Endocrine Surgery Section Research Articles

Same-Day Discharge for Thyroidectomy: Why the Holdup?

Clinical ThyroidologyVol. 35, No. 4 Thyroid SurgerySame-Day Discharge for Thyroidectomy: Why the Holdup?Eric Walser and Jesse D. PasternakEric Walser Division of General Surgery, Division of Critical Care, Western University Schulich School of Medicine, London Health Sciences Center, London, Ontario, Canada. Section of Endocrine Surgery, Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada.Search for more papers by this author and Jesse D. Pasternak Division of General Surgery, Division of Critical Care, Western University Schulich School of Medicine, London Health Sciences Center, London, Ontario, Canada. Section of Endocrine Surgery, Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada.Search for more papers by this authorPublished Online:11 Apr 2023https://doi.org/10.1089/ct.2023;35.167-169AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 35Issue 4Apr 2023 Information© Copyright 2023, Mary Ann Liebert, Inc.To cite this article:Eric Walser and Jesse D. Pasternak.Same-Day Discharge for Thyroidectomy: Why the Holdup?.Clinical Thyroidology.Apr 2023.167-169.http://doi.org/10.1089/ct.2023;35.167-169Published in Volume: 35 Issue 4: April 11, 2023PDF download

Patterns of Prescribing Postoperative Analgesic Medication After Thyroid Surgery: A Retrospective Cohort Study.

Mild-to-moderate postoperative pain is common after surgical procedures of the thyroid. Opioid analgesics have been commonly prescribed in such cases, but their use has been debated owing to concerns regarding the addictive nature of opioids. Recently, experts from the Endocrine Surgery Section of the American Head and Neck Society released a consensus document to limit the use of opioids as the first-line pain control medication after head and neck or endocrine procedures. However, differences in pain management prescriptions have been noted in many settings. This study aims to assess the post-thyroid surgery pain control medication prescription practices of head and neck and endocrine surgeons. This study retrospectively reviewed the charts of 105 adult patients who underwent thyroid surgery (total thyroidectomy, thyroid lobectomy, or subtotal thyroidectomy) by head and neck or endocrine surgeons. The type of prescribed pain medication at hospital discharge postoperatively was then retrieved from each patient's discharge medication list. Descriptive statistics mean, standard deviations, frequencies, and percentages were computed, while the Chi-square test was applied to measure the significant differences among variables at a 5.00% significant level. An outpatient oral opioid, in the form combining paracetamol and codeine, was prescribed for 62 (59%) patients, whereas 43 (41%) were discharged on paracetamol only. The use of opioids is the practice pattern for pain management among some head and neck or endocrine surgeons despite emerging evidence that supports the use of non-opioid and other alternative analgesic strategies in outpatient thyroid and parathyroid surgery. Further research and quality improvement interventions should be geared towards leading all health professionals to appropriate prescription practices to improve patient safety and reduce unnecessary opioid prescriptions.

American Head and Neck Society Endocrine Surgery Section and International Thyroid Oncology Group consensus statement on mutational testing in thyroid cancer: Defining advanced thyroid cancer and its targeted treatment.

The development of systemic treatment options leveraging the molecular landscape of advanced thyroid cancer is a burgeoning field. This is a multidisciplinary evidence-based statement on the definition of advanced thyroid cancer and its targeted systemic treatment. An expert panel was assembled, a literature review was conducted, and best practice statements were developed. The modified Delphi method was applied to assess the degree of consensus for the statements developed by the author panel. A review of the current understanding of thyroid oncogenesis at a molecular level is presented and characteristics of advanced thyroid cancer are defined. Twenty statements in topics including the multidisciplinary management, molecular evaluation, and targeted systemic treatment of advanced thyroid cancer are provided. With the growth in targeted treatment options for thyroid cancer, a consensus definition of advanced disease and statements regarding the utility of molecular testing and available targeted systemic therapy is warranted.

Pediatric intraoperative nerve monitoring during thyroid surgery: A review from the American Head and Neck Society Endocrine Surgery Section and the International Neural Monitoring Study Group.

