Concepts in Thyroid, Parathyroid, and Adrenal Surgery

Abstract

Surgical endocrinology is a unique surgical discipline that goes beyond the technical aspects of an operation. Understanding the endocrinopathy that functioning endocrine tumors create, recognizing how to appropriately prepare the patient for surgical intervention, understanding the physiological changes once such tumor has been removed, all are part of the endocrine surgeon’s responsibility. Thyroid, parathyroid, and adrenal surgery are constantly evolving. Screening ultrasounds and liberal use of cross-sectional imaging have increased the recognition of small tumors in the thyroid and adrenal glands. Not all these incidental lesions require surgical resection, but each requires assessment by the surgeon to appropriately select those that do require surgery. The addition of adjuncts such as intraoperative PTH has increased the surgical armamentarium for the parathyroid surgeon. Yet appropriate patient selection and application of the correct operative approach are paramount if the operation is to be successful. Understanding the concepts of thyroid, parathyroid, and adrenal surgery are important for the surgeon embarking on operative intervention on these glands. Outlined in this chapter are some guiding principles in the management of thyroid, parathyroid, and adrenal disease.