Thyroid Surgery Consultation

1. Dr Wilson · turn 1

   Good morning, Ms Zhang. I’ve reviewed the ultrasound and biopsy results your GP sent through. The nodule on the right side of your thyroid has increased in size over the past twelve months. Although the biopsy hasn’t shown definite signs of cancer, given its size and continued growth, I’d recommend surgery to remove the affected part of the thyroid.

   張女士，早安。我已經看過您的全科家庭醫生轉介過來的超聲波和活檢結果。在過去的十二個月裡，您甲狀腺右側的結節體積有所增大。雖然活檢並未顯示出明確的癌症跡象，但考慮到它的大小以及持續增長的情況，我建議進行手術切除受影響的部分甲狀腺。

2. Ms Zhang · turn 2

   醫生，我聽到要做手術還是挺緊張的。我以前只是覺得脖子有點腫，吞東西的時候偶爾不舒服，沒想到會嚴重到需要手術。這個結節是不是已經導致甲狀腺功能亢進或者甲狀腺功能減退了？

   Doctor, hearing that I need surgery still makes me quite nervous. Previously, I only felt that my neck was a bit swollen and that swallowing was occasionally uncomfortable; I didn't expect it to be serious enough to require surgery. Has this nodule already caused hyperthyroidism or hypothyroidism?

3. Dr Wilson · turn 3

   At this stage, your thyroid function tests are reasonably normal, so you don’t currently have significant hyperthyroidism or hypothyroidism. The main concern is the thyroid nodule itself and the gradual enlargement of your thyroid, which we call a goitre. If it continues to grow, it may eventually put pressure on your windpipe or make swallowing more difficult.

   目前這個階段，您的甲狀腺功能檢查結果大致正常，因此您目前並沒有明顯的甲狀腺功能亢進或甲狀腺功能減退。我們主要擔心的問題是甲狀腺結節本身，以及甲狀腺的逐漸腫大，我們稱之為甲狀腺腫。如果它繼續生長，最終可能會壓迫您的氣管，或使吞嚥變得更加困難。

4. Ms Zhang · turn 4

   那如果我暫時不做手術，只是定期檢查，可以嗎？我最擔心的是手術以後會不會出現併發症，或者以後必須一輩子吃藥。我想先把所有選擇都弄清楚，再做好心理準備。

   What if I don't have surgery for now and just have regular check-ups, would that be alright? What I am most worried about is whether complications will occur after surgery, or if I will have to take medication for the rest of my life. I'd like to clarify all the options first before mentally preparing myself.

5. Dr Wilson · turn 5

   That’s perfectly reasonable. You will have the final say. My job is to explain the benefits and risks so that you can make an informed decision. We could continue monitoring the nodule, but because it has already grown significantly, I think surgery is the safer long-term option. If we remove only the right side of the thyroid, there’s a reasonable chance that the remaining half will produce enough thyroid hormone on its own.

   這完全合情合理。最終的決定權在您手上。我的職責是向您解釋其好處和風險，以便您能做出知情的決定。我們可以繼續監察該結節，但因為它已經明顯增大，我認為手術是更安全的長期方案。如果我們只切除右側甲狀腺，剩餘的一半很有可能可以自行產生足夠的甲狀腺激素。

6. Ms Zhang · turn 6

   您說的手術具體是怎麼做的？我聽說現在很多手術都可以採用微創或者所謂的「鎖孔手術」。這種甲狀腺切除術也可以用微創方式進行嗎？

   How exactly is the operation you mentioned performed? I have heard that many surgeries nowadays can be done using minimally invasive techniques, or so-called 'keyhole surgery'. Can this type of thyroidectomy also be done minimally invasively?

7. Dr Wilson · turn 7

   There are minimally invasive techniques for selected thyroid operations, but they’re not suitable for everyone. In your case, I’d make a relatively small incision at the lower part of your neck and remove the right thyroid lobe. I would be the operating surgeon, assisted by another surgeon and the theatre team. We wouldn’t normally need to insert any implant, prosthesis or artificial parts.

   針對某些特定的甲狀腺手術，確實有微創技術，但並不適合所有人。就您的情況而言，我會在您頸部下方開一個相對較小的切口，並切除右側甲狀腺葉。我會擔任主刀醫生，並由另一位外科醫生和手術室團隊協助。我們通常不需要植入任何植入物、假體或人造零件。

8. Ms Zhang · turn 8

   那我需要住院多久？這是門診手術，做完當天就能回家，還是屬於住院手術？我家裡只有我丈夫可以照顧我，所以我也得提前安排一下。

   How long will I need to stay in hospital? Is this day surgery where I can go home the same day, or is it an inpatient procedure? My husband is the only one at home who can look after me, so I need to make arrangements in advance.