Children are more likely to experience recurrent laryngeal nerve (RLN) injury during thyroid surgery. Intraoperative nerve monitoring (IONM) may assist in nerve identification and surgical decision making. A literature review of pediatric IONM was performed and used to inform a monitoring technique guide and expert opinion statements. Pediatric IONM is achieved using a variety of methods. When age-appropriate endotracheal tubes with integrated surface electrodes are not available, an alternative method should be used. Patient age and surgeon experience with laryngoscopy influence technique selection; four techniques are described in detail. Surgeons must be familiar with the nuances of monitoring technique and interpretation; opinion statements address optimizing this technology in children. Adult IONM guidelines may offer strategies for surgical decision making in children. In some cases, delay of second-sided surgery may reduce bilateral RLN injury risk.

Perioperative pain management and opioid-reduction in head and neck endocrine surgery: An American Head and Neck Society Endocrine Surgery Section consensus statement.

This American Head and Neck Society (AHNS) consensus statement focuses on evidence-based comprehensive pain management practices for thyroid and parathyroid surgery. Overutilization of opioids for postoperative pain management is a major contributing factor to the opioid addiction epidemic however evidence-based guidelines for pain management after routine head and neck endocrine procedures are lacking. An expert panel was convened from the membership of the AHNS, its Endocrine Surgical Section, and ThyCa. An extensive literature review was performed, and recommendations addressing several pain management subtopics were constructed based on best available evidence. A modified Delphi survey was then utilized to evaluate group consensus of these statements. This expert consensus provides evidence-based recommendations for effective postoperative pain management following head and neck endocrine procedures with a focus on limiting unnecessary use of opioid analgesics.

Consensus statement by the American Association of Clinical Endocrinology (AACE) and the American Head and Neck Society Endocrine Surgery Section (AHNS-ES) on Pediatric Benign and Malignant Thyroid Surgery.

To provide a clinical disease state review of recent relevant literature and to generate expert consensus statements regarding the breadth of pediatric thyroid cancer diagnosis and care, with an emphasis on thyroid surgery. To generate expert statements to educate pediatric practitioners on the state-of-the-art practices and the value of surgical experience in the management of this unusual and challenging disease in children. A literature search was conducted and statements were constructed and subjected to a modified Delphi process to measure the consensus of the expert author panel. The wording of statements, voting tabulation, and statistical analysis were overseen by a Delphi expert (J.J.S.). Twenty-five consensus statements were created and subjected to a modified Delphi analysis to measure the strength of consensus of the expert author panel. All statements reached a level of consensus, and the majority of statements reached the highest level of consensus. Pediatric thyroid cancer has many unique nuances, such as bulky cervical adenopathy on presentation, an increased incidence of diffuse sclerosing variant, and a longer potential lifespan to endure potential complications from treatment. Complications can be a burden to parents and patients alike. We suggest that optimal outcomes and decreased morbidity will come from the use of advanced imaging, diagnostic testing, and neural monitoring of patients treated at high-volume centers by high-volume surgeons.

Patient experience with electronic health record–integrated postoperative telemedicine visits in an academic endocrine surgery program

BackgroundIn response to the coronavirus 2019 pandemic, telemedicine use has increased throughout the United States. We aimed to measure patient experience with electronic health record-integrated postoperative telemedicine encounters following thyroid and parathyroid surgery. MethodsIn this preliminary study, adult patients receiving postoperative electronic health record–integrated telemedicine video encounters or standard in-person visits after thyroid or parathyroid surgery at a single institution were prospectively enrolled from November 2019 through May 2020. Patients with home zip codes 10 to 75 miles from the medical center were included. Patient experience was assessed using the Consumer Assessment of Health Care Providers and Systems Clinician & Group Visit Survey 2.0 and the Communication Assessment Tool. Top box analysis was performed, defined as the percentage of respondents who chose the most positive response score. ResultsThe cohort consisted of 45 telemedicine and 32 in-person encounters. Both groups reported similar and excellent patient experience and satisfaction (9.7 of 10 for telemedicine vs 9.8 of 10 for in-person encounters, mean difference 0.02, 95% confidence interval, [–0.25 to 0.29]). Similar surgeon communication performance was observed (mean Communication Assessment Tool top box score 83% telemedicine vs 86% in-person, mean difference 3%, 95% confidence interval [–10% to 17%]). Nonlinear increases in monthly telemedicine encounter volume were observed within the section of endocrine surgery (3-fold increase) and the health system (125-fold increase) from November 2019 to May 2020. ConclusionPatients who underwent cervical endocrine surgery reported similarly high rates of satisfaction and excellent surgeon communication following either telemedicine or in-person postoperative encounters. Electronic health record–integrated telemedicine for a subset of low-risk procedures can act as a suitable replacement for in-person encounters. A surge in telemedicine use, stimulated by the coronavirus 2019 pandemic, was experienced at our institution.

