B Berry, J. 25 see also suspensory ligament of Berry biopsy see fine-needle aspiration biopsy (FNAB); open wedge biopsy

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1 174 Index Index Page numbers in italics refer to illustrations A abscess 80, 137 adenoma 61 parathyroid 18, 18 19, 62, 84 differential diagnosis 84, 84, 85, 85 thyroid 63 follicular 62, 63, 64 macrofollicular 67, 68, 69 microfollicular 90, 126, 126 toxic 57 adrenalectomy 146, 147 anaplastic thyroid carcinoma (ATC) 121, differential diagnosis 136 genetic basis 136 prognosis 136 treatment gene therapy surgical , 137, 139 anatomy, surgical 3 see also capsular dissection; fascia, visceral; incision antibody anti-tsh receptor 56 antithyroglobulin 115 antithyroid drugs 46 50, 89 overtreatment 50 atypia, cellular 62 autoimmune thyroid disease see Graves disease; Hashimoto thyroiditis autonomy 55 functional 53, 55, 56, autoradiography 55 disseminated 96 in Graves disease (Marine Lenhart Syndrome) 96 in multinodular goiter 44, 45, in solitary thyroid nodule 70 molecular causes nuclear scans 55 surgical treatment 56 thyrotoxic crisis 89 see also Plummer disease of growth 53 proliferative 55 see also hyperthyroidism autoradiography 55 B Berry, J. 25 see also suspensory ligament of Berry biopsy see fine-needle aspiration biopsy (FNAB); open wedge biopsy C C-cells 141 calcitonin levels and hyperplasia 143 calcitonin (CT) 142 C-cell pathology and medullary thyroid carcinoma and , 146, 148, 152 capsular dissection 3, 9 24, 13 14, 35 38, 36 37, 44, 45, 77 79, 79, 154, anatomy of 9 12, 9, 10, 11 historical remarks minimal-access surgery modern technologies and 23 parathyroid glands 11, 11 preservation of 10, 31 reoperation and 7 tubercle of Zuckerkandl 26, 33, 34 35, 34, 157, 158 upper thyroid pole 12 17, 13 15, 16 versus subtotal thyroidectomy 63 see also hemithyroidectomy; lobectomy; thyroidectomy carcinoma classifications extrathyroidal tumor growth 72 familial, nonmedullary in graves disease 97, 97, 98, 98 in Hashimoto thyroiditis 100 in multinodular goiter 39, 39, 76 parathyroid 28 29, 29, 62 small carcinoma 72, 127 surgeon as prognostic factor 39, see also anaplastic thyroid carcinoma (ATC); follicular thyroid carcinoma (FTC); medullary thyroid carcinoma (MTC); papillary thyroid carcinoma (PTC) cellular atypia 62 cellularity 60, 61, 92 93, 146 see also fine-needle aspiration biopsy (FNAB); follicular neoplasia clinical examination 154, 155 clonality 52, 53 54, 105 determination of 58 see also fine-needle aspiration biopsy (FNAB); goiter Cowden syndrome 58 cricothyroid space 12 Cushing, Harvey 22 Cushing syndrome cyst colloid 119, 120 lymph node metastases , 128, 129 papillary thyroid carcinoma , 128, 129 parathyroid 28, 29, 29 cytology see fine-needle aspiration biopsy (FNAB) D Dunhill, T. P. 23, 32, 46 dysphonia, postoperative 30 E ectopic thyroid 39 40, differential diagnosis embryology goiter in 40 intrathymic 84 lateral anlage 39, 40, 40, 41, 83 posterior mediastinum 83 median anlage 40, 83 anterior mediastinum 40, 83 thyroglossal route 83 thyrothymic area 83 thyroglobulin secretion 40 embryology 31, 31, endemic goiter see goiter evidence-based medicine 159 external thyroid capsule 9 resection through see also capsular dissection; fascia, visceral extrathyroidal tumor growth 72, , 119, 120 minimal 39, 118 retrovisceral extension 76, 76, 119 F familial nonmedullary thyroid carcinoma (FNMTC) fascia, visceral 3, 9 see also capsular dissection fine-needle aspiration biopsy (FNAB) cellular atypia 62

