Explore the vast range of titles available.

Assessing thyroid nodules for malignancy is complex. The impact of patient and nodule factors on cancer evaluation is uncertain. To determine precise estimates of cancer risk associated with clinical and sonographic variables obtained during thyroid nodule assessment. Analysis of consecutive adult patients evaluated with ultrasound-guided fine-needle aspiration for a thyroid nodule ≥1 cm between 1995 and 2017. Demographics, nodule sonographic appearance, and pathologic findings were collected. Estimated risk for thyroid nodule malignancy for patient and sonographic variables using mixed-effect logistic regression. In 9967 patients [84% women, median age 53 years (range 18 to 95)], thyroid cancer was confirmed in 1974 of 20,001 thyroid nodules (9.9%). Significant ORs for malignancy were demonstrated for patient age <52 years [OR: 1.82, 95% CI (1.63 to 2.05), P < 0.0001], male sex [OR: 1.68 (1.45 to 1.93), P < 0.0001], nodule size [OR: 1.30 (1.14 to 1.49) for 20 to 19 mm, OR: 1.59 (1.34 to 1.88) for 30 to 39 mm, and OR: 1.71 (1.43 to 2.04) for ≥40 mm compared with 10 to 19 mm, P < 0.0001 for all], cystic content [OR: 0.43 (0.37 to 0.50) for 25% to 75% cystic and OR: 0.21 (0.15 to 0.28) for >75% compared with predominantly solid, P < 0.0001 for both], and the presence of additional nodules ≥1 cm [OR: 0.69 (0.60 to 0.79) for two nodules, OR: 0.41 (0.34 to 0.49) for three nodules, and OR: 0.19 (0.16 to 0.22) for greater than or equal to four nodules compared with one nodule, P < 0.0001 for all]. A free online calculator was constructed to provide malignancy-risk estimates based on these variables. Patient and nodule characteristics enable more precise thyroid nodule risk assessment. These variables are obtained during routine initial thyroid nodule evaluation and provide new insights into individualized thyroid nodule care.

Background A number of reports have been published concerning the surgical treatment of substernal goiters; however, there is yet to be a comprehensive review of this body of literature using evidence-based methodology. Methods This article is a systematic review of the literature using evidence-based criteria and a review of unpublished data from our institution. Results Issue 1. Limited level III/IV data suggest that the incidence of cancer in substernal goiters is not higher than the incidence of cancer in cervical goiters. Risk factors for malignancy in substernal goiters may include a family history of thyroid pathology, a history of cervical radiation therapy, recurrent goiter, and the presence of cervical adenopathy (grade C recommendation). Issue 2. Prospective level V data suggest that, for most patients, expert endocrine surgeons utilize an extracervical approach approximately 2% of the time to remove a substernal goiter safely; a sternotomy or thoracotomy appears more likely in cases of a primary substernal goiter or a mass larger than the thoracic inlet (no recommendation). Issue 3. There may be a higher rate of permanent hypoparathyroidism and unintentional permanent recurrent laryngeal nerve injury when total thyroidectomy is performed for removal of a substernal goiter than for removal of a cervical goiter alone (grade C recommendation). Injury of the external branch of the superior laryngeal nerve was not specifically addressed and is almost certainly underreported. Issue 4. The presence of a substernal goiter, especially being present more than 5 years and causing significant tracheal compression, is likely a risk factor for tracheomalacia and tracheostomy (grade C recommendation). Tracheomalacia with substernal goiter is an infrequent occurrence, and many cases of tracheomalacia can be managed without tracheostomy (no recommendation). Issue 5. Prospective level V data suggest that about 5% to 10% of operations for substernal goiters are performed because of recurrent or persistent disease, although retrospective level V data report an even higher rate, up to 37%. The most common initial operations with recurrence or persistence appear to be subtotal or hemithyroidectomy (no recommendation). Conclusion Evidence-based recommendations provide reliable information regarding the pathologic findings and operative management of substernal goiters in expert hands.

This survey study assesses physicians’ recommendations regarding overdiagnosis and overtreatment of thyroid nodules and low-risk papillary thyroid cancer.

The IAES is critical for surgeons who wish to have a high-impact career, that is, a career affecting the health of strangers. The IAES is a platform designed for exposure to the multiplicity of approaches to patients with endocrine surgical problems. Our international membership shares its knowledge and experience freely, educating one another about our varied contexts of care, and range of solutions. Our membership model supports and encourages participation from a diverse assortment of sites. The IAES is the intersection of the various national and continental echo-chambers of our groups organized inside of their prevailing paradigms where most participants practice along similar principles and care frameworks. This professional association is our chance to understand what works in other systems, so that we have that information available to us to apply in our home system. The IAES experience is indispensable in creating mastery in endocrine surgery.

Background Prophylactic central lymph node dissection (CLND) accompanying total thyroidectomy for papillary thyroid cancer (PTC) remains controversial. Our hypothesis is that CLND may help select patients who benefit from postoperative radioactive iodine (RAI). Methods A total of 119 patients who were clinically node-negative underwent total thyroidectomy/bilateral CLND for papillary thyroid cancer (PTC) > 1 cm during 2002–2010. Pathology results, RAI results, and outcomes were compared between node-positive (NP) and node-negative (NN) patients. Results NP and NN patients were similar in age, gender, tumor size, and MACIS score. Median number of nodes excised was six. The rate of permanent hypocalcemia was 1.7% without permanent recurrent laryngeal nerve injuries. Thirteen of 52 (25%) NN patients and 24 of 67 (36%) NP patients had suspicious nodes by intraoperative inspection. The node assessment negative predictive value was 75%; positive predictive value was 36%. Fifty-six percent (67/118) were NP; 100 patients were treated with RAI. Fourteen of 62 NP patients had abnormal postoperative RAI scans aside from the thyroid remnant versus 4 of 38 NN patients (23 vs. 11%, p  = 0.18). Median 1-year stimulated thyroglobulin (Tg) level was 0.0 for both (range 0.0–1.2, NN; 0.0–22.7, NP; p  = 0.1). NP patients received higher doses of RAI (150 vs. 30 mCi, p  < 0.001). Rate of recurrent or persistent disease was 3.4%. Conclusions Few node-negative patients have abnormal RAI scans outside of the thyroid bