The aetiology, investigation and management of surgical disorders of the thyroid gland.
There have been many recent advances in our understanding of thyroid disease, including thyroid physiology, the molecular biology of thyroid neoplasms, guidelines for the management of surgical thyroid disease and the operative approach to thyroidectomy. The control of thyroid growth and function is better understood now that the thyroid stimulating hormone (TSH) receptor has been characterized as a G-protein coupled transmembrane receptor. The peripheral action of thyroid hormones is also better understood in terms of their interaction with nuclear thyroid hormone receptors. An adenoma-carcinoma sequence for the development of thyroid neoplasms has been proposed based on the characterization of a number of proto-oncogenes and tumour suppressor genes, and different pathways for the development of papillary and follicular thyroid carcinoma have been demonstrated. Fine needle biopsy has become, over the past few years, the principal diagnostic technique for evaluation of thyroid nodules, and has resulted in a significant reduction in the need for surgery for benign thyroid nodules. The approach to the management of thyroid carcinoma can now be based on comprehensive scoring systems for assigning patients to a particular risk group, the most recent of which is the MACIS system based on distant metastases (M), age (A), completeness of resection (C), invasion (I) and size (S). The capsular technique of thyroidectomy as described has now been shown to be the best method to preserve parathyroid blood supply, protect the recurrent laryngeal nerve and minimize the complications of thyroid surgery.
Younes
N
N
Department of Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Robinson
B
B
Delbridge
L
L
D029721:Drosophila Proteins; D016158:Genes, p53; D011905:Genes, ras; D006044:Goiter, Nodular / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D061224:Laryngeal Nerve Injuries; D011183:Postoperative Complications; D011518:Proto-Oncogene Proteins / Q000235:genetics; D051096:Proto-Oncogene Proteins c-ret; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics; D011989:Receptors, Thyrotropin / Q000235:genetics / Q000502:physiology; D013959:Thyroid Diseases / Q000209:etiology* / Q000235:genetics / Q000601:surgery*; D013961:Thyroid Gland / Q000502:physiology; D013964:Thyroid Neoplasms / Q000209:etiology / Q000235:genetics; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D013971:Thyrotoxicosis / Q000209:etiology; D013973:Thyrotropin-Releasing Hormone / Q000502:physiology
D029721:Drosophila Proteins; D011518:Proto-Oncogene Proteins; D011989:Receptors, Thyrotropin; D013973:Thyrotropin-Releasing Hormone; D051096:Proto-Oncogene Proteins c-ret; D020794:Receptor Protein-Tyrosine Kinases; C416649:Ret protein, Drosophila