Surgery of the Thyroid and Parathyroid Glands

3rd Edition - April 10, 2020
Author: Gregory W. Randolph
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 6 6 1 2 7 - 0

Bringing together more than over 120 expert contributors from otolaryngology, general surgery, endocrinology, and pathology, Surgery of the Thyroid and Parathyroid Glands, 3rd E… Read more

Surgery of the Thyroid and Parathyroid Glands

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Bringing together more than over 120 expert contributors from otolaryngology, general surgery, endocrinology, and pathology, Surgery of the Thyroid and Parathyroid Glands, 3rd Edition, presents an interdisciplinary approach to surgical management and treatment of benign and malignant disease. This renowned text/atlas is an ideal resource at all levels of surgical experience: for residents and junior surgeons, it clearly provides all relevant anatomy, surgical procedures, and workup; for experienced surgeons, it details the management of difficult cases, including revision surgery. Highly illustrated and accompanied by dozens of videos, this edition brings you up to date with the full continuum of care in thyroid and parathyroid surgery.

Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
Foreword to the Second Edition
Foreword
Preface
Acknowledgments
Video Contents
Section 2 Benign Thyroid Disease
Section 3 Preoperative Evaluation
Section 4 Thyroid Neoplasia
Section 5 Thyroid and Neck Surgery
Section 6 Postoperative Considerations
Section 7 Postoperative Management
Section 8 Parathyroid Surgery
Half Title
Section 1: Introduction
Introduction
1: History of Thyroid and Parathyroid Surgery
The early years
The surgical revolution
Development of modern thyroid surgery
Laryngeal nerves
Parathyroid glands
Historical vignette of endocrine surgery at the massachusetts general hospital
Summary
2: Applied Embryology of the Thyroid and Parathyroid Glands
Acknowledgment
The Thyroid Gland
The Recurrent Laryngeal Nerve
Superior Laryngeal Nerve
Applied Embryology of the Parathyroid Glands
3: Thyroid Physiology and Thyroid Function Testing
Thyroid physiology
Diagnostic thyroid testing
Evaluation of hypothyroidism
Evaluation of hyperthyroidism
Thyroid function testing in pregnancy
Conclusions
Section 2: Benign Thyroid Disease
Introduction
4: Thyroiditis
Introduction
Hashimoto’s thyroiditis (chronic lymphocytic thyroiditis)
Subacute thyroiditis (de quervain’s thyroiditis)
Sporadic silent and postpartum thyroiditis
Drug-induced thyroiditis
Acute suppurative/infectious thyroiditis
Invasive fibrous thyroiditis (riedel’s thyroiditis)
Chronic infectious thyroiditis
Radiation-associated thyroiditis
Palpation thyroiditis
5: Thyroglossal Duct Cysts and Ectopic Thyroid Tissue
Embryology
Thyroglossal Duct Cysts
Ectopic Thyroid Tissue
6: Surgery of Cervical and Substernal Goiter
General Considerations
Anterior Mediastinal Goiter (Substernal Goiter Type I)
Posterior Mediastinal Goiter (Substernal Goiter Type II)
Isolated Mediastinal Goiter (Substernal Goiter Type III)
Prevalence, Pathogenesis, and Natural History
Clinical Presentation
Goiter Workup
Evaluation of Upper Airway Compromise and Other Regional Symptoms
Treatment Options
Intubation of the Goiter Patient and Laryngeal Edema
Goiter Surgery
Surgical Technique for Goiter
Postoperative Complications of Goiter Surgery
Recurrent Goiter: Prevention and Treatment
7: Approach to the Mediastinum: Transcervical, Transsternal, and Video-Assisted
Indications
Surgical approaches to the mediastinum
Video-assisted thoracoscopy
Summary
8: Surgical Management of Hyperthyroidism
Introduction
Graves’ Disease
Toxic Nodular Goiter
Toxic Multinodular Goiter
Solitary Toxic Nodule
9: Reoperation for Benign Thyroid Disease
Introduction
Epidemiology
Clinical Presentation of Recurrent Nodular Goiter
