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Using evidence and international consensus to guide treatment of thyroid nodules

The authors of this practical review paper highlight a growing issue within thyroid surgery, where high-quality ultrasound has increased the detection of subclinical nodules: what do we do with the patient presenting with an ‘incidental’ thyroid nodule? This has both...

Thyroid ultrasound elastography: does nodule stiffness predict malignancy?

Approximately 50% of the general population has a thyroid nodule while 5-15% of these are malignant [1]. A major challenge, therefore, is how to detect the malignant nodules for appropriate, timely treatment and avoid unnecessary, costly investigations for the remainder....

Prediction of morbidity and mortality in patients undergoing thyroid or parathyroid surgery

Major postoperative adverse events in thyroid or parathyroid surgery are uncommon. Various authors have developed risk indices to identify physical deficits in patients undergoing elective surgery. The literature is less clear about patients undergoing thyroid or parathyroid surgery. In this...

Role of sentinel lymph node biopsy in managing papillary thyroid cancer

Although studies have shown that the presence of lymph nodes metastases in papillary thyroid carcinoma does not alter survival, other studies have shown that it increases morbidity and mortality and that the presence of cervical lymph node metastasis at diagnosis...

How reliable are PTH levels for the prediction of hypocalcaemia after thyroid surgery?

Hypoparathyroidism is one of the most common complications of thyroid surgery. There is significant controversy in calcium management practices post thyroid surgery. The drop in PTH levels has been used to predict the likelihood of hypocalcaemia after thyroid surgery. But...

Active surveillance for papillary thyroid cancers – what is the risk of progression?

Papillary thyroid cancers (PTCs) are generally considered to be indolent malignancies with favourable outcomes. Active surveillance (AS) has consequently been trialled as a management option for small PTCs with no evidence of regional lymph node involvement, especially papillary thyroid microcarcinomas...

What is the right balance to strike in the management of anaplastic thyroid cancer?

This is a pragmatic article on a difficult and much debated subject. Management of anaplastic thyroid cancer (ATC) can feel like making decisions between a rock and a hard place, and this article suggests one path to help navigate some...

CT and intraoperative nerve monitoring to identify non-recurrent laryngeal nerve during thyroid surgery

A non-recurrent laryngeal nerve (NRLN) is a rare (incidence 0.3% to 1.3%) anatomical variant that results in a higher rate of vocal cord palsy following thyroid surgery. This team from China examined the utility of preoperative CT and intraoperative nerve...

Lymph node ratio is a significant predictor for loco-regional recurrence after neck dissection in patients with papillary thyroid cancer

Lymph node metastases are common in papillary thyroid cancer (PTC), yet the impact of nodal metastases on survival remains unclear. Lymph node density (LND) is the ratio between the number of positive lymph nodes excised and the total number of...