The Flying Goitre

I first met Mr Syed Maktum in 2004. A good looking tall man of 42 with great poise, he came bearing a letter from his doctor about a thyroid swelling. He wore a worried look on his face.

Further tests revealed a 4.4cm solitary nodule in the right lobe of his thyroid gland. A needle biopsy of the nodule was reported to be benign (harmless).

Nevertheless, in view of the size, I recommended removal of the right lobe of the thyroid gland with the nodule.

He replied that he would think it over. He had a busy job as a senior airline steward and spent more time out of the country than in.

No show…

He reappeared in my clinic 2 years later in 2006 bearing another letter from a different doctor. The neck swelling had increased significantly in size and had started to push his trachea (windpipe) to the other side. By this time, there were many nodules, suggestive of multinodular goiter, a benign condition.

Multinodular goiters can get very big.

My personal record was a 900g monster, a subject of a future story. The need for surgery was clear.

However, thyroid surgery is not without risks. The main risk is to the recurrent laryngeal nerve, a nerve that lies very close to the thyroid gland.

Anyone taking on thyroid surgery would have to approach the area of the nerve with extreme caution, with extra careful and gentle dissection. Injury to the nerve would result in a weak or hoarse voice for the patient.

I carefully explained all this to him and after a good deal of persuasion, he agreed to go ahead and arrangements were made.

He never showed up.

“…my job depends on my voice…”

Fast forward to 2009.

He turns up again with another letter from yet another doctor.

By now, the thyroid gland had grown huge.

The previous nodule had grown from 4.4cm to a whopping 8.5cm. He had neck discomfort and his voice had gone hoarse by itself! Concerns had been raised at work about his neck swelling and his voice.

He was having difficulty doing up his collar. He was worried about his goiter, worried about his voice before surgery, and after surgery. He needed to make clear inflight announcements. His job and livelihood depended on it.

I had an ENT colleague look at him.

He diagnosed an infection of the vocal cords and thankfully his voice improved after a course of antibiotics. But it could have been due to the thyroid gland pressing on the nerve!

This time he did not need so much convincing. He revealed that his sister Puan A had been operated by me way back in 1998 for a thyroid swelling too. The operation had gone well, without complication and she was egging him to get on with it and have the operation done. He was very worried about the risk to his recurrent laryngeal nerve and the impact that would have on his job.

I did my best to reassure him, silently making a note to set aside plenty of time for his operation so I could approach the nerve with extra meticulous care. We looked at his flight schedules and made plans.

The operation proceeded without a hitch, staying well clear of the nerve. The left lobe looked normal so I left it well alone.

The lab report on the lump showed it to be benign. But best of all, his voice was completely normal afterwards and he was so relieved!

Another thyroid swelling!

In October this year, another sister of his, Puan K comes to my clinic (this time in Gleneagles Penang), also with a large thyroid swelling!

She had noticed it since last December but had put off coming to see me. This time, it was Syed Maktum who was egging her to come for a consult.

Her operation went smoothly. As she had hardly any normal thyroid tissue, I had to remove the entire gland. This carried an additional risk of a low blood calcium level after operation but happily, not only was her calcium completely normal afterwards but so was her voice.

Syed Maktum still flies and still has a hectic work schedule.

A model jumbo jet sits on my desk silently reminding me of Syed Maktum jetting his way around the world.

Syed Maktum & me, when he came to visit his sister at Gleneagles Penang
Syed Maktum & me, when he came to visit his sister at Gleneagles Penang

My name is Syed Maktum. I had a thyroid operation on my neck done by Dr Khoo Saye Thiam. The operation was very successful and I am very happy because the growth in my neck was very big.

I am very impressed Dr Khoo did the operation very well and there no scar seen in my neck. My 2 sisters also had their thyroid operations done by Dr Khoo very successfully. Thank you for everything and all the best to Dr Khoo!

Syed Maktum, November 2013