2 Index 175 cellularity 60, 92 cystic neck lesion see cyst follicular neoplasia 28, 29, 62 functional autonomy and 56 Hashimoto thyroiditis 99, 100, lymphoma 100, 136 multinodular goiter 22, 62, 67 papillary thyroid carcinoma 42, 43, 92, 110, 111 selective FNAB 22, 62, 67, 68 solitary nodules 29, 70, 92 follicular neoplasia 60 62, 63, 70 clinical features diagnostic hemithyroidectomy 34, 35, 63 differential diagnosis 60, 62 follicular adenoma 62 follicular thyroid carcinoma 62 medullary thyroid carcinoma 62, , 149 papillary thyroid carcinoma 62 parathyroid adenoma 62 parathyroid carcinoma 62 fine-needle aspiration biopsy 28, 29, 62 frozen sections 60 (FTC) follicular thyroid carcinoma (FTC) 63, 91, 91, 92 classification 70 72, 72 minimally invasive 61, 69 70, 69, 72 75, 72 75, 91, 91, 92 risk-group assignment 70 72, 72 widely invasive 62, 64, 64, 70, 72, 72, 73, 75 77, 76, 80, 81 82, 82 diagnosis 62 extrathyroidal extension 72 lymph node metastases of 72 microcarcinoma 72 molecular profiling 58 retrovisceral extension 76, 76 small tumors 72 treatment 34 35, 35, 72 73, 72 results 73, 73 selective, risk-dependent see also follicular neoplasia functional autonomy see autonomy G gene profiling gene therapy 121, Goetsch disease 55, 90 goiter acute symptoms 105 dyshormonogenetic 133 ectopic 83, 84, 85 emergency case in 79, 80 endemic, Switzerland 44, 76 goitrogenesis 53 hemorrhage 79 80, 80 intrathoracic 84, 85 mediastinal 20 21, 40, 41, 77, 78, 79, 83 anterior mediastinum 82, 83, 84 mobilisation 28, 28 pemperton sign 82 posterior mediastinum 36, 37, 80 81, 81, 83 respiratory distress and 77, 79, 80 secondary 83 surgical technique in 28, 28, 77 79, 79 necrosis 79 80, 80 nodular 18, 40, 41, 56 fine needle aspiration biopsy 22, 62, 67, 92 hyperplastic 64, 67, 67, 73, 74, 92 multinodular 35, 36, 39, 39, 62, 67 68, 67, 75 carcinoma in 39, 39, 76, 88 colloidal 13, 14, 62, 63, 67, 67 intrathoracic 84, 85 long-standing (large) 75, 81 82, 82, 87, 87, 88 toxic 38, 38, 54, 62, 74, 76, 81, 88 89, 89 with functional autonomy 44, 45, solitary nodule 53, 60, 92, 93 see also thyroid nodules radioactive iodine (RAI) treatment 81 recurrent prophylaxis 35 pyramidal lobe 85 86, 86 surgical treatment 18 22, 44, 45 back door approach 18 22, retrovisceral 20 21, 36, 37, 38 simple 44, 45, 67 68, 67, 92, 93 pyramidal lobe 85 86, 86 surgical treatment,, capsular dissection 13 14, 16 17, 35 38, 36 37,, completion lobectomy 44, 45 total lobectomy 20 21, 32, 33, total thyroidectomy 36, 37, 44, 45, morbidity 89 resection through external capsule subtotal resection 64, 64,, tubercle of Zuckerkandl 38, 38 see also Hashimoto thyroiditis; thyroid nodule Graves disease 70, 76 nodules in differential diagnosis 89, 96 Marine Lenhart Syndrome 96 papillary thyroid carcinoma 97, 98 ultrasound 96 recurrent thyrotoxicosis 40, 44 46, 47 surgical treatment 32 completion thyroidectomy 44 46, 47 follow-up 50 ophthalmopathy 46, 49 total thyroidectomy 39, 40, 46 50, 48, 49, 96 97, 96 versus subtotal 46 Grenzlamelle 3 see also fascia, visceral growth advantage 53, 57 H Halsted, W.S. 22 Hashimoto thyroiditis , 105 carcinoma in 100 compressive symptoms 101 diagnosis 99 hyperthyroidism in 99 lymphoma in 99, 100, , nodules in pseudonodules 99, 101, recurrent painful 101 surgical treatment , variants 99, 101 hemithyroidectomy anaplastic thyroid carcinoma 137 diagnostic 34, 35, 63, 147, 148 follicular thyroid carcinoma 34 35, 35 medullary thyroid carcinoma 144, 147, 148, 149 multinodular goiter 67, 67 papillary thyroid carcinoma , , 119, 120, 135 postoperative function 66 see also lobectomy; thyroidectomy hemorrhage large goiter 79 80, 80 postoperative 50 Hürthle (oxyphilic) cells focal 62 neoplastic 62 Hashimoto thyroiditis 102 in papillary thyroid carcinoma 132 hypercalcemia 29, 50 hypercalcitoninemia 143 hyperparathyroidism, primary 18, 18 19, 29, 31 hyperplasia 54, 57, 60, 62 C-cell 143 hyperthyroidism apathetic, in elderly 75, 80

