What's new in general surgery: endocrine.

Abstract

There have been many advances in the field of endocrine surgery over the past year. We continue to gain a better understanding of the pathophysiology of endocrine dis- ease through the use of intraoperative hormone mea- surement. Standard surgical procedures have been mod- ified to allow a less invasive approach to surgically cure several endocrine problems. Videoscopic technology has also improved to allow safe operative resection of adre- nal, pancreatic, thyroid, and parathyroid pathology. These procedures have shortened hospital stays, time off work, and improved patient comfort after the proce- dure. A summary of some of these advances, resulting from thoughtful investigation by endocrine surgeons throughout the world, is presented below. solved in only 6% of patients 1 month after undergoing RAI ablation. Hyperthyroidism eventually resolved in 84% of RAI patients with a mean RAI treatment dose of 28 mCi and only 10 (6%) required a second treatment dose. More than half of the patients studied had local symptoms of compression, and size reduction of the goi- ter was seen in only 55 patients (38%) treated with RAI. Thyroidectomy resulted in no postoperative mortality and recurrent nerve paresis and hypoparathyroidism each occurred in three patients (2%). Surgical treatment of toxic multinodular goiter results in rapid and reliable correction of hyperthyroidism with low morbidity. RAI ablation is also safe and effective, usually with a single dose, but resolution of hyperthyroidism is delayed and thyroid goiter persists in many patients. Fine needle aspiration biopsy (FNAB) continues to play an important role in the characterization and treat- ment of thyroid nodules, but distinguishing benign from malignant follicular nodules remains difficult if not impossible. The accuracy of FNAB in detecting thy- roid malignancy is well known in both the academic and community healthcare environments. 2 Thyroid nodules containing follicular cytopathologic features, often de- scribed as follicular neoplasms, are almost always treated with thyroidectomy and are associated with a 20% to 30% malignancy rate. 3 Goldstein and colleagues 4 fur- ther characterized follicular thyroid nodules based on the presence or absence of cytologic atypia. Thyroid ma- lignancy was found by histopathologic examination in only 6.8% of patients without atypia in their FNAB sample, and all of these tumors were a follicular variant of papillary carcinoma. In contrast, 44% of patients with atypia in their FNAB samples harbored thyroid carci- noma, including two invasive follicular carcinomas. This observation may allow for a more conservative ap- proach for carefully selected patients with follicular thy- roid nodules without atypia. The thyroid malignancy