Surgical Management Of Thyroid Disease Research Articles

Out-of-Pocket Costs for Patients Undergoing Thyroid Surgery.

The aim of this study was to determine out-of-pocket costs (OOPC) in patients undergoing thyroidectomy for benign and malignant conditions in a commercially insured US population. Little is known about OOPC for thyroid surgery in the United States. Retrospective cohort study using claims of patients undergoing thyroidectomy from the IBM Watson Marketscan database from 2008 to 2017. OOPCs accrued from 90 days before surgery to 360 days after thyroid surgery were quantified. Costs were divided into expenditures for inpatient care, outpatient care and outpatient drug costs and over three time periods: from 90 days preoperatively to 30 days post operatively, from 30 days post operatively to 90 days postoperatively, and from 90 days to 1 year after surgery. A total of 45,971 commercially insured patients aged 18 to 95 years who underwent thyroidectomy were identified after excluding patients who changed coverage and patients on capitated plans. The median OOPC per patient in the study period of 90 days before surgery to 360 days after surgery was $2434 [interquartile range (IQR) $1273-$4226], the median insurance reimbursement was $15,520 (IQR $7653-$29,149). Patients undergoing thyroidectomy for malignant conditions had a median OOPC of $3019 (IQR $1596-$5021) compared to $2271 (IQR $1201-3954) for benign conditions ( P < 0.0001).Patients with preferred provider organization coverage had a median OOPC of $2624 (IQR $1458-$4358) compared to HMO patients with a median OOPC of $1529 (IQR $739 to 3058), and high deductible health plans with a median OOPC of $4265 (IQR $2788-$6210) ( P < 0.0001). Despite commercial insurance coverage, patients face substantial OOPCs in the surgical management of thyroid disease in the United States.

Targeted use of intraoperative frozen-section analysis lowers the frequency of completion thyroidectomy

BackgroundThe impact of intraoperative frozen section (iFS) analysis on the frequency of completion thyroidectomy for the management of thyroid carcinoma is controversial. Although specialized endocrine centres have published their respective results, there are insufficient data from primary and secondary healthcare levels. The aim of this study was to analyse the utility of iFS analysis.MethodsIn the Prospective Evaluation Study Thyroid Surgery (PETS) 2 study, 22 011 operations for benign and malignant thyroid disease were registered prospectively in 68 European hospitals from 1 July 2010 to 31 December 2012. Group 1 consisted of 569 patients from University Medical Centre (UMC) Mainz, and group 2 comprised 21 442 patients from other PETS 2 participating hospitals. UMC Mainz exercised targeted but liberal use of iFS analysis for suspected malignant nodules. iFS analysis was compared with standard histological examination regarding the correct distinction between benign and malignant disease. The percentage of completion thyroidectomies was assessed for the participating hospitals.ResultsiFS analysis was performed in 35.70 per cent of patients in group 1 versus 21.80 per cent of those in group 2 (risk ratio (RR) 1.6, 95 per cent c.i. 1.5 to 1.8; P < 0.001). Sensitivity of iFS analysis was 75.0 per cent in group 1 versus 63.50 per cent in group 2 (RR 1.2, 1.2 to 1.3; P = 0.040). Completion surgery was necessary in 8.10 per cent of patients in group 1 versus 20.8 per cent of those in group 2 (RR 0.4, 0.2 to 0.7; P = 0.001).ConclusioniFS analysis is a useful tool in determining the appropriate surgical management of thyroid disease. Targeted use of iFS was associated with a significantly higher sensitivity for the detection of malignancy, and with a significantly reduced necessity for completion surgery.

Executive Summary of the American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults.

The aim of this study was to develop evidence-based recommendations for safe, effective and appropriate thyroidectomy. Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the United States. The medical literature from January 1, 1985 to November 9, 2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches Laryngology Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults.

To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.