Consensus Statement by the American Association of Clinical Endocrinology (AACE) and the American Head and Neck Society Endocrine Surgery Section (AHNS) on Pediatric Benign and Malignant Thyroid Surgery

ObjectivesTo provide a clinical disease state review of recent relevant literature and to generate expert consensus statements regarding the breadth of pediatric thyroid cancer diagnosis and care, with an emphasis on thyroid surgery. To generate expert statements to educate pediatric practitioners on the state-of-the-art practices and the value of surgical experience in the management of this unusual and challenging disease in children. MethodsA literature search was conducted and statements were constructed and subjected to a modified Delphi process to measure the consensus of the expert author panel. The wording of statements, voting tabulation, and statistical analysis were overseen by a Delphi expert (J.J.S.). ResultsTwenty-five consensus statements were created and subjected to a modified Delphi analysis to measure the strength of consensus of the expert author panel. All statements reached a level of consensus, and the majority of statements reached the highest level of consensus. ConclusionPediatric thyroid cancer has many unique nuances, such as bulky cervical adenopathy on presentation, an increased incidence of diffuse sclerosing variant, and a longer potential lifespan to endure potential complications from treatment. Complications can be a burden to parents and patients alike. We suggest that optimal outcomes and decreased morbidity will come from the use of advanced imaging, diagnostic testing, and neural monitoring of patients treated at high-volume centers by high-volume surgeons.

Salivary and lacrimal dysfunction after radioactive iodine for differentiated thyroid cancer: American Head and Neck Society Endocrine Surgery Section and Salivary Gland Section joint multidisciplinary clinical consensus statement of otolaryngology, ophthalmology, nuclear medicine and endocrinology.

Postoperative radioactive iodine (RAI) administration is widely utilized in patients with differentiated thyroid cancer. While beneficial in select patients, it is critical to recognize the potential negative sequelae of this treatment. The prevention, diagnosis, and management of the salivary and lacrimal complications of RAI exposure are addressed in this consensus statement. A multidisciplinary panel of experts was convened under the auspices of the American Head and Neck Society Endocrine Surgery and Salivary Gland Sections. Following a comprehensive literature review to assess the current best evidence, this group developed six relevant consensus recommendations. Consensus recommendations on RAI were made in the areas of patient assessment, optimal utilization, complication prevention, and complication management. Salivary and lacrimal complications secondary to RAI exposure are common and need to be weighed when considering its use. The recommendations included in this statement provide direction for approaches to minimize and manage these complications.

What the thyroid cancer patient wants to know: ThyCa survey by the American Head and Neck Society Endocrine Surgery Section.

To survey a large cohort of thyroid cancer survivors from ThyCa on information needs and expectations of their treatment to better understand the pretreatment counseling, information, and support needs of this population. Anonymous survey of thyroid cancer survivors. One thousand one hundred twenty-four patients with thyroid cancer participated in the survey. Three hundred sixty-two (37.44%) reported not having had a full understanding of their treatment plan and 407 (46.41%) reported that their thyroid cancer treatment did not conform to expectations. Patients diagnosed at younger ages were significantly more likely to report inadequate understanding of the treatment, failure of treatment to meet expectations, and call for greater attention to psychological well-being. Older patients were more likely to report unexpected effects on speech and swallowing. Regardless of age, patients most frequently called for greater attention to management of energy levels (endorsed by 61% of respondents), psychological well-being (50%), and weight changes (48%). Improvements are needed in age-specific communication of thyroid cancer diagnosis and treatment.