3 176 Index functional autonomy and 70, multinodular goiter 75, preoperative preparation 89 solitary toxic nodule 70 surgical treatment of 89 see also Plummer disease hereditary nonautoimmune 56, 96 recurrence 40, 41, 44 46, 47 subclinical 55, 77, 87 see also autonomy; Graves disease; Hashimoto thyroiditis hypocalcemia 50 hypothyroidism 105 antithyroid overtreatment and 50 in Hashimoto thyroiditis 101, 104, 105 subclinical 101 transient, following hyperthyroidism 90 I incidentaloma 68 69, 68, 95 incision 4 8 back-door 6, 8, 8, 17 22, Kocher 4, 4 longitudinal 6 7, 6 McFee 4 minimal access surgery modifications 7 8, 7, 8 skin and platysma 4, 4 transverse 4 6, 5 infarction, goiter 80 infection, wound 80, 137 inferior laryngeal nerve 25 functional investigation 30 neuromonitoring of 30 paralysis 80 surgical anatomy extralaryngeal division 27, 27 nonrecurrent nerve 27 risk of injury suspensory ligament relationship 27 tubercle of Zuckerkandl relationship 27, 28 internal laryngeal nerve see superior laryngeal nerve iodine deficiency 53 treatment with 50 K Kocher incision 4, 4 Kocher, Th. 22, 22, 23 L laryngeal nerve see inferior laryngeal nerve; superior laryngeal nerve laryngoscopy 30 lateral (back-door) approach 6, 8, 8, 17 22, lobectomy 16 completion 44, 45, 47, 63 near total subtotal 63 total 3, 12, 20 21, 32 35, 32, 35 see also hemithyroidectomy; thyroidectomy Lugol s solution (iodine) 50 lymph nodes anatomy , 116, 117 metastasis to , 119, 120, 122, 123, 148 low intensity metastasis metachronous 116, , 131 microcarcinoma , 125, 127, 128, 128, 130 occult carcinoma and , 124, 125 penetration of lymph node capsule 116 risk factors for 116 skip lesion 117, 118, 128, , staging 115 prophylactic dissection 135 sentinel node biopsy 117 lymphadenectomy 117 berry picking 117 central 117 lateral 117 medullary thyroid carcinoma and 146, 148 prophylactic 43, 115, 117, 146 selective 117 stage migration 116 systematic 117 therapeutic , 117 see also neck dissection lymphangiogenesis 114, 131 lymphoma 95, 100, , 136 differential diagnosis 136 Hashimoto thyroiditis and 99, 100, , malignant , MALT lymphoma 100 M McFee incision 4 Madelung, O. W. 32 magnifying glasses 27, 154, 155 MALT lymphoma 100 Marine Lenhart Syndrome 96 medullary thyroid carcinoma (MTC) C-cells 141 hyperplasia/neoplasia 143 classification 141, 141 Cushing syndrome and diagnosis follicular neoplasia 62, , 149 serum calcitonin (CT) , 146, 148, 152 screening hereditary 141, 144, index patient 144, 146, multiple endocrine neoplasia (MEN) 144, 146, , 150 pheochromocytoma 144, 149, 150 incidental 148 metastases distant 145 lymph nodes 144, 148 skip lesion recurrence , 151 occult paraneoplastic syndrome 151 prevalence 142 rapidly progressing residual, recurrent disease somatostatin receptors in sporadic 141, 143, , 145, , 147 treatment 141 hemithyroidectomy 144, 149 lymphadenectomy 146, 148 selective 148 microcarcinoma 94 95, 112, 127 lymph node metastases 127, 130 treatment 127 see also papillary thyroid carcinoma (PTC); TNM classification middle fascia 3 longitudinal median division 6 7, 6 transverse division 4 6, 5 minimal-access surgery molecular biology functional autonomy RET protooncogene 141, 144 thyroid nodules 53 molecular classification 58 multiple endocrine neoplasia (MEN) 58, 144, 146, , 150 N Nebenschilddrüse see ectopic thyroid neck dissection 117 functional, modified radical 117 selective 117, 118, 132 see also lymph nodes; lymphadenectomy neoplasia 53 54, 57, 70 C-cell 143 see also follicular neoplasia neuromonitoring, inferior laryngeal nerve 30