9. Dr Wilson · turn 9

   For a straightforward procedure, some patients can go home the same day, but I usually recommend staying overnight after thyroid surgery. That allows us to monitor you for bleeding, changes in calcium levels and any breathing difficulties. Assuming everything is stable, you should be discharged the following morning.

   如果是簡單順利的手術，有些患者當天就可以回家，但在甲狀腺手術後，我通常建議留院觀察一晚。這樣一來，我們便可以監察您是否有出血情況、鈣水平的變化以及是否有任何呼吸困難。如果一切平穩，您應該在第二天早上就可以出院。

10. Ms Zhang · turn 10

    我以前有個親戚做完骨科手術以後在床上躺了很久，差不多一個月都臥床不起。我這個手術應該不會需要那麼長時間康復吧？我還得考慮什麼時候可以回去上班。

    I had a relative who was bedridden for a long time after orthopaedic surgery, lying in bed for nearly a month. My surgery shouldn't require such a long recovery time, right? I also have to consider when I can return to work.

11. Dr Wilson · turn 11

    No, thyroid surgery is very different from major orthopaedic operations. You certainly shouldn’t be bedridden or confined to bed for weeks. In fact, we encourage gentle movement soon after the operation. Most people can manage normal daily activities within a few days, although you should avoid strenuous exercise and heavy lifting for about two weeks.

    不會的，甲狀腺手術與大型骨科手術非常不同。您絕對不需要臥床數週或無法下床。事實上，我們鼓勵您在手術後不久進行輕微的活動。大多數人在幾天內就能應付正常的日常生活，但您在大約兩週內應避免劇烈運動和提重物。

12. Ms Zhang · turn 12

    那術後還需要專門做康復治療嗎？比如物理治療或者其他治療性支持？還有，我的聲音會不會受到影響？我的工作需要經常跟客戶說話，所以這個問題對我很重要。

    Will I need specialised rehabilitation afterwards, such as physiotherapy or other therapeutic support? Also, will my voice be affected? My job requires speaking with clients frequently, so this issue is very important to me.

13. Dr Wilson · turn 13

    Most patients don’t require formal rehabilitation or therapeutic support after an uncomplicated thyroidectomy. Regarding your voice, there is a nerve close to the thyroid that controls the vocal cords. Temporary hoarseness can occur after surgery. Permanent damage to that nerve is uncommon, but it is one of the complications I’m required to discuss with you before you consent to the operation.

    在無併發症的甲狀腺切除術後，大多數患者並不需要正式的康復治療或治療性支持。關於您的聲音，甲狀腺附近有一條控制聲帶的神經。手術後可能會出現暫時性的聲音沙啞。對該神經的永久性損傷並不常見，但這是我在您同意手術之前必須與您討論的併發症之一。

14. Ms Zhang · turn 14

    明白了。還有一個實際問題，就是費用。我有私人醫療保險，但是不太清楚保險能報多少。除了保險公司支付的部分，我是不是還會有自費費用或者差額自付？

    I see. There is also a practical issue, which is the cost. I have private health insurance, but I am not very clear on how much the insurance will cover. Apart from the portion paid by the insurance company, will I have out-of-pocket expenses or a gap payment?

15. Dr Wilson · turn 15

    Potentially, yes. There may be out-of-pocket expenses depending on your level of hospital cover. My surgical fee, the assistant surgeon’s fee and the anaesthetist’s fee are billed separately. If any of those fees are higher than the amount covered by Medicare and your private insurer, you may have to make a gap payment.

    有可能會有。自費費用取決於您的住院保險級別。我的手術費、副刀醫生的費用以及麻醉科醫生的費用都是分開計費的。如果其中任何一項費用高於國民保健（Medicare）和您的私人保險公司承保的金額，您可能就需要支付差額。

16. Ms Zhang · turn 16

    那在我正式同意手術之前，醫院能不能先給我一個費用估算？我不希望做完手術以後才突然收到一大筆賬單。如果有幾千澳元的自費部分，我需要提前做好財務上的準備。

    Could the hospital give me a cost estimate before I formally consent to the surgery? I don't want to suddenly receive a massive bill after the operation. If there is an out-of-pocket amount of several thousand Australian dollars, I need to make financial preparations in advance.

17. Dr Wilson · turn 17

    Absolutely. My receptionist can give you written information about my fees, and you should contact the anaesthetist and your health fund as well. The private hospital can also provide an estimate of any accommodation excess or other hospital charges. I’d recommend confirming all of that before you book the operation.