Development of Contralateral Disease after Previous Lobectomy
Initial Inadequate Partial Resection or Enucleation for Nodular Goiter
Initial Bilateral Subtotal Procedure for Multinodular Goiter
Recurrent Disease in an Embryologic Remnant after Total Thyroidectomy
Underlying Aggressive Benign Nodular Disease Causing Recurrence
Preoperative Evaluation
Operative Strategy
Postoperative Complications
Postoperative Management and Prevention of Further Recurrence
Management of Recurrent Graves’ Disease
Conclusion
Section 3: Preoperative Evaluation
Introduction
10: The Evaluation and Management of Thyroid Nodules
Introduction
Risk factors for nodules and malignancy
Signs, symptoms, and physical examination
Laboratory testing
Screening for thyroid nodules
Incidentally found thyroid nodules
Ultrasound evaluation for known or suspected thyroid nodules
Evolving imaging modalities
Size, growth pattern, and multinodularity
Cervical lymph nodes
Thyroid nodule risk stratification
Fine needle aspiration, bethesda classification, and molecular testing
Management of thyroid nodules
Conclusion
11: Fine-Needle Aspiration of the Thyroid Gland: The 2017 Bethesda System
Introduction
Indications for Thyroid FNA
FNA Technique
Accuracy of Thyroid FNA
Reporting Terminology: The Bethesda System
Nondiagnostic Thyroid Aspirates
Benign Conditions
Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance
Suspicious for A Follicular Neoplasm/Follicular Neoplasm: Follicular Adenomas and Follicular Carcinomas
Hürthle Cell Neoplasms
Malignant Tumors
Thyroid FNA Complications
12: Fine-Needle Aspiration and Molecular Analysis
Introduction
Principles of Molecular Testing
ThyroSeq®
AFIRMA® Expression Classifier
Gene Sequencing Classifier
ThyGeNext®-ThyraMIR®
Choosing a Molecular Test
Illustrative Cases
Future Applications
Conclusion
13: Ultrasound of the Thyroid and Parathyroid Glands
Introduction
Physics and Principles of Ultrasound
Thyroid Ultrasound
Ultrasound Characteristics of Malignant Lesions
Ultrasound-Guided Thyroid Procedures
Sonography of Neck Nodes
Parathyroid Ultrasound
Summary
14: Preoperative Radiographic Mapping of Nodal Disease for Papillary Thyroid Carcinoma
Macroscopically Positive Versus Microscopically Positive Metastasis
Importance of Radiographic Detection of Macroscopically Positive Nodes PrEoperatively
Central Neck Nodes
Lateral Neck Nodes
Preoperative Radiographic Evaluations: Ultrasounds and Cat Scans
Physical Examination
Ultrasound
CT Scanning with Contrast
Combination of CT Scan and Ultrasound
15: Laryngeal Examination in Thyroid and Parathyroid Surgery
Introduction
Anatomy and the voice
Reported prevalence of recurrent laryngeal nerve paralysis
Glottic examination and the voice
Voice symptoms with normal vocal fold mobility
Vocal cord paralysis without voice symptoms
Rationale for preoperative laryngeal examination
Laryngeal examination guidelines
Rationale for postoperative laryngeal examination
Flexible laryngoscopy: a standard technique to be mastered by all thyroid surgeons
Summary
16: Radiofrequency and Laser Ablation of Thyroid Nodules and Parathyroid Adenoma
Introduction
Radiofrequency Ablation
Follow-Up Evaluation
Laser Ablation
Autonomously Functioning Thyroid Nodules
Alternative Therapies
Parathyroid Tumors
Future Perspectives
Conclusion
Section 4: Thyroid Neoplasia
Introduction
17: Differentiated Thyroid Cancer Incidence
Incidence of Differentiated Thyroid Cancer
Overview of Current Incidence Rates
Recent Trends in the Incidence of Differentiated Thyroid Cancer
Mortality Trends of Differentiated Thyroid Cancer
The Effect of the Increased Incidence of Thyroid Cancer
Managing the Increasing Incidence of Thyroid Cancer
Conclusions and next steps
18: Molecular Pathogenesis of Thyroid Neoplasia
Introduction
Thyroid Cancer Epidemiology
Pathology
Thyroid Cancer Prognosis
Germline Genetics of Thyroid Cancer