4 Index 177 NIS (sodium iodide symporter) 54, 55 nodule see thyroid nodules nuclear scan 55 functional autonomy and 55, 89 Graves disease differential diagnosis 89, 96 nodular thyroid disease evaluation 55 toxic nodular goiter 89 O open wedge biopsy 105 ophthalmopathy, Graves disease 46, 49 P palpation 154, 155 papillary thyroid carcinoma (PTC) 63, classification systems 97, 108, morphological subclassification prognostic classification 97, 108, TNM classification 39, 113, 114, 119 clinical features 108 cystic , 128, 129 diagnosis 62, 70, fine-needle aspiration biopsy 42, 43, 92, 110, 111 frozen section macroscopic appearance 42, 43, 92, 110, 110, 113 nuclear features ultrasound 95, 95, 110 encapsulated 131, 132 extrathyroidal tumor extension 97, , 119, 120 minimal 39, 118 retrovisceral extension 119 familial , 132, 134 early diagnosis , 134 follicular variant (FVPTC) 62, follow up thyroglobulin, serum measurement genetic basis 108 in Graves disease 96, 97 98, 98 incidental 39, 39 intrathyroidal 39 lymph node metastasis , 119, 120, 122, 123, 129, 130 cystic , 128, 129 extension through lymph node capsule 116 low intensity metachronous 116, , 131 occult carcinoma and , 124, 125 prophylactic lymphadenectomy 115 recurrence 116 skip metastasis 117, 118, 128, solitary 128, 128 see also lymph nodes macrofollicular 132 microcarcinoma 94, 97 98, 98, 108, 112, 112, 127 capsular penetration 124 familial 127 incidental 126, 126 metastases , 125, 127, 128, 128, 130 minimal 127 multicentric/multifocal 108, 111, 122, 125, 126, 128 occult , 124, 125, 127 oxyphilic 132 pulmonary metastases , 123 pyramidal lobe 86 recurrence 108, 122, 159 contralateral, after hemithyroidectomy lymph node metastasis risk factors 108 solitary nodule , 111 staging 43, 115 treatment of , 135 hemithyroidectomy , , 119, 120, 135 lymph node dissection 135 overtreatment results 121, 121, 122 selective, risk-dependent 109, 135 subtotal thyroidectomy 111 total lobectomy 34, 35 total thyroidectomy 39, 39, 42 44, 42 44, , 109, 132, 135 parathyroid 31 adenoma 18, 18 19, 84 differential diagnosis 62, 85, 85 sites of 31, 31 autotransplantation of 31 capsular dissection 11, 11 carcinoma 28 29, 29, 62 cyst 28, 29, 29 preservation of 31, 84, 84, 85, 85 ultraligation 10, 11, 33, 47 patient positioning 2 Pemperton sign 82 Pendred syndrome 54, 55 pendrin 55 pheochromocytoma 144, 149, 150 platysma incisions 4, 4 Plummer disease 53, 55, 55, 73, 74, 77 79, 80 81, 88 89, 90 multinodular goiter and 75, 76, preoperative treatment 89 surgical treatment 89 preclinical hyperthyroidism 55, 77, 87 propranolol 50, 89 proteomic analysis 58 pulmonary metastases , 123 R radioactive iodine (RAI) therapy 72 large goiters 81 thyroid carcinoma 72, 121, 135 metastases (FTC); papillary thyroid carcinoma (PTC) radionuclid scan see nuclear scan radiotherapy anaplastic thyroid carcinoma 136, 137 see also radioactive iodine (RAI) therapy receptor somatostatin, in MTC see also TSH receptor (TSHR) recurrent inferior laryngeal nerve see inferior laryngeal nerve respiratory distress 77, 79, 80 RET protooncogene 58, 141, 144 Riedel thyroiditis 105 S sentinel lymph node biopsy 117 skin incisions 4, 4 sodium iodide symporter (NIS) 54, 55 solitary nodule see goiter; thyroid nodules somatostatin receptors in MTC subclinical hyperthyroidism 55, 77, 87 superficial fascia 3 longitudinal median division 6 7, 6 transverse division 4, 5 superior caval syndrome 80 superior laryngeal nerve 16 external branch 16 internal branch 16 suspensory ligament of Berry transection 27, 46, 48, 157, 158 T tachycardia 50 thymus ectopic 84, 84, 85, 85 intrathymic thyroid 84 thyroglobulin, serum 142 antibodies 115

