Current thyroid surgical technique

There is no lack of texts about thyroid and parathyroid surgery, but this new contribution by George Randolph and colleagues stands out as a successful compilation of information about the management of patients with thyroid or parathyroid disease. It covers preoperative diagnosis, operative methods, decision making during and after operation, and post-operative support. Surgery of the Thyroid and Parathyroid Glands contains all the expected features of a surgical text: a little embryology and anatomy; chapters about benign and malignant thyroid disease, and all aspects of thyroid surgery; and a similarly extensive approach to parathyroid surgery. It is made outstanding by the illustrations, including many of surgical techniques by Robert Galla.Important features of Surgery of the Thyroid and Parathyroid Glands are the chapters about pathophysiology and diagnosis, written by a group of strongly medically oriented collaborators. These chapters are less extensive than one might find in a medically oriented text about thyroid disease, but are, nevertheless, useful. Any surgeon whose knowledge encompasses the material in the chapters about thyroid function testing by Hurley, about thyroiditis by Farwell and Braverman, or about nontoxic goiter by Christoph Meier, will have no trouble holding their own in a debate with the most erudite thyroidologist. A nice feature is the careful, well balanced attention given to competing approaches to therapy. For example, in the discussion of nontoxic goiters, there are presentations about suppressive therapy using thyroxine, the use of radioactive iodine to treat large multinodular goiters, and the rationale for surgical resection. Imaging procedures are also fully examined. Surgical problems and complications, including damage to that troublesome recurrent nerve and parathyroid glands, are evaluated. Many of these sections are excellent reading for medical endocrinologists as well as surgeons, because the operative problems are well explained, such as methods to prevent damage to the recurrent nerve and to preserve parathyroid tissue, the approach to sternotomy, if required, and tumor recurrences. It is unfortunate that some of the figures are not in color, such as the presentations about thyroid fine needle aspiration cytology provided by Gharib and Goellner.The sections about thyroid carcinoma are especially strong, including an up-to-date chapter about its molecular pathogenesis by Robert Gagel, and chapters assessing prognosis, prognostic scoring systems, and risks in papillary, follicular, Hurthle, anaplastic and medullary tumors. The sections about thyroid surgery begin with a consideration of risk groups and complications, followed by a thorough analysis of the dissection and preservation of the laryngeal nerve and of the parathyroid glands. It even includes a discussion of whether to dissect the superior pole of the thyroid as an initial or final maneuver, or to do it in between. To illustrate the detail, there is a long paragraph about management of the thyroid isthmus. Surgical technique and problems related to the recurrent nerve are more thoroughly examined than in any analysis with which I am familiar, offering plenty of information about non-invasive monitoring of the nerve. Especially useful are the chapters by McCaffrey and Grillo about management of invasive disease involving the larynx and trachea, and the possible surgical approaches. These are complemented by a set of illustrations that gives the reader a feel for these difficult problems and the possible solutions to them.The parathyroid surgery section is naturally shorter, but equally well covered. Sections are devoted to surgery when the parathyroids are in their normal location, how to find a missing gland, whether it is inferior or superior, dissecting for a fifth gland, looking for mediastinal adenomas and, of course, the intraoperative parathyroid hormone assay and its use.Surgery of the Thyroid and Parathyroid Glands is a book for people with a specific interest in thyroid and parathyroid disease. However, the book could also be basic reading for every endocrine fellow, who, if they truly master its content, could manage their patients with knowledge that they would usually gain only by years of practice. It is a fine book and the authors are to be congratulated on putting it together.