Somatic Genomics of Thyroid Cancer
Clinical Implications of the Somatic Genomic Data
Conclusions
19: Papillary Thyroid Cancer
Introduction
Epidemiology
Factors that may Contribute to Thyroid Cancer Risk
Factors Influencing Prognosis
Initial Treatment of Papillary Thyroid Cancer
Response to Therapy
Long-Term Management and Surveillance
20: Papillary Thyroid Microcarcinoma
Prevalence: Autopsy Series and Incidental Finding at the Time of Thyroid Surgery
Clinical Incidence and Prevalence
Clinical Series of Patients with Micropapillary Cancer
Observational Data and Active Surveillance
Impact of Initial Surgery
Completion Thyroidectomy
Node Dissection
Radioiodine
Braf
Postoperative Surveillance
Summary and Recommendations
21: Papillary Carcinoma Observation
Introduction
Disease Progression During Active Surveillance of Low-Risk Papillary Thyroid Cancer
Clinical Framework for an Active Surveillance Management Strategy
Indications to Move from Active Surveillance to Surgical Intervention
Active Surveillance: Practical Application
Research Needs
Conclusion
22: Follicular Thyroid Cancer
Introduction
Epidemiology
Etiology
Diagnosis
Treatment
Prognosis
Summary
23: Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP)
Introduction
Definition
Epidemiology
Etiology
Diagnosis
Treatment
Prognosis
Summary
24: Dynamic Risk Group Analysis and Staging for Differentiated Thyroid Cancer
Introduction
Initial Risk Stratification
Response to Therapy Assessment
Integrating Initial Risk Estimates with Response to Therapy (Dynamic Risk Assessment)
Representative Case Example
Predicting Clinical Outcomes Using Response to Therapy Variables Superimposed on Initial ATA Risk Stratification
Summary
25: Hürthle Cell Tumors of the Thyroid
Introduction
Pathology
Presentation and Natural History
Genetics of Hürthle Cell Tumors
Staging and Prognostic Factors
Preoperative Evaluation
Surgery
Hürthle Adjuvant Therapy
Follow-Up
Summary
26: Sporadic Medullary Thyroid Carcinoma
Introduction
Pathophysiology
Genetics: Sporadic Versus Hereditary
Diagnostic Considerations, Workup, and Staging
Primary Surgical Treatment
Follow-Up and Surveillance
Surgical Management of Recurrent Disease
Radiation Therapy for MTC
Distant Metastatic Disease and Systemic Therapy for MTC
Conclusion
27: Syndromic Medullary Thyroid Cancer: MEN 2A and MEN 2B
Introduction
Clinical Presentation by Genotype
Evaluation of Gene Carriers for Surgery
Surgery
Conclusion
28: Anaplastic Thyroid Cancer and Primary Thyroid Lymphoma
Introduction
Evaluation of a Patient with Rapidly Enlarging Neck Mass
Pathologic Evaluation of a Rapidly Growing Neck Mass
Anaplastic Thyroid Cancer
Clinical Course and Prognosis
Radiotherapy
Primary Thyroid Lymphoma
29: Pediatric Thyroid Cancer
Introduction
Etiology
Pathology
Genetics
Presentation and Preoperative Evaluation
Treatment
Surgical Management of FTC
Surgical Management of MTC
Radioactive Iodine Therapy for Children with Thyroid Cancer
Summary
30: Familial Nonmedullary Thyroid Cancer
Introduction
Epidemiology
Classification of Familial Disease
Clinical Features
Tumor Histology
Genetics of FNMTC
Screening and Surveillance
Treatment
Prognosis/Outcome
Summary
Section 5: Thyroid and Neck Surgery
Introduction
31: Principles in Thyroid Surgery
Introduction
Extent of Thyroidectomy
Extent of Surgery Based on Fna Result
Nomenclature of Thyroidectomy
Thyroidectomy Surgical Steps
32: Robotic and Extracervical Approaches to the Thyroid and Parathyroid Glands
Introduction
Patient Selection, Indications, and Contraindications
Surgical Technique
Postoperative Care
Conclusions
33: Transoral Thyroidectomy
History of Transoral Thyroidectomy
Better Cosmetic RESULTS are a Natural Outcome of Process Improvement
Remote-Access Thyroid Surgery is more Popular in Asia Than in the Western World?
Why Offer Remote Access Thyroid Surgery at All?