5 178 Index metastasis detection postoperative measurement thyroglobulin gene-specific transcripts (TgmRNA) 126 TSH-stimulated thyroglobulin 125 thyroid 52 adenoma see adenoma capsule, external see external thyroid capsule carcinoma see carcinoma clonality of 52 ectopic see ectopic thyroid embryological development of 31, 31, hilus 25 27, 25 intrathymic 84 lateral aberrant 124 nodules see thyroid nodules posterior tubercle of Zuckerkandl see Zuckerkandl, tubercle of suspensory ligament thyroid hormone treatment goiter 53, 112 prophylaxis 53, 66 replacement therapy thyroid carcinoma , 135 thyroid nodules 29, 53 54, adenomatous 67 68, 67 cold 56, 74, 88 89, colloid 61, 63, 67 68, 67, 68 69, 68 diagnoses 63 evaluation of excision strategy frozen section 92, 93 hyperplastic 67 68, 67 macrofollicular 68 molecular genetic causes 53 small nodules solitary nodule 60, 68 70, 68, 69, 75, 93, 94, , 118 autonomously functioning (AFN) 70 diagnosis 70, 71 encapsulated 68 69, 68, , 111 fine-needle aspiration biopsy 70 long-standing medullary thyroid carcinoma , 145, 151 papillary thyroid carcinoma , 111 toxic 90, 90 treatment 70, 71 (FTC); goiter; Graves disease; Hashimoto thyroiditis; medullary thyroid carcinoma (MTC); papillary thyroid carcinoma (PTC) thyroid stimulating hormone (TSH) 53, 112 antithyroid overtreatment and 50 postoperative levels 66 receptor (TSHR) antibodies 56 mutations 54, recombinat (rhtsh) 113 suppression of 55, 113 endogenous 53, 55, 68, 70, 94 see also autonomy; hyperthyroidism exogenous 53, 73, , 135 see also thyroid hormone treatment subsuppression 112, 113 thyroid function and 90 thyroglobulin stimulation, postoperative measurement 125 thyroidectomy completion 44 46, 47, 146 complications 66, 80 hemorrhage 50 wound infection 80, 137 en bloc 36, 37, 38 goiter surgical treatment 32, 33, 36, 36, 37, 44, 45 near total 63, 111 postoperative function 66 subtotal 18, 32, 33, 34, 44 46, 63, 111 total 3, 33, 35 40, 36 39, 72 anaplastic thyroid carcinoma 136, , 139 goiter 36 39, 44, 45, 87 89, 87 89, 101, 102 Graves disease 40, 46 50, 48, 49, 96 97, 96 Hashimoto thyroiditis 101, 102 papillary thyroid carcinoma 35, 42 44, 42 44, , 109, 111, 132, 135 see also capsular dissection; hemithyroidectomy; lobectomy thyroiditis, Hashimoto see Hashimoto thyroiditis thyrotoxic crisis 89, 105 TNM classification 39, 113, 114, 119, 141, 141 treatment results and 121, 121, 122 toxic goiter 38, 38, 54, 62, 74, 76, 81 TSH see thyroid stimulating hormone (TSH) tubercle of Zuckerkandl see Zuckerkandl, tubercle of tumor lysis syndrome 136, 137 U ultraligation 10, 11, 11, 33, 47 ultrasonography 95 Graves disease 96 Hashimoto thyroiditis 99 lymph node lymphoma 95, 100 thyroid 95 follicular thyroid carcinoma 74, 75 multinodular disease 95, 95 papillary thyroid carcinoma 95, 95, 110, , 134 follow-up 126 upper pole, capsular dissection of 12 17, 13 15, 16 V visceral fascia 3, 9 see also capsular dissection vocal cord paralysis 30 voice impairment, postoperative 30 W Will Rogers phenomenon 116 wound closure 7 wound infection 80, 137 Z Zuckerkandl, E. 32 Zuckerkandl, tubercle of 31 41, 31, 83 capsular dissection 26, 33 41, 34 35, 157, 158 goiter of 38, 38, 83 surgical importance 32, 32 41, 34 41

Foreword. Foreword. in a blood-free field, which decreases the risk of complications.

Foreword. Foreword. in a blood-free field, which decreases the risk of complications. Foreword V Foreword During my first visit to Basel, Switzerland, in 1980, I had the pleasure of meeting Prof. Ernst Gemsenjäger. I was immediately impressed by the knowledge of this experienced and skillful