
43:44retire
43:45it's not
43:45you know
43:46stay at
43:46home
43:47but you
43:47still have
43:48to continue
43:48your journey
43:49it's most
43:50important not
43:51to disconnect
43:52with what
43:53you do
43:54so this is
43:55something that
43:56I think is
43:57important
43:57when I do
43:59the surgery
43:59it's not
44:00it's basically
44:00because of
44:01the passion
44:01I like to
44:02do the
44:03operation
44:03and you
44:04know
44:04it's driven
44:05by passion
44:06rather than
44:07other reason
44:08so I have
44:09the opportunity
44:09to do now
44:10I have the
44:11time
44:11and I can
44:12actually develop
44:13the endocrine
44:15surgery in a
44:15private hospital
44:16hospital and
44:17I think I
44:18have done
44:18it in a
44:19public hospital
44:20I can
44:20actually
44:20replicate
44:21the whole
44:22concept of
44:23centre of
44:25excellence
44:25and build
44:26a hub in
44:26a private
44:27hospital
44:27UCSI
44:28yeah I
44:29have no
44:29doubt
44:30I'm sure
44:30that
44:30Tan Sri
44:31is able
44:31to do
44:31that
44:32hopefully
44:32inshallah
44:33so before
44:34we end
44:35before we
44:36ask the
44:36take home
44:38message
44:39this is for
44:40the junior
44:40doctors
44:41just now
44:41we talked
44:42more of
44:42in general
44:43what advice
44:44would you
44:45give to
44:45the junior
44:46general
44:46surgeon
44:46like for
44:47me
44:47who aspire
44:48to pursue
44:49breast and
44:49endocrine
44:49surgery
44:50I mean
44:51beyond the
44:51technical
44:51skills
44:52what are
44:53the most
44:53important
44:54qualities
44:54and also
44:55discipline
44:55emotional
44:56not just
44:57the junior
44:57doctors
44:57I mean
44:58as you
44:58can see
44:59a lot
44:59of issues
44:59nowadays
45:00in
45:00healthcare
45:01but
45:01to become
45:02a doctor
45:02I mean
45:03that
45:03I think
45:04for
45:04junior
45:04doctors
45:05I think
45:05the first
45:05is the
45:06passion
45:06to be
45:07a doctor
45:07so you
45:08must have
45:08the
45:10passion
45:10and desire
45:11to be a
45:11doctor
45:12and then
45:12that's
45:13the most
45:13important
45:13second
45:14is that
45:15you must
45:15ask yourself
45:16the area
45:17of interest
45:17that you
45:18like to
45:18do
45:18you know
45:19because
45:19you're
45:19going to
45:20do
45:20this
45:20surgery
45:21for example
45:22for the
45:22rest of
45:23your life
45:23so you
45:24must enjoy
45:25the
45:26operation
45:26you must
45:27enjoy
45:28the
45:28discipline
45:29breast
45:29and
45:30endocrine
45:30surgery
45:31so if
45:31you don't
45:32enjoy
45:32every morning
45:33will be
45:34you know
45:34a struggle
45:35for you
45:35to come
45:35to the
45:35hospital
45:36but if
45:37you enjoy
45:37you don't
45:37mind
45:38doing
45:38extra
45:39even
45:39it's
45:39like a
45:39hobby
45:41some
45:42people like
45:42to play
45:43golf
45:43but I
45:43like to
45:44go to
45:44operating
45:44theater
45:45right
45:45that is
45:46my
45:46environment
45:47my passion
45:48I think
45:49you must
45:50have that
45:50passion
45:50to make
45:51a difference
45:52in healthcare
45:52and to
45:53yourself
45:53and you
45:54can continue
45:55to look
45:56into how
45:57you can
45:57develop
45:57once you
45:58acquire
45:58the
45:59skill
45:59then
46:00the
46:00next
46:00is
46:00the
46:01creative
46:01ideas
46:01and
46:02innovation
46:02will
46:02come
46:03in
46:03to do
46:04things
46:04differently
46:04for example
46:05I always ask
46:06myself
46:06how can
46:07thyroid surgery
46:08be done
46:08under local
46:08anesthesia
46:09so then
46:10I read
46:11about the
46:11article
46:11you know
46:12in Malaysia
46:12they have
46:12done it
46:13before 1970
46:13but why
46:14they are not
46:15doing it
46:15now
46:15so I
46:16explore
46:17and
46:17embark
46:17of it
46:17and I've
46:18done
46:18more than
46:19200 cases
46:19of thyroid
46:20surgery
46:20under local
46:21anesthesia