Pediatric endocrine surgery development

Отделение детской хирургии на базе ФГБУ “Эндокринологический научный центр” функционирует около двух лет. За время работы хирургическое лечение получили более 500 пациентов с различной эндокринной патологией. В статье обсуждаются современные диагностические подходы и выбор хирургической тактики при заболеваниях, входящих в круг интересов нового направления детской хирургии – эндокринной хирургии детского возраста. В рамках дискуссии обсуждаются варианты радикального лечения болезни Грейвса у детей, рассматриваются положительные и отрицательные стороны хирургического лечения и радиойодтерапии. Приводится собственная статистика послеоперационного гипопаратиреоза. Предлагается оптимизация алгоритма действий при выявлении узлового зоба у детей. При первичном гиперпаратиреозе делается акцент на сложностях послеоперационного ведения пациентов, связанных с особенностями детского возраста, определяющими остроту реакции на водно-электролитные нарушения. Отдельно рассмотрены данные литературы по заболеваниям надпочечников у детей, демонстрируются собственные клинические случаи, потребовавшие хирургического вмешательства. Освещаются возможности современной нейрохирургической техники, применяемой в Эндокринологическом научном центре при операциях на гипофизе у детей. Пациентам различных возрастных групп проводится трансназальное транссфеноидальное удаление опухолей хиазмально-селлярной области с применением эндоскопической ассистенции. В статье также приведены данные исследований в области изучения болезней поджелудочной железы и их хирургического лечения. Большое внимание уделяется гендерному разделу эндокринной хирургии детского возраста. Обсуждается тактика при нарушениях формирования пола, опухолях половых желез у детей, заболеваниях молочных желез. В заключение обрисовываются перспективы развития эндокринной хирургии детского возраста.

Prognostic factors and staging systems in parathyroid cancer: A multicenter cohort study

Parathyroid carcinoma (PC) is an uncommon disease that generally is detected postoperatively and traditionally is associated with a poor prognosis. Our purpose was to evaluate treatment outcomes, prognostic factors, and usefulness of some proposed staging systems for this disease. A multicenter review of patients with surgically resected PC was performed, led by the Spanish Association of Surgery. All surgical units affiliated with its endocrine surgery section were invited to answer a questionnaire that collected several hospital-related, clinical, biochemical, operative, pathologic, and follow-up data. Their relationships with prognosis were assessed by both univariate and multivariate analysis, as well as the effectiveness of three staging systems for parathyroid carcinoma. Of the 6,863 patients undergoing parathyroidectomy, 62 (0.9%) had PC. Of them, 12 (19.3%) died, in 5 cases (8%) because of disease, and 14 (22.6%) suffered recurrence, after a median follow-up of 55 months. The most predictive independent variables on tumor recurrence were intraoperative tumor rupture (hazard ratio [HR] 6.22; 95% confidence interval [CI] 1.19-32.36; P = .030); the presence of mitotic figures within tumor parenchyma cells (HR 4.76; 95% CI 1.24-18.21; P = .022); and allocation in class III according to Schulte differentiated staging classification (HR 5.23; 95% CI 1.41-19.31; P = .013). As to disease-specific survival, poor outcomes were associated with intraoperative tumor rupture (HR 58.71; 95% CI 2.39-1,439.96; P = .013) and distant recurrence (HR 38.74; 95% CI 3.44-435.62; P = .003). In addition to factors associated with tumor histopathology and stage, prognosis of PC is greatly influenced by surgeon's performance, which emphasizes the importance of preoperative diagnosis.

Endocrine surgery as a model for value-based health care delivery

Background:Experts advocate restructuring health care in the United States into a value-based system that maximizes positive health outcomes achieved per dollar spent. We describe how a value-based system implemented by the University of California, Los Angeles UCLA Section of Endocrine Surgery (SES) has optimized both quality and costs while increasing patient volume.Methods:Two SES clinical pathways were studied, one allocating patients to the most appropriate surgical care setting based on clinical complexity, and another standardizing initial management of papillary thyroid carcinoma (PTC). The mean cost per endocrine case performed from 2005 to 2010 was determined at each of three care settings: A tertiary care inpatient facility, a community inpatient facility, and an ambulatory facility. Blood tumor marker levels (thyroglobulin, Tg) and reoperation rates were compared between PTC patients who underwent routine central neck dissection (CND) and those who did not. Surgical patient volume and regional market share were analyzed over time.Results:The cost of care was substantially lower in both the community inpatient facility (14% cost savings) and the ambulatory facility (58% cost savings) in comparison with the tertiary care inpatient facility. Patients who underwent CND had lower Tg levels (6.6 vs 15.0 ng/mL; P = 0.024) and a reduced need for re-operation (1.5 vs 6.1%; P = 0.004) compared with those who did not undergo CND. UCLA maintained its position as the market leader in endocrine procedures while expanding its market share by 151% from 4.9% in 2003 to 7.4% in 2010.Conclusions:A value-driven health care delivery system can deliver improved clinical outcomes while reducing costs within a subspecialty surgical service. Broader application of these principles may contribute to resolving current dilemmas in the provision of care nationally.