TransOral Thyroid Surgery (TOTS) Versus Other Remote Access Approaches
Patient Selection and Contraindications
Preoperative Workup
Technique
Outcomes
Future directions
34: Minimally Invasive Video-Assisted Thyroidectomy
Introduction
Indications
Instruments
Surgical Technique
Personal Experience
Minimally Invasive Video-Assisted Neck Dissection
35: Surgical Anatomy and Monitoring of the Superior Laryngeal Nerve
History
Anatomy
Physiology and Pathophysiology
Surgical Technique
Diagnosis of EBSLN Paralysis
IBSLN Monitoring
Conclusion
36: Surgical Anatomy and Monitoring of the Recurrent Laryngeal Nerve
Introduction
Surgical Anatomy
Visual Appearance
Surgical Approaches to the RLN
RLN Surgical Dissection Tips and Pitfalls
RLN Monitoring
IONM Setup and Standards
Continuous Neural Vagal Monitoring (C-IONM)
Management of Infiltrated Nerve
Management of Neural Injury
Vocal Cord Recovery: Timing and Assessment
SLN Monitoring
37: Surgery for Locally Advanced Thyroid Cancer: Larynx, Tracheal Invasion, and Esophageal
Signs and Symptons of Invasive Thyroid Cancer
Imaging
Mechanism for Visceral Invasion by Thyroid Cancer
Surgical Management
Management of The Recurrent Laryngeal Nerve in Invasive Thyroid Cancer
Tracheal Invasion
Laryngeal Invasion
Cricoid Invasion
Advanced Laryngeal Invasion
Esophageal Invasion
Conclusion
38: Central Neck Dissection: Indications and Technique
Introduction
Anatomy
Terminology
Therapeutic Central Lymph Node Dissection
Elective/Prophylactic Central Neck Dissection
Summary of Indications
Preoperative Evaluation
Surgical Technique
Bilateral Paratracheal Dissection
39: Lateral Neck Dissection: Indications and Technique
Anatomy of the Neck
Thyroid Gland Lymphatics
Risk Factors for Lymph Node Metastases
Lymph Node Metasis and its Effect on Disease Outcome
Management of the N0 Lateral Neck in Differentiated Thyroid Cancer
Management of the N0 Lateral Neck in Medullary Thyroid Cancer
Management of the N+ Lateral Neck
Radioactive Iodine for Nodal Metastases
Types of Neck Dissection
Technique
Closure and Postoperative Care
Complications
40: Incisions in Thyroid and Parathyroid Surgery
Introduction
Historical Perspectives
General Principles
Specific Procedure Considerations
Best Practices
41: Surgical Pathology of the Thyroid Gland
Introduction
Benign Neoplasms: Adenomas and Adenomatous Nodules
Variants of Follicular Adenoma
Malignant Neoplasms
Papillary Carcinoma
Variants of Papillary Cancer
Immunohistochemistry of Papillary Carcinoma
Follicular Carcinoma
Molecular Pathology of Follicular Carcinoma
Well-Differentiated Follicular “Tumors of Undetermined/Uncertain Malignant Potential”
Hürthle cell / Oncocytic Follicular Tumors
“High-Grade” Thyroid Carcinomas
Poorly Differentiated Carcinoma
Anaplastic Carcinoma
Follicular-Derived Familial Tumors
Medullary Carcinoma
Tumors with Thymic or Related Branchial Pouch Differentiation
Mucoepidermoid Carcinoma of Thyroid Gland
Primary Nonepithelial Tumors of Thyroid
Carcinoma in Thyroglossal Duct Cyst and Ectopic Thyroid Tissue
Pathologist and Thyroid
Intraoperative Assessment of Thyroid Nodules
Gross Examination of Thyroid Specimens
Histopathologic Reporting of Thyroid Tumors
Section 6: Postoperative Considerations
Introduction
42: Pathophysiology of Recurrent Laryngeal Nerve Injury
Introduction
Variations in Symptoms
Configuration of the Paralyzed Vocal Fold
Biology of Nerve Injury and Regeneration
Mechanisms of Intraoperative Laryngeal Nerve Injury
Why are Vocal Folds Immobile Despite Reinnervation?
Muscle Compartments and Laryngeal Motion
Preferential Reinnervation
Acute Management of the Transected Nerve
Summary
43: Management of Recurrent Laryngeal Nerve Paralysis
Introduction
Unilateral Vocal Fold Paralysis
Management of Unilateral Vocal Fold Paralysis
Bilateral Vocal Fold Immobility
Summary
44: Nonneural Complications of Thyroid and Parathyroid Surgery
Introduction
Hypoparathyroidism
Hypothyroidism
Thyrotoxic Storm
Hemorrhage and Hematoma
Hypertrophic Scar
Seroma
Infection
Aerodigestive Tract Injury
Airway Complications
Methylene Blue
Rare Complications
Mortality
45: Quality Assessment in Thyroid and Parathyroid Surgery
History of Quality Improvement in Medicine
Defining Quality
Measuring Quality
Improving Quality
Future Directions
Conclusion
46: Ethics and Malpractice in Thyroid and Parathyroid Surgery
Ethical Issues
The Surgeon’s Responsibility
Malpractice Issues
Conclusions
Section 7: Postoperative Management
Introduction
47: Postoperative Management of Differentiated Thyroid Cancer
Goals of Postoperative Management
Treatment According to Risk of Cancer Recurrence
Dynamic Risk Assessment
Follow-Up
Prognosis
Treatment of Distant Metastases
Conclusion
48: Postoperative Radioactive Iodine Ablation and Treatment of Differentiated Thyroid Cancer
Introduction
Why RAI Therapy For Thyroid Cancer Management?