46:21then
46:22after anesthesia
46:24can we do
46:24thyroid surgery
46:25under daycare
46:26I have
46:27published a
46:27paper
46:27in one day
46:28surgery
46:28in UK
46:29showing the
46:30two comparison
46:31under GA
46:32under LA
46:33under LA
46:35100%
46:35discharge
46:36the same
46:36day
46:36under GA
46:3725%
46:38admitted
46:39because of
46:40nausea
46:40and vomiting
46:41and obviously
46:42after
46:42thyroid surgery
46:43under daycare
46:44then I proceed
46:45to look
46:46explore
46:46thyroid surgery
46:47under acupuncture
46:48can it be done
46:49yes it can be done
46:50I've seen it
46:51I have done it
46:51and then
46:52this is where
46:53the excitement
46:54comes in
46:54for us
46:55to come up
46:56with creative
46:56ideas and
46:57innovation
46:57in your field
46:58of expertise
46:59okay I look
47:01forward actually
47:01to probably
47:03inshallah be the
47:03trainee for
47:04Tan Sri
47:05okay before we
47:06close finally
47:07Tan Sri
47:07do you have
47:08any take-home
47:09message
47:09do you have
47:10any advices
47:11for the
47:11the Malaysians
47:13out there
47:13who are
47:14watching us
47:14for this podcast
47:16maybe it be
47:17thyroid surgery
47:17or even to
47:18the doctors as well
47:19well
47:19to I think
47:21thyroid is
47:21actually a
47:22very important
47:22subject
47:23most importantly
47:24that you know
47:25it's a timely
47:26diagnosis
47:26more importantly
47:28to engage
47:29with the patient
47:30to explain
47:31issues and
47:31challenges
47:32manage the
47:32expectation
47:33of the patient
47:34once you
47:35manage the
47:35expectation
47:36of patient
47:37then patient
47:37they build
47:38trust
47:38and then you
47:39have to
47:40deliver the
47:40trust
47:40in terms of
47:41the outcome
47:42of the surgery
47:43etc
47:43so I think
47:44you know
47:45to allay the
47:46fear of our
47:46patient
47:47timely diagnosis
47:48and then
47:49you know
47:50position
47:50of
47:51position
47:52medicine
47:52and most
47:54important is
47:55safety of
47:55the operation
47:56so I think
47:57we need to
47:58assure that
47:59thyroid operation
48:00can be done
48:00safely in this
48:01country
48:02and more
48:03importantly
48:03I think
48:04is that
48:04you know
48:05we need to
48:05continue to
48:06have
48:07you know
48:07clinical trials
48:08and research
48:09in the area
48:10of expertise
48:10that we have
48:11and see
48:12how best
48:13we can come up
48:14with new
48:14ways of
48:15doing things
48:15differently
48:16as I said
48:17earlier
48:17you know
48:18how can we
48:18do things
48:19better
48:19faster
48:20cheaper
48:20safer
48:21smarter
48:22and you
48:23know
48:23most important
48:24is a
48:24safer
48:25you know
48:26than the
48:26technique
48:27that we
48:27have today
48:28okay
48:29that's
48:30I don't
48:31think so
48:31I need to
48:31add on
48:32anything
48:32Tan Sri
48:33has already
48:33summarized
48:34in a nutshell
48:35yeah
48:36so just
48:37my message
48:38for all
48:38the audience
48:39out there
48:39if you have
48:40any
48:40problems
48:41if you have
48:42any
48:43uncertainties
48:43you have
48:44to go
48:44I mean
48:44you can
48:45find
48:46you can
48:46google
48:46and go
48:46to the
48:47respective
48:47doctors
48:48or surgeons
48:49and get
48:49yourself
48:50treated
48:50although
48:51thyroid cancer
48:52is a slow
48:52growing cancer
48:53but do not
48:54ignore it
48:55right Tan Sri
48:56thank you so
48:57much to all
48:58our audience
48:58and our listeners
48:59and our viewers
48:59for watching
49:00this special
49:01edition
49:01please follow
49:03Sina Delhi
49:03on all social
49:04media platforms
49:05and download
49:06our award winning
49:07mobile app
49:07for the best
49:08news and stories
49:09so I'll see you
49:10guys again
49:10insyaAllah
49:11assalamualaikum
49:18you
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