Adrenal Surgery in Spain: Final Results of a National Survey

IntroductionThe indications for adrenalectomy could be changing by the availability of laparoscopy and the growing detection of incidentalomas. The Endocrine Surgery Section of the Spanish Association of Surgeons conducted a survey to analyse the current indications for adrenalectomy and their results in Spanish surgical departments. Material and methodsData were gathered as regards the type of hospital and department, volume of procedures, localisation studies and pre-surgical preparations, indications, surgical approach, and results in terms of morbidity and hospital stay. The results of the centres were compared as regards their volume of activity using the Mann–Whitney Test for the quantitative variables and chi squared for the qualitative ones. ResultsThirty-six centres completed the questionnaire and 301 adrenalectomies were reported to be performed in 2008. Most frequent indications were pheochromocytoma (25.2%), non-functioning adenoma (16.2%), aldosteronoma (15.9%), Cushing adenoma (11.2%), metastasis (10.3%), myelolipoma (5.6%), and carcinoma (4.9%).Laparoscopic adrenalectomy was performed in 83.7% of cases (6.7% required conversion to laparotomy). The mean hospital stay was 3.9 days for laparoscopic adrenalectomy and 7.4 days for laparotomy. High-volume units (more than 10 per year) used more frequently the laparoscopic approach (P=.019), and had a shorter overall hospital stay (P<.0001. Laparoscopic adrenalectomy was also associated with a shorter hospital stay (P<.0001). ConclusionsLaparoscopy for adrenalectomy has become the standard practice in Spain, with good results in terms of morbidity and hospital stay. High volume centres have better results as regards the use of minimally invasive surgery and hospital stay.

Cirugía suprarrenal en España: resultados finales de una encuesta nacional

Introduction The indications for adrenalectomy could be changing by the availability of laparoscopy and the growing detection of incidentalomas. The Endocrine Surgery Section of the Spanish Association of Surgeons conducted a survey to analyse the current indications for adrenalectomy and their results in Spanish surgical departments. Material and methods Data was gathered as regards the type of hospital and department, volume of procedures, localisation studies and pre-surgical preparations, indications, surgical approach, and results in terms of morbidity and hospital stay. The results of the centres were compared as regards their volume of activity using the Mann-Whitney Test for the quantitative variables and chi squared for the qualitative ones. Results Thirty-six centres completed the questionnaire and 301 adrenalectomies were reported to be performed in 2008. Most frequent indications were pheochromocytoma (25.2%), non-functioning adenoma (16.2%), aldosteronoma (15.9%), Cushing adenoma (11.2%), metastasis (10.3%), myelolipoma (5.6%), and carcinoma (4.9%). Laparoscopic adrenalectomy was performed in 83.7% of cases (6.7% required conversion to laparotomy). The mean hospital stay was 3.9 days for laparoscopic adrenalectomy and 7.4 days for laparotomy. High-volumen units (more than 10 per year) used more frequently the laparoscopic approach ( P = .019), and had a shorter overall hospital stay ( P < .0001). Laparoscopic adrenalectomy was also associated with a shorter hospital stay ( P < .0001). Conclusions Laparoscopy for adrenalectomy has become the standard practice in Spain, with good results in terms of morbidity and hospital stay. High volume centres have better results as regards the use of minimally invasive surgery and hospital stay.