Selective Use of RAI Therapy
Role of Postoperative Disease Assessment
Postoperative Use of Rai Therapy Using a Selective Use Approach
Thyroid Hormone Withdrawal Versus Recombinant Thyroid-Stimulating Hormone
Choice of Administered RAI Activity Based on Clinicopathologic Presentation
Conclusion
49: External Beam Radiotherapy for Thyroid Malignancy
Introduction
Differentiated Thyroid Cancer
Medullary Thyroid Cancer
Anaplastic Thyroid Cancer
Treatment of Metastatic Disease
Lymphoma
Indolent (Low-Grade) Lymphomas
Aggressive Histology Lymphomas
External Beam Radiotherapy Technique
Toxicity From External Beam Radiotherapy
50: Reoperative Thyroid Surgery
Introduction
Indications for Revision Surgery
Routine Postoperative Surveillance
Management Options
Surgical Management
Reoperative Surgery: Completion Thyroidectomy
Reoperative Surgery: Central Neck Dissection-Paratracheal and Superior Mediastinal Dissection
Conclusion
51: Nonsurgical Treatment of Thyroid Cysts, Nodules, Thyroid Cancer Nodal Metastases, and Hyperparathyroidism: The Role of Percutaneous Ethanol Injection
Introduction
General Principles of us-Guided Percutaneous Ethanol Injection of Cysts and Tumors
Ultrasonography Imaging Anatomy of Head and Neck
Etiologies Amenable to pei in Head and Neck Endocrine Tumors
The procedure of Cyst Injection
Outcomes of PEI in Cystic and Predominantly Cystic Nodules
The procedure of Alcohol Injection into Solid Nodules
Alcohol Ablation of Malignant Metastatic Lymphadenopathy in Thyroid Cancer
Techniques, Materials Used, and Practical Considerations
Cost Effectiveness of PEI for Metastatic Lymphadenopathy
Percutaneous Ethanol Injection of Parathyroid Adenoma and Hyperplasia
Risks and Side Effects of Alcohol Injection
Strategies for Reducing Risk of Ethanol Extravasation and Related Tissue Damage
Procedure Suite Safety Policies, Complication Recognition and Mitigation
Summary and Conclusions
52: Medical Treatment Horizons for Metastatic Differentiated and Medullary Thyroid Cancer
Introduction
Differentiated Thyroid Cancer Subtypes
Medullary Thyroid Carcinoma
Section 8: Parathyroid Surgery
Introduction
53: Primary Hyperparathyroidism: Pathophysiology, Surgical Indications, and Preoperative Workup
Clinical Presentations of Primary Hyperparathyroidism
Epidemiology of PHPT
Skeleton
Bone Densitometry
Bone Histomorphometry
Fractures
Nephrolithiasis
Other Organ Involvement
Normocalcemic Primary Hyperparathyroidism
Pathology
Clinical Course with and Without Surgery
Surgery
Medical Management
Diagnosis and Course of Normocalcemic Primary Hyperparathyroidism
Drug Treatment
Calcimimetic Agents
Unusual Presentations
Parathyroid Cancer
54: Guide to Preoperative Parathyroid Localization Testing
Introduction
Localization Studies
Unique Scenarios
Algorithms For First-Time Operations and Recurrent/Persistent Disease
Conclusion
55: Principles in Surgical Management of Primary Hyperparathyroidism
Preoperative Evaluation
Vitamin D and Primary Hyperparathyroidism
Normocalcemic Primary Hyperparathyroidism
Localization Testing
Uniglandular Versus Multiglandular Disease
Asynchronous Multiglandular Disease
Intraoperative PTH: Functional Criteria for Uniglandular Versus Multiglandular Disease
Histology
Molecular Genetics of Primary Hyperparathyroidism
Parathyroid Surgical Anatomy
Embryologic Variation
Locations of Missed Adenomas Based on Reoperative Series
Intrathyroidal Adenoma
Thyroidectomy During Parathyroidectomy
Parathyroid Exploration: Surgical Technique
Mediastinal Adenoma
Surgical Technique for Multiglandular Disease
Parathyroid Surgery Failure
Surgical Controversies
Postoperative Assessment
56: Standard Bilateral Parathyroid Exploration
Anatomy and Embryology Relevant for Bilateral Parathyroid Exploration
The Rationale for Bilateral Parathyroid Exploration
Preoperative Planning: Parathyroid Localization Studies
Surgical Technique of Bilateral Parathyroid Exploration
Strategy for Finding the “Missing” Parathyroid
Postoperative Management
Special Considerations in Bilateral Parathyroid Exploration
Summary
57: Minimally Invasive Single Gland Parathyroid Exploration
Background
Considerations for Performing MIP
A Standard Parathyroid Nomenclature System
Preoperative Imaging and Localization
Operative Preparation and Techniques
Postoperative Care and Follow-up
58: Minimally Invasive Video-Assisted Parathyroidectomy
Introduction
Preoperative Localization Studies
Intraoperative PTH Assay
Minimally Invasive Parathyroidectomy
Techniques for MIP
MIP: Evidence-Based Recommendations
59: Intraoperative PTH Monitoring During Parathyroid Surgery
Introduction
History of Intraoperative PTH Monitoring
Which Patients Benefit from IPM-Guided Parathyroidectomy?
Intraoperative PTH Monitoring as an Adjunct During Parathyroidectomy
IPM Protocol for Intraoperative Blood Sampling
Intraoperative Scenarios and Troubleshooting
Intraoperative Criteria in Predicting Operative Success
Limitations of Intraoperative PTH Monitoring with the “> 50% PTH Drop” Criterion
Results of Parathyroidectomy Guided by IPM
Other Applications for Intraoperative Rapid PTH Assays
Summary
60: Surgical Management of Multiglandular Parathyroid Disease
Definition and Incidence
Macroscopic and Microscopic Pathology of Abnormal Glands
Histopathological Criteria for Adenoma and Hyperplasia
Extent of Parathyroid Exploration and Diagnosis of MGD
Tumor Clonality in Uniglandular and Multiple Gland Disease
Etiology and Risk Factors for MGD
Preoperative Diagnosis of MGD
Intraoperative Adjuncts in MGD
Surgical Treatment
Operative Strategy in Localized Disease (Unilateral Exploration/Lateral Approach)
61: Surgical Management of Secondary and Tertiary Hyperparathyroidism
Secondary Hyperparathyroidism
Tertiary Hyperparathyroidism
62: Parathyroid Management in the MEN Syndromes
Multiple Endocrine Neoplasia (Men) Type 1
Genetic Testing in Men 1
Men 1–Associated Hyperparathyroidism
Indications for Surgery
Surgical Treatment of Men 1–Associated Hpt
Treatment of Persistent or Recurrent Men 1–Associated Phpt
Multiple Endocrine Neoplasia Type 2a
Genetic Testing in Men 2a
Men 2a–Associated Phpt
Indications for Surgery
Surgical Treatment of Men 2A–Associated Phpt
Treatment of Persistent or Recurrent Men 2a–Associated Phpt
Use of Intraoperative Adjuncts During Parathyroidectomy for Men–Associated Phpt
Nonsurgical Management of Persistent or Recurrent Men–Associated Phpt
Conclusions
63: Revision Parathyroid Surgery
Introduction
Why?
Who?
When?
How?
Common Reoperative or Challenging Primary Operative Scenarios
Summary
64: Parathyroid Carcinoma
Background
Risk Factors and Etiology
Clinical Presentation
Histopathology
Preoperative Management
Resection of Recurrence
Genetic Testing
Outcome and Prognosis
Summary
65: Surgical Pathology of the Parathyroid Glands
Development and Anatomy
Hyperparathyroidism
Primary Hyperparathyroidism
Parathyroid Carcinoma
Primary Chief Cell Hyperplasia
Other Familial Hyperparathyroidism Syndromes
Other Familial Hyperparathyroidism Syndromes
Cysts
Cysts
Secondary Tumors
Secondary Tumors
Hypoparathyroidism
Hypoparathyroidism
Index

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Surgery of the Thyroid and Parathyroid Glands

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Gregory W. Randolph