TY - CHAP M1 - Book, Section TI - Thyroid, Parathyroid, and Adrenal A1 - Lal, Geeta A1 - Clark, Orlo H. A2 - Brunicardi, F. Charles A2 - Andersen, Dana K. A2 - Billiar, Timothy R. A2 - Dunn, David L. A2 - Kao, Lillian S. A2 - Hunter, John G. A2 - Matthews, Jeffrey B. A2 - Pollock, Raphael E. PY - 2019 T2 - Schwartz's Principles of Surgery, 11e AB - Key Points There has been a paradigm shift in the surgical management of Graves’ disease with increased use of total or near-total thyroidectomy, rather than subtotal thyroidectomy. Familial nonmedullary thyroid cancer is increasingly being recognized as a separate entity. Surgeons must be aware of the potential for false-negative fine-needle aspiration biopsy in this setting. Fine-needle aspiration biopsies are now classified into six groups based on the risk of malignancy associated with each group (Bethesda criteria). Encapsulated follicular variants of papillary thyroid cancers are now designated noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Lobectomy or total/near-total thyroidectomy are considered appropriate treatments for low-risk thyroid cancers. Some small papillary thyroid cancers (<1 cm) can be followed with active surveillance. Focused mini-incision parathyroidectomy, after appropriate localization, has become the procedure of choice for the treatment of sporadic primary hyperparathyroidism. Parathyroidectomy has been shown to improve the classic and the so-called nonspecific symptoms and metabolic complications of primary hyperparathyroidism. Normocalcemic hyperparathyroidism is being increasingly recognized; however, there are no definitive guidelines for management. Very high calcium and parathyroid hormone levels in a patient with primary hyperparathyroidism should alert the surgeon to the presence of a possible parathyroid carcinoma. Subclinical Cushing’s syndrome is characterized by subtle abnormalities in corticosteroid synthesis, and many of its manifestations appear to be treated by adrenalectomy. Fine-needle aspiration biopsy has a very limited role in the evaluation of adrenal incidentalomas unless the patient has previously had a cancer and should only be performed after appropriate biochemical studies have been performed to rule out pheochromocytoma. Laparoscopic adrenalectomy has become the procedure of choice for excision of most adrenal lesions, except known or suspected cancers. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1175972167 ER -