What should be included in the informed consent for a patient undergoing combined surgery for thyroid gland removal and squamous cell carcinoma resection on the tongue?

Informed Consent for Combined Thyroid Gland Removal and Tongue Squamous Cell Carcinoma Resection

An informed consent for combined thyroid gland removal and tongue squamous cell carcinoma resection must include comprehensive information about both procedures, their specific risks, benefits, and alternatives to enable the patient to make a truly informed decision. 1

Patient Information

• Patient name, date of birth, and medical record number
• Name and credentials of the surgeon(s) performing the procedure
• Date of the planned procedure
• Clear description of the diagnosed condition(s): thyroid disease and squamous cell carcinoma of the tongue

Procedure Description

• Detailed explanation of both procedures:
  • Thyroidectomy (thyroid gland removal)
  • Resection of squamous cell carcinoma from the tongue
• Explanation that these are being performed as a combined procedure
• Expected duration of surgery
• Type of anesthesia to be used

Benefits of the Procedures

• For thyroidectomy: removal of diseased thyroid tissue, prevention of spread if malignant
• For tongue carcinoma resection: removal of cancerous tissue, prevention of spread, potential cure
• Benefits of combining procedures (single anesthesia event, single recovery period)

Risks and Complications

General Surgical Risks

• Bleeding and hematoma formation (1:100 risk of hemorrhage following thyroidectomy) 1
• Infection
• Adverse reactions to anesthesia
• Venous thromboembolic events
• Pain and discomfort
• Scarring

Specific Risks of Thyroidectomy

• Recurrent laryngeal nerve injury (1-2% risk even in experienced hands) 1
  • Temporary or permanent voice changes
  • Hoarseness
  • Vocal cord paralysis (unilateral or bilateral)
• Hypoparathyroidism and hypocalcemia
• Need for lifelong thyroid hormone replacement therapy
• Risk of hematoma formation causing acute airway compromise (approximately 1:400 thyroidectomies) 1

Specific Risks of Tongue Carcinoma Resection

• Changes in speech and articulation
• Difficulty swallowing
• Altered taste sensation
• Changes in tongue mobility
• Potential need for reconstruction
• Risk of positive margins requiring additional surgery
• Potential need for adjuvant therapy (radiation, chemotherapy)

Alternative Treatment Options

• For thyroid disease: medication management, radioactive iodine therapy (if applicable), observation
• For tongue carcinoma: radiation therapy, chemotherapy, combined chemoradiation, observation
• Separate procedures performed at different times rather than combined

Post-Operative Care

• Expected hospital stay duration
• Pain management plan
• Dietary restrictions and modifications
• Voice rest requirements
• Follow-up appointments
• Signs and symptoms requiring immediate medical attention

Recovery Expectations

• Timeline for recovery
• Expected functional outcomes
• Potential need for speech therapy
• Potential need for swallowing therapy
• Return to work/normal activities timeline

Additional Required Elements

• Statement that the patient has had the opportunity to ask questions and has received satisfactory answers
• Statement that no guarantees have been made regarding outcomes
• Acknowledgment that the patient understands the information provided
• Space for patient signature (or legal representative if applicable) and date
• Space for witness signature and date
• Space for surgeon signature and date
• Statement that the patient may withdraw consent at any time 1

Special Considerations

• Pre-operative laryngoscopy documentation (to identify any pre-existing vocal cord issues) 1
• Documentation of discussion about the possibility of emergency bedside intervention in case of post-operative hematoma 1
• Clear explanation that neural damage in thyroid surgery is a predictable but not always preventable complication 1
• Documentation of the multidisciplinary approach to post-operative care (including otolaryngologist and speech therapist involvement) 1

Important Pitfalls to Avoid

1. Failing to document pre-existing voice or swallowing issues
2. Using overly technical language that patients cannot understand
3. Rushing the consent process immediately before surgery
4. Not allowing sufficient time for questions and consideration
5. Failing to discuss the specific risks of the combined procedure approach

The informed consent should be provided to the patient well in advance of the surgery (ideally at least 24 hours before) to allow adequate time for review and consideration 2. The surgeon should personally discuss the key elements with the patient and ensure understanding through interactive conversation, not just relying on the written form 3.

Remember that informed consent is not just a document but a process of communication that results in the patient's authorization of a specific intervention 1.