Endocrine Surgery
Endocrine Surgery tests thyroid, parathyroid, adrenal, pancreatic and gastrointestinal neuroendocrine tumors, and breast disease. The exam focuses on preoperative localization, indications, and avoiding complications.
Thyroid and parathyroid
- Thyroid nodule: TSH, ultrasound, FNA by Bethesda category. Bethesda IV (follicular neoplasm) cannot be diagnosed as benign or malignant by cytology; diagnostic lobectomy is needed.
- Papillary and follicular cancers are differentiated; medullary arises from C cells (calcitonin); anaplastic is aggressive. Recurrent laryngeal nerve and parathyroid preservation are key.
- Primary hyperparathyroidism: high calcium, low phosphate, high PTH. Surgery for symptoms, calcium >1 mg/dL above the upper limit, age <50, reduced creatinine clearance, osteoporosis, or nephrolithiasis.
Adrenal, NET, breast
- Pheochromocytoma: alpha-blockade before beta-blockade, never the reverse.
- Breast: triple assessment (clinical, imaging, core biopsy). Sentinel node biopsy for clinically node-negative invasive cancer.
Worked example: A 45-year-old woman has a 2.5 cm thyroid nodule; FNA is Bethesda IV. Total thyroidectomy is not automatically required. Reasoning: follicular neoplasm needs histology to assess capsular and vascular invasion; lobectomy provides diagnosis and may be definitive if benign or minimally invasive.
Traps: using FNA to rule out follicular carcinoma; blocking beta before alpha in pheochromocytoma; ignoring postoperative hypocalcemia after total thyroidectomy; performing sentinel node biopsy in inflammatory breast cancer.