    那是當然的。我的診所接待員可以為您提供有關我收費的書面資料，您也應該聯絡麻醉科醫生和您的醫療保險基金。私立醫院也可以提供任何住院自付額（excess）或其他醫院費用的估算。我建議您在預約手術前把這些全部確認清楚。

18. Ms Zhang · turn 18

    好的。假如我決定做手術，切下來的甲狀腺組織是不是還要送去化驗？如果化驗以後發現是惡性的，會不會還要再做一次手術，把剩下的甲狀腺也切掉？

    All right. If I decide to have the surgery, will the removed thyroid tissue still be sent for lab testing? If it turns out to be malignant after testing, would I have to undergo another surgery to remove the remaining thyroid as well?

19. Dr Wilson · turn 19

    Yes. The tissue we remove will be sent to pathology for examination. If the pathology unexpectedly shows a significant thyroid cancer, we may recommend a second operation to remove the remaining thyroid tissue. That would be called a completion thyroidectomy. However, we wouldn’t make that decision until we had the final pathology report.

    是的。我們切除的組織會送到病理科進行檢驗。如果病理結果意外顯示有明顯的甲狀腺癌，我們可能會建議進行第二次手術，切除剩餘的甲狀腺組織。這稱為全甲狀腺切除補行術（completion thyroidectomy）。不過，在拿到最終的病理報告之前，我們是不會做出該決定的。

20. Ms Zhang · turn 20

    如果整個甲狀腺最後都被切除了，那是不是就一定會出現甲狀腺功能減退？我是不是以後每天都需要服用甲狀腺激素？

    If the entire thyroid ends up being removed, does that mean hypothyroidism will definitely occur? Will I need to take thyroid hormone every day in the future?

21. Dr Wilson · turn 21

    Yes. After a total thyroidectomy, your body can no longer produce thyroid hormone naturally, so you would need lifelong thyroid hormone replacement. If we only remove one lobe, however, the remaining thyroid tissue may be sufficient. We’d arrange blood tests several weeks after surgery and adjust treatment if necessary.

    是的。在甲狀腺全切除術後，您的身體將無法再自然產生甲狀腺激素，因此您將需要終身服用甲狀腺激素替代藥物。然而，如果我們只切除一側甲狀腺葉，剩餘的甲狀腺組織可能就足夠了。我們會在術後幾週安排驗血，並在必要時調整治療方案。

22. Ms Zhang · turn 22

    聽您解釋完以後，我放心多了。不過我還是想回去跟丈夫商量一下，也想先聯繫保險公司，把自費費用和住院安排都問清楚。我不想因為緊張就馬上作決定。

    After hearing your explanation, I feel much more reassured. However, I'd still like to go home and discuss it with my husband, and also contact the insurance company first to clarify the out-of-pocket expenses and hospital arrangements. I don't want to rush into a decision just because I'm nervous.

23. Dr Wilson · turn 23

    There’s no need to decide today. Take the information home, discuss it with your family and get yourself mentally prepared. Unless you develop sudden breathing or swallowing difficulties, this isn’t an emergency operation. My recommendation is that we arrange the surgery within the next couple of months rather than leaving the nodule untreated indefinitely.

    今天不需要立刻決定。把這些資料帶回家，與家人商量，做好心理準備。除非您突然出現呼吸或吞嚥困難，否則這不是一項緊急手術。我的建議是在接下來的一兩個月內安排手術，而不是無休止地對結節置之不理。

24. Ms Zhang · turn 24

    好的，那我回去考慮一下。如果決定接受手術，我就聯繫您的診所預約日期。手術前如果還有問題，我是不是也可以再約一次門診，把具體的手術流程和風險確認清楚？

    All right, I will go home and consider it. If I decide to proceed with the surgery, I will contact your clinic to book a date. If I have further questions before the operation, can I make another appointment to clarify the specific surgical procedures and risks?

25. Dr Wilson · turn 25

    Of course. We can arrange another consultation if you need one. Before the operation, you’ll also have a pre-admission assessment, and the anaesthetist will review your medical history and medications. Once you’re comfortable with the plan, we’ll ask you to sign the consent form. Remember, even after discussing all of this, you still have the final say.

    當然可以。如果您需要，我們可以再安排一次諮詢。在手術之前，您還會接受入院前評估，麻醉科醫生也會檢視您的病史和用藥情況。一旦您對方案感到放心，我們就會請您簽署手術同意書。請記住，即使在討論了所有這些之後，最終的決定權仍然在您手上。

26. Ms Zhang · turn 26

    好的，謝謝醫生。我覺得現在至少知道自己面對的是什麼了。我先把保險、費用和請假的事情安排好，再跟您聯繫。這樣我在身體上和心理上都能準備得充分一點。

    All right, thank you Doctor. I feel that at least now I know what I am facing. I will sort out the insurance, costs, and leave arrangements before contacting you. That way, I can be more thoroughly prepared both physically and mentally.

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