Pediatric thyroid surgery: experience in 75 consecutive thyroidectomies

The main objective of this study is to report our experience in a university hospital in the surgical management of thyroid disease in pediatric patients. We also aim to analyze the results and evaluate the efficacy of fine-needle aspiration biopsy (FNAB) and frozen section analysis. A retrospective review of thyroid surgeries from January 1997 to December 2017 was conducted. Patients aged under 18 who underwent total or partial thyroidectomy were included. The indication of the surgery, the investigation results, the surgical technique used and the final diagnosis were reviewed and analyzed. A total of 75 patients were included. 80% (n = 60) were females and 20% (n = 15) were males. The average age was 13.3years ± 3.76 and age range was 3-18years. The indication for thyroidectomy was thyroid nodule in 80% (n = 60), Grave's disease in 13.3% (n = 10), multiple endocrine neoplasm type II (MEN II) in 6.7% (n. 5). FNAB was done in 42.7% (n = 32/75) with sensitivity and specificity of 62.50% and 94.4%, respectively, the positive predictive value was 83.3% and the negative predictive value was 85%. Frozen section, which is a quick intraoperative micro and/or macroscopic examination, was done in 66.7% (n = 50/75). It was malignant in 12% (n = 6/50) and was benign in 88% (n = 44/50). Among benign results, nine (n = 9/44) patients had malignant disease in final pathological diagnosis. Its sensitivity and specificity were 40% and 100%, respectively, the positive predictive value and the negative predictive value were 100% and 79.6%, respectively. Total thyroidectomy was done in 54.7% (n = 41/75) and partial thyroidectomy was done in 45.3% (n = 34/75). Of the 75 patients, 29.3% (n = 22) had thyroid carcinoma on final pathological analysis. Thyroid diseases that require surgical intervention are rare in pediatric populations. However, when surgery is indicated, there is higher risk of malignancy compared to adults. Our study showed that FNAB has a lower specificity and sensitivity compared to adults, and that surgical decision should be made considering all investigations. We also showed that frozen section is considered primarily for papillary thyroid carcinoma but is not reliable for follicular carcinoma or Bethesda IV. Finally, thyroid surgery in children and adolescents must be part of global multidisciplinary management.

Surgical Management of Thyroid Disease in Children

To provide a comprehensive, up-to-date guide for the surgical management of the most common malignant and benign thyroid diseases within the pediatric population. 26.4% of nodules are malignant in the pediatric population. Concerning ultrasound features of hypoechogenicity, irregular margins, increased intranodular blood flow, or microcalcifications should prompt FNA, while size criteria is less important. The Bethesda System is effective in stratifying risk in pediatric nodules. The role of molecular genetic testing to guide patient management is emerging. Total thyroidectomy has become more frequent in the treatment of differentiated thyroid cancer due to its aggressive nature in the pediatric population and concern for recurrence. The role of adjunctive radiofrequency iodine ablation and the impact of extensive resection on survival are controversial. Management of pediatric thyroid disease can be complex and should be managed by a multidisciplinary team with an experienced, high-volume surgeon.

Comprehensive Review of Thyroid Embryology, Anatomy, Histology, and Physiology for Surgeons

Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.

Subtotal Thyroidectomy with Local Cervical Block Anesthesia in Rural Uganda

Introduction: Thyroid disease remains endemic in many developing nations and is largely the consequence of iodine deficiency. Patients with large goiters may have associated compressive symptoms, hyperthyroidism, or report poor quality of life. Surgery is the principal treatment of large symptomatic goiters but remains particularly challenging in resource-limited settings. Constraints to the surgical management of thyroid disease in Uganda include more advanced disease because of delayed presentation, limited supplies and equipment, limited formal training in endocrine surgery, and limited access to anesthesia.1–4 With a population of >40 million people, Uganda has <100 qualified anesthesia providers, with only a minority of those being physicians.2,3 Owing to this shortage of anesthesia providers in Uganda, some surgeons opt to perform thyroidectomies under local anesthesia. This video demonstrates a subtotal thyroidectomy performed under local cervical block anesthesia for the treatment of a large symptomatic goiter. Materials and Methods: The aim of this video is to provide a demonstration of a subtotal thyroidectomy performed by using only local anesthesia. A 52-year-old female presented with a large symptomatic multinodular goiter. The operation was performed as part of a surgical outreach camp at Nebbi hospital in northwestern rural Uganda.5 Owing to inaccessibility of thyroid replacement hormone and low suspicion for malignant disease, a subtotal thyroidectomy was performed. The patient was alert and conscious throughout the procedure. A 0.25% lidocaine solution with diluted adrenaline was used as local anesthetic.6 The lateral aspect of the sternocleidomastoid muscle is injected bilaterally as it is the standard Kocher incision site. Owing to constraints of the operative facility, the procedure was performed without the use of electrocautery or suction irrigation. Hemostasis was achieved with hand-tied 3-0 or 2-0 silk sutures. The recurrent laryngeal nerve and parathyroid glands were identified intraoperatively. The patient's pain level and phonation can be tested throughout the procedure. The specimen was extracted en bloc and pathology analysis grossly demonstrated multinodular goiter. No drain was placed. Results: An effective subtotal thyroidectomy was performed without intraoperative complication. The patient tolerated the procedure well. The recurrent laryngeal nerve and parathyroid glands were preserved. The operative time was <2 hours and blood loss was minimal. There was no stridor, hoarseness, or symptoms of hypocalcemia identified postoperatively. Gross pathology analysis confirmed suspicion of multinodular goiter. Conclusion: Subtotal thyroidectomy for large symptomatic goiters may be performed safely in a resource-limited setting with the use of local anesthetic only. It is an excellent option for patients when access to anesthesia care is limited or unavailable. No competing financial interests exist. Runtime of video: 4 mins 38 secs

Minimal Access Thyroid Surgery in Children: A Retrospective Study and Literature Review

Minimal access thyroid surgery (MATS) is a technique whereby a part of or whole of a thyroid lobe is removed through a small (3–4 cm) neck incision. Its use in the surgical management of thyroid disease in children has not been well elucidated. We present a retrospective case study of 12 patients over the period of 2007 to 2010 to assess the feasibility of MATS in the management of thyroid disease. Minimal access thyroid surgery is a safe and feasible approach for hemithyroidectomy/lobectomy in selected patients. There were no associated adverse events, complications or disease recurrence. We also reviewed the literature and discussed the use of MATS as a routine procedure in selected pediatric patients.

National trends in thyroid surgery and the effect of volume on short‐term outcomes

To characterize contemporary patterns of thyroid surgical care and the effect of volume status on surgical care and short-term outcomes. Retrospective cross-sectional study. Discharge data from the Nationwide Inpatient Sample for 871,644 patients who underwent surgery for thyroid disease in 1993 through 2008 were analyzed using cross-tabulations and multivariate regression modeling. Surgical cases increased from 364,288 in 1993 through 2000 to 507,356 in 2001 through 2008, with an increase in thyroid cancer surgical cases from 28% to 34%. Cases performed by high-volume surgeons increased from 12% in 1993 through 2000 to 25% in 2001 through 2008, whereas cases performed by very-low volume surgeons decreased from 51% to 34% (P < .001). Cases performed at high-volume hospitals increased from 14% in 1993 through 2000 to 29% in 2001 through 2008, whereas cases performed at very-low volume hospitals decreased from 46% to 33% (P < .001). High-volume surgeons were significantly more likely to perform total thyroidectomy (odds ratio [OR] = 1.4, P < .001) and had a lower incidence of recurrent laryngeal nerve injury (OR = 0.7, P = .024), hypocalcemia (OR = 0.7, P = .002), and in-hospital death (OR = 0.3, P = .004). High-volume hospital care was not associated with extent of surgery, postoperative morbidity, or mortality after adjusting for surgeon volume. After controlling for other variables, thyroid surgery in 2001 through 2008 was associated with an increase in cases performed by low-volume (relative risk ratio [RRR] = 1.5, P < .001), intermediate-volume (RRR = 1.7, P < .001), and high-volume surgeons (RRR = 2.1, P < .001), high-volume hospitals (RRR = 2.0, P = .008), total thyroidectomy (RRR = 2.1, P < .001), and neck dissection (RRR = 1.3, P = .016). These data reflect changing trends in the surgical management of thyroid disease, with meaningful differences in the type of surgical care provided by high-volume surgeons.

Radioactive iodine scanning is not beneficial but its use persists for euthyroid patients

BackgroundRadioactive iodine (RAI) scanning is a method of determining the functional status of thyroid nodules. Historically, practitioners thought “cold” or inactive nodules were more likely malignant. However, surgeons no longer find these scans helpful for preoperative management of euthyroid patients. The purpose of this study was to evaluate the utility of RAI scans. MethodsWe retrospectively reviewed cases of euthyroid patients (thyroid-stimulating hormone > 1.0 mIU/L) who underwent RAI scans before thyroid surgery at our institution between 1994 and 2011. We correlated the RAI scan results with final pathology. We considered RAI scans concordant with pathology when we found a malignancy on the same lobe as a cold nodule. We also tabulated the specialty and affiliation of the ordering physicians. ResultsA total of 109 euthyroid patients underwent RAI scanning as part of their preoperative workup. Of these, 88 patients (81%) had a cold nodule. A malignancy concordant with the RAI scan findings occurred in only 15 of these patients (17%). Non-surgical specialties ordered 90 scans (95%). Only 11 of these scans (10%) were performed in the past 5 y, and physicians outside the academic institution ordered all 11 (100%) of these. A linear regression of RAI scanning per year yielded a slightly negative slope (m–0.32 per year). ConclusionsRadioactive iodine scanning is not useful for the surgical management of thyroid disease in euthyroid patients because it poorly predicts malignancy. The overall use of RAI scans is trending downward, but they are still ordered by non-surgical referring physicians.

