Nerve Protection during Thyroid Ablation: An Interview with Dr. Catherine Sinclair

Nerve Protection during Thyroid Ablation: An Interview with Dr. Catherine Sinclair

A recent interview from the TNT conference on thyroid ablation in Italy, Philip James of the Doctor Thyroid and RFAMD podcasts had a one-on-one discussion with Dr. Catherine Sinclair, a seasoned head and neck surgeon from Melbourne, Australia. Having served at Mount Sinai in New York for 11 years before relocating back to Melbourne in 2021, Dr. Sinclair offers a unique perspective and extensive expertise in thyroid surgery and laryngology.

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The Importance of Nerve Protection

As a specialist who’s invested in both head and neck surgery and the voice box, Dr. Sinclair developed a keen interest in thyroid surgery due to the significant risks it presents to the vocal nerves during thyroid procedures, including during ablation. The laryngeal nerves, in particular, tend to be the patients’ greatest concern during thyroid procedures due to the potential damage they might sustain.

Many patients seeking Dr. Sinclair’s services are often singers or professional voice users who want to avoid surgery out of fear for their vocal nerves. As such, they prefer ablation. However, as she explains, it is crucial that they understand the risks to the laryngeal nerves and other vital structures in the area and the strategies used to mitigate these risks during ablation.

Limitations in Nerve Monitoring

In surgery, nerve monitoring is employed to keep track of and protect the nerves. But with ablation, patients are usually awake, which means the conventional nerve monitoring technology can’t be used. This presents a significant area of research on how to protect the nerves when the patient is conscious.

Dr. Sinclair emphasizes that though the risk is slightly lessened with surgery, it still exists. To counter this, specific strategies are used to minimize potential damage, but it’s never a guarantee that no injuries will occur.

Patients’ Preparedness and Awareness

Patients must ask about the surgeon’s experience, the number of ablations performed, and any potential complications that they should worry about. The more experienced the surgeon, the less likely there are to be complications of any kind, nerve injury included.

Contrary to some patients’ assumptions, nerve monitoring isn’t used in ablation since it requires general anesthesia. Early in her ablation experience, Dr. Sinclair used nerve monitoring on patients under general anesthesia. This procedure showed that nerve potentials remain stable as long as lower energy is used at the back of the thyroid gland where the nerves run. Furthermore, by minimizing time spent in the critical zones, nerve injury can be mostly prevented.

Real-time Vocal Assessment

During ablation, Dr. Sinclair often asks her patients to count in a monotone. This simple technique allows her to detect any changes in the voice, a potential indicator of nerve damage due to heat during the procedure. According to her, this method has helped prevent nerve issues.

State of Thyroid Ablation in Australia

Until recently, Dr. Sinclair was the only one performing thyroid ablations in Australia. Now, a colleague has started doing them in Western Australia. However, given the demand and the country’s size, she anticipates more physicians will adopt this procedure. Her main concern is ensuring that it’s done safely, with physicians possessing good ultrasound skills, interventional biopsy skills, and comprehensive knowledge of neck anatomy.

Final Thoughts

Dr. Sinclair’s parting advice to those considering thyroid ablation or thyroidectomy is to have realistic expectations. They should understand that injuries can happen despite the best precautions. However, the experience of the proceduralist can help lessen complications, and there are strategies to reduce the likelihood of nerve damage. Patients should also be well-informed and know what questions to ask their proceduralist before opting for ablation.

Interested parties can reach Dr. Sinclair by email at Catherine@melbournethyroidsurgery.com. She encourages inquiries from both domestic and international individuals.

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About Philip James

In 2013, his laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.
Later, a vocal cord implant was inserted to help him speak.

The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others.


About RFAMD

RFAMD is solely dedicated to helping healthcare organizations build deeper, enduring relationships with patients. Our team brings together expertise and insights to create enterprise-wide solutions that transform the patient experience.

With years of experience in understanding the patient’s journey, we can help healthcare organizations thrive in today’s patient-centered healthcare market. Our range of solutions includes smart, measurable patient acquisition programs, physician marketing touch-points that drive referrals into priority service lines, and credible, easy-to-digest content at the point of care and beyond, in patients’ preferred formats and languages.

We also provide brand strategies that increase patient preference and physician referrals and differentiate your brand in the market through reputation-building tools.

Our commitment is to enable providers and payers to deliver personalized care by activating, educating, and motivating patients to prioritize their health every day. As your strategic partner, we combine our unique capabilities and industry expertise to better engage patients at every step of their health journey.

Our goal is to help healthcare organizations achieve stronger patient and member outcomes, sustained improvements in brand reputation, measurable gains in market share, and increased revenue.

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Content on the RFAMD and Doctor Thyroid with Philip James websites and podcasts is for informational purposes only and not a substitute for professional medical advice. See our full Legal Disclaimer for details.

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