Results of adrenal surgery. Data of a Spanish National Survey

Given the availability of laparoscopy and the rising detection of incidentalomas, indications for adrenalectomy may be changing. The Endocrine Surgery Section of the Spanish Association of Surgeons designed a survey to assess its indications, techniques, and results in Spanish Surgical Departments. Collected data included hospital and department type, yearly hospital volume of procedures; location studies and preoperative preparation performed, indications, surgical approach and instruments used, and results in terms of morbidity and overall hospital stay. The analysis included a comparison between results of high- or low-volume centers and surgeons, using the Student's t test for quantitative and chi-square test for qualitative variables. Level of significance was set at 0.05. Nineteen centers returned the questionnaire, including 155 adrenalectomies performed in 2008. Most frequent indications were pheochromocytoma (23.2%), aldosteronoma (16.7%), incidentaloma (12.2%), metastasis (10.3%), Cushing adenoma (9.6%), and carcinoma (3.8%). Laparoscopy was performed in 83.9% of cases (9.4% required conversion to laparotomy). Four patients required urgent reoperation. Average hospital stay: 4.6 days (3.3 days after laparoscopy, 7 days after laparotomy). High-volume centers had a greater proportion of laparoscopically treated cases (p = 0.008), more malignant lesions treated (p = 0.03), a shorter overall stay (p < 0.0001), and a shorter stay after laparotomic adrenalectomy (p = 0.01). High-volume surgeons had similar results, and less in-hospital morbidity (p = 0.02). In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidity and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay.

Evolution in the surgical management of well‐differentiated thyroid cancer or not: To dissect or not dissect the central lymph node compartment

Journal of Surgical OncologyVolume 101, Issue 2 p. 101-102 Guest EditorialFree Access Evolution in the surgical management of well-differentiated thyroid cancer or not: To dissect or not dissect the central lymph node compartment Martha A. Zeiger MD, FACS, FACE, Corresponding Author Martha A. Zeiger MD, FACS, FACE [email protected] Department of Surgery, Endocrine Surgery Section, The Johns Hopkins University School of Medicine, Baltimore, MarylandChief, Endocrine Surgery, Professor of Surgery, Oncology, Cellular and Molecular Medicine, The Johns Hopkins University School of Medicine, Blalock 606, Baltimore, MD 21287. Fax: 410-502-1891.Search for more papers by this author Martha A. Zeiger MD, FACS, FACE, Corresponding Author Martha A. Zeiger MD, FACS, FACE [email protected] Department of Surgery, Endocrine Surgery Section, The Johns Hopkins University School of Medicine, Baltimore, MarylandChief, Endocrine Surgery, Professor of Surgery, Oncology, Cellular and Molecular Medicine, The Johns Hopkins University School of Medicine, Blalock 606, Baltimore, MD 21287. Fax: 410-502-1891.Search for more papers by this author First published: 15 January 2010 https://doi.org/10.1002/jso.21385Citations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1 Cooper DS, Doherty GM, Haugen BR, et al.: Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167– 1214. 2 Frazell EL, Foote FW, Jr.: Papillary cancer of the thyroid: A review of 25 years of experience. Cancer 1958; 11: 895– 922. 3 Crile G, Jr.: The fallacy of the conventional radical neck dissection for papillary carcinoma of the thyroid. Ann Surg 1957; 145: 317– 320. 4 Noguchi S, Murakami N: The value of lymph-node dissection in patients with differentiated thyroid cancer. Surg Clin North Am 1987; 67: 251– 261. 5 Mazzaferri EL, Young RL, Oertel JE, et al.: Papillary thyroid carcinoma: The impact of therapy in 576 patients. Medicine (Baltimore) 1977; 56: 171– 196. Citing Literature Volume101, Issue21 February 2010Pages 101-102 ReferencesRelatedInformation

Evaluation for concomitant thyroid nodules and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy

Previous investigators have reported the incidence of thyroid nodules in patients with primary hyperparathyroidism; others have noted the incidence of primary hyperparathyroidism in patients who underwent thyroidectomy. It is well known that both of these entities coexist. In this article, we present a single-center experience with the incidence of concomitant thyroid nodular disease and primary hyperparathyroidism in patients who underwent parathyroidectomy or thyroidectomy. From May 2006 to December 2007, 526 patients underwent thyroidectomy, parathyroidectomy, or both. Operations were performed by surgeons in the Johns Hopkins Endocrine Surgery Section after screening preoperatively for concomitant thyroid nodular disease or primary hyperparathyroidism. Among the 200 patients who underwent a parathyroidectomy, 102 (51.0%) were found to have thyroid nodular disease. Six percent of these 200 patients also had a thyroid malignancy. Of the 326 patients who were primarily seen for thyroid disease, the incidence of primary hyperparathyroidism was 3.1%. By implementing a comprehensive approach to patients who present with thyroid disease or primary hyperparathyroidism, concomitant pathology may be elucidated preoperatively. This approach will facilitate the detection of otherwise unsuspected thyroid cancer and hyperparathyroidism as well as prevent unnecessary reoperative surgery.