Robotic transaxillary thyroidectomy with gasless approach in a girl with goitre

Robotic-assisted transaxillary thyroidectomy is a minimally invasive approach for the removal of the thyroid through the axilla. This technique eliminates a visible scar and affords excellent optics of the cervical anatomy. We sought to describe the technique and outcome for transaxillary gasless subtotal thyroidectomy in the paediatric population. A 13 year-old female with an enlarged goitre underwent a transaxillary robot-assisted gasless subtotal thyroidectomy in an academic institution. The main outcome measures were feasibility of the robotic approach, patient and gland characteristics, operative time and complications. There was no conversion to laparoscopic or open surgery. The robotic docking time was 110 min and total operative time was 150 min. The patient tolerated the procedure well. Estimated blood loss was 10 ml. The patient was discharged within 24 h. There were no perioperative or postoperative complications. In addition there was no evidence of postoperative vocal cord palsy or paresis. This initial experience demonstrates that this technique can be a feasible, safe and effective method for subtotal thyroidectomy in the paediatric population. The use of robotic technology for endoscopic thyroid surgery could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid disease.

Thyroid disease associated with cowden syndrome: A meta-analysis

We investigated the pathology and surgical management of thyroid disease in patients with Cowden syndrome (CS). A query of the PubMed database between 2001 and January 2010 was performed using the terms "cowden syndrome OR cowden's syndrome OR cowden disease OR cowden's disease." Original articles, reviews, case reports, and case series were included. Articles were excluded if they were not written in English, did not present case/cases of CS, or did not include patient information to qualify for a diagnosis of CS. Ninety-five articles met the inclusion and exclusion criteria. A total of 181 cases were analyzed. Of the 181 patients, 99 female (54.7%) and 77 male patients (42.5%) had sex reported. The age at presentation ranged from 3 days to 78 years. Ninety-six patients (96/181, 53.0%) were reported to have thyroid disease. Surgical management of thyroid disease was performed in 80.2% (77/96) of patients with thyroid disease, with total thyroidectomy being the most common operation reported (23/77, 29.9%). Thyroid pathology reported with CS patients included goiter (39/96, 40.6%), adenoma (24/96, 25%), unknown/unspecified pathology (8/96, 8.3%), follicular carcinoma (7/96, 7.3%), thyroiditis (7/96, 7.3%), papillary carcinoma (6/96, 6.3%), cancer (unknown type) (3/96, 3.1%), medullary carcinoma (1/96, 1%), and hyperthyroidism (1/96, 1%). Careful monitoring of thyroid disease in CS patients is imperative.

Transaxillary Gasless Robotic Thyroidectomy&lt;subtitle&gt;A Single Surgeon's Experience in North America&lt;/subtitle&gt;

To describe a robotic technique for transaxillary gasless thyroidectomy with the addition of intraoperative peripheral nerve monitoring in the surgical management of thyroid disease. Prospective study. Academic institution. Fifty patients underwent robotic transaxillary thyroidectomy from September 1, 2009, to August 31, 2010. All the patients underwent preoperative and postoperative direct laryngoscopy. The patients' demographic information, operative times, complications, postoperative hospital stay, and the surgeon's learning curve were evaluated. Feasibility of the robotic approach, patient and gland characteristics, operative time, and complications. Thirty-nine females and 11 males with a mean age of 48.2 (age range, 13-76) years were included in the study. A total of 37 surgical procedures were lobectomies, and 13 were total or near-total thyroidectomies. The mean nodule size (range) was 24.9 (10-72) mm. The mean operative time (range) was 122.5 (81-280) minutes, mean docking time (range) was 10.1 (6-15) minutes, and mean console time (range) was 55.5 (10-140) minutes. Mean blood loss (range) was 25 (10-100) mL. There were no conversions to conventional open surgery. One patient developed transient radial nerve neuropathy that resolved spontaneously. There were no other postoperative complications. In addition, there was no evidence of vocal cord palsy or paresis on postoperative laryngoscopy. All the patients were discharged home within 24 hours. Subjectively, the cosmetic results were considered excellent owing to the hidden anatomical location of the incision site. We have demonstrated the technique to be feasible, safe, and applicable for patients with thyroid disease. We believe that the use of robotic technology for endoscopic thyroid surgical procedures could overcome the limitations of conventional endoscopic surgical procedures in the surgical management of thyroid disease. To our knowledge, this is the first reported large series using this novel technique in the United States.

