The Initial Step in Developing Comprehensive Thyroid and Parathyroid Care
Thyroid and parathyroid disorders, particularly thyroid carcinomas, are increasingly prevalent in contemporary practice, largely due to diagnostic technological advancements that facilitate early-stage detection. Although the majority of patients exhibit an excellent prognosis, current clinical management paradigms have become increasingly diverse and complex, encompassing multifaceted domains of diagnosis, therapeutic selection, and long-term surveillance.

Consequently, the Division of Laryngology, Head and Neck Surgery, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, initiated the establishment of the “Siriraj Thyroid and Parathyroid Clinic.” This initiative aims to lay the foundation for a specialized, comprehensive disease management system spanning the continuum of care—from diagnosis, treatment planning, and surgical intervention, to postoperative surveillance and the ongoing rehabilitation of the patient’s quality of life.

Personalized Care Paradigm
The contemporary management of thyroid pathology emphasizes a personalized care approach, acknowledging that each patient presents with a distinct disease profile, risk stratification, and specific therapeutic goals.

Certain patients may be optimal candidates for a partial gland resection (thyroid lobectomy), while others may necessitate a total thyroidectomy combined with cervical lymph node dissection (neck dissection). Furthermore, adjuvant therapeutic modalities, such as radioactive iodine (RAI) therapy or molecular targeted therapy, must be carefully evaluated.

The clinic meticulously focuses on tailoring treatment strategies for each individual. By integrating clinical data, laboratory outcomes, and advanced imaging modalities, the clinic fosters shared decision-making between the physician and the patient. This ensures an optimal balance between therapeutic efficacy, surgical safety, and long-term quality of life.

Technologies Enhancing Surgical Safety
Medical technology plays a paramount role in enhancing the safety of thyroid and parathyroid surgery. Currently, intraoperative nerve monitoring (IONM) is routinely employed to mitigate the risk of iatrogenic injury to the recurrent laryngeal nerve—a pivotal surgical complication that can profoundly impair phonation and patient quality of life. In addition, innovative surgical modalities have been adopted, notably the Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA). This scarless technique avoids anterior cervical incisions, thereby promoting postoperative quality of life in terms of cosmesis and patient confidence. The clinic also incorporates thermal ablation for the minimally invasive management of thyroid nodules.

In the realm of research, the clinic is investigating the application of Near-Infrared Autofluorescence (NIRAF) technology for the intraoperative identification of parathyroid glands, which may help reduce the incidence of postoperative hypocalcemia. Furthermore, the integration of genetic profiling and mutation analysis is being utilized to refine the diagnosis, risk assessment, and prognostic evaluation of patients with thyroid carcinoma.

“Thyroid Cancer 2-in-1”: Streamlining Pathways and Enhancing Continuity
A core operational concept of the clinic is the “Thyroid Cancer 2-in-1” program, which synchronizes patient care between the Thyroid Clinic and the Nuclear Medicine team on the same day. Designed for thyroid cancer patients undergoing post-treatment surveillance, this clinical pathway reduces travel burdens and wait times while substantially improving the continuity of care. It ensures that patients receive comprehensive clinical evaluations and therapeutic planning within a patient-centered framework.

Multidisciplinary Team (MDT) Approach
The clinic places high importance on a Multidisciplinary Team (MDT) approach, fostering collaboration among the Department of Otorhinolaryngology, Department of Surgery, Department of Medicine, Division of Nuclear Medicine, Department of Radiology, and Department of Pathology. This collaborative framework is instrumental in planning the management of highly complex or high-risk cases. This approach enhances the appropriateness of treatment plans, minimizes redundancies in clinical workflows, and supports evidence-based decision-making tailored to individual patient needs.

Conclusion
Although the Siriraj Thyroid and Parathyroid Clinic is in its initial stages of development, its primary objective is to establish a robust foundation for a comprehensive, modernized, and patient-centered thyroid and parathyroid care system. In the future, the clinic aspires to expand its academic endeavors, research, and interdisciplinary collaborations to elevate the management of thyroid and parathyroid diseases in Thailand toward international clinical standards.

Clinic Information:
The “Siriraj Thyroid and Parathyroid Clinic” operates every Thursday from 09:00 to 12:00 at Room 102, 1^st Floor, Syamindra Building, Siriraj Hospital.