Therapeutic options for patients with metastatic gastrointestinal carcinoid

Journal of Surgical OncologyVolume 97, Issue 3 p. 203-204 Editorial Therapeutic options for patients with metastatic gastrointestinal carcinoid Herbert Chen MD, FACS, Corresponding Author Herbert Chen MD, FACS [email protected] Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WisconsinUniversity of Wisconsin, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792. Fax: 608-263-7652.Search for more papers by this author Herbert Chen MD, FACS, Corresponding Author Herbert Chen MD, FACS [email protected] Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WisconsinUniversity of Wisconsin, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792. Fax: 608-263-7652.Search for more papers by this author First published: 08 February 2008 https://doi.org/10.1002/jso.20956Citations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume97, Issue31 March 2008Pages 203-204 RelatedInformation

Surgical Management of Familial Hyperparathyroidism

In the February 2007 issue of the journal, the members of the Section of Endocrine Surgery at the University of Wisconsin under the leadership of Dr. Herb Chen report their experience with radioguided parathyroidectomy in 19 patients with familial hyperparathyroidism (HPT). The cause of HPT was multiple endocrine neoplasia type 1 (MEN1) in 11 patients, multiple endocrine neoplasia type 2 (MEN2) in 1, and presumed nonsyndromic or familial isolated HPT (FIHPT) in 7. The gamma probe accurately localized all hyperplastic parathyroid glands and when combined with the intraoperative parathyroid hormone (IOPTH) assay resulted in the correction of hypercalcemia (at least in the short term) in all 19 patients. Such excellent results require accurate intraoperative identification of the parathyroid glands, including those that may exist in ectopic locations, as well as a thorough understanding of the natural history of the familial syndromes associated with HPT to allow for the proper management of the parathyroids once they are identified. Finding the parathyroid glands is of value only if one knows how many to remove, when to cryopreserve, and when and where to autograft; the gamma probe is just one piece of the puzzle necessary to generate the results as seen from the University of Wisconsin. Familial HPT is caused by several known inherited disorders, but it may also occur in nonsyndromic form with autosomal dominant inheritance or familial tendency. Syndromic disorders in which HPT is a central feature include MEN1 and MEN2A, hyperparathyroidism jaw tumor syndrome (HPT-JT), and familial hypocalciuric hypercalcemia (FHH). The genetic basis of nonsyndromic HPT or FIHPT is unknown, but recent evidence suggests that a causative gene for FIHPT may reside on chromosome 2. Patients with MEN1 typically develop HPT due to hyperplasia of multiple parathyroid glands in early adulthood and essentially all are affected by age 50, though HPT may go undiagnosed for years. Most patients with MEN1 have one or more affected relatives with autosomal dominant transmission of disease. In 75% to 90% of affected families, a causative germline mutation has been identified in the putative tumor suppressor gene, MEN1, located on chromosome 11q13. More than 400 different germline mutations in MEN1 have been reported and are scattered throughout the coding region (exons 2 through 10) as well as in splice sites within noncoding introns. Most mutations are unique to individual families without marked clustering or correspondence to protein functional domains that would suggest genotype-phenotype correlations. Several functional roles for menin (protein product of the MEN1 gene) have been proposed, including regulation of DNA replication and repair, transcriptional activation, and chromatin modification. Patients with MEN1 also commonly develop functioning and nonfunctioning tumors of the pancreatic islet cells and duodenum, and the anterior pituitary gland. Less commonly, they may develop bronchial and thymic carcinoid tumors, adrenal tumors, thyroid neoplasms, and/or meningiomas. Received October 31, 2006; accepted October 31, 2006; published online: February 7, 2007. Address correspondence and reprint requests to: Douglas B. Evans, M.D.; E-mail: devans@mdanderson.org