Isthmusectomy: The Un‐thyroidectomy

Objective: Learn the indications, surgical technique, and role of isthmusectomy in the overall surgical management of thyroid disease. Method: Prospective observational case series in which 7 patients with lesions confined to the thyroid isthmus underwent isthmusectomy. Results: All of the patients successfully underwent isthmusectomy. There were no operative complications, and blood loss was minimal. In 6 patients benign pathology was found. The other patient had a papillary thyroid cancer and was converted to a total thyroidectomy at the same setting. None of the patients with benign disease required thyroid supplementation postoperatively. Conclusion: For lesions 3 cm and under, isthmusectomy is a safe alternative to lobectomy with isthmusectomy for lesions confined to the thyroid isthmus. The technique is straight forward and can be performed as an outpatient procedure. As the majority of the gland is preserved, postoperative thyroid supplementation is seldom required.

Thyroid Disease Associated with Cowden Syndrome: A Meta‐Analysis

Background We investigated the pathology and surgical management of thyroid disease in patients with Cowden syndrome (CS). Methods A query of the PubMed database between 2001 and January 2010 was performed using the terms “cowden syndrome OR cowden's syndrome OR cowden disease OR cowden's disease.” Original articles, reviews, case reports, and case series were included. Articles were excluded if they were not written in English, did not present case/cases of CS, or did not include patient information to qualify for a diagnosis of CS. Ninety-five articles met the inclusion and exclusion criteria. A total of 181 cases were analyzed. Results Of the 181 patients, 99 female (54.7%) and 77 male patients (42.5%) had sex reported. The age at presentation ranged from 3 days to 78 years. Ninety-six patients (96/181, 53.0%) were reported to have thyroid disease. Surgical management of thyroid disease was performed in 80.2% (77/96) of patients with thyroid disease, with total thyroidectomy being the most common operation reported (23/77, 29.9%). Thyroid pathology reported with CS patients included goiter (39/96, 40.6%), adenoma (24/96, 25%), unknown/unspecified pathology (8/96, 8.3%), follicular carcinoma (7/96, 7.3%), thyroiditis (7/96, 7.3%), papillary carcinoma (6/96, 6.3%), cancer (unknown type) (3/96, 3.1%), medullary carcinoma (1/96, 1%), and hyperthyroidism (1/96, 1%). Conclusion Careful monitoring of thyroid disease in CS patients is imperative. © 2012 Wiley Periodicals, Inc. Head Neck, 2013

Thyroïdectomie endoscopique par une approche médiane avec insufflation gazeuse : analyse des 100 premiers patients

Objective To report the initial experience with videoscopic thyroidectomy using a cervical approach with median placement of the optical trocar and gas insufflation. Patients and methods Retrospective study of the first 100 consecutive patients. Results Seven isthmectomies, 86 lobectomies, and 7 total thyroidectomies were performed. Parathyroidectomy for hyperparathyroidism was also performed in 3 patients. Mean operative time was 77 minutes. No post-operative subcutaneous emphysema was noted. Conversion to open surgery occurred in 10% of cases but the conversion rate decreased to 2.6% when the harmonic scalpel became available. Post-operative complications included one transient recurrent laryngeal nerve palsy. There were no hematomas and no hypocalcemia. The mean post-operative pain scale was 2.7 (on a visual scale of 1-10). Mean hospital stay was 1.5 days. The cosmetic result was considered excellent. Conclusions Endoscopic total thyroidectomy aided by gas insufflation is technically feasible. The harmonic scalpel aids greatly in dissection and hemostasis. It is a valid option in the surgical management of thyroid disease but careful pre-operative selection of patients is mandatory.

Interspecialty and intraspecialty differences in the management of thyroid nodular disease and cancer

The management of thyroid cancer includes multiple medical specialties. Physicians from different specialties may vary in opinion regarding the optimal investigation and treatment of patients. Little data exist evaluating the differences within or between various specialties treating thyroid disease. This study aims to examine responses from a variety of specialty physicians closely involved in the medical or surgical management of thyroid disease to provide evidence as to whether any difference exists. A cross-sectional survey of attendees at the 5(th) Biennial Course on the Management of Thyroid Nodular Disease and Cancer was conducted using an anonymous electronic touch pad system. Touch pads were given to 213 attendees who were asked to respond to 44 questions. This study analyzes the responses obtained from 19 selected questions (43%) and compares the results between endocrinologists (n = 48), general surgeons (n = 41), otolaryngologists (n = 61), and pathologists (n = 20). Responses were obtained from 69% of endocrinologists, 68% of general surgeons, 72% of otolaryngologists, and 65% of pathologists. Statistically significant interspecialty differences were observed in 12 (63%) of 19 questions. Each question and a summary of responses from all touch pads were recorded. Significant differences in the attitudes toward, and presumably the practice of, managing thyroid nodular disease and cancer exist between specialties. An understanding of these differences is helpful when working as a multidisciplinary team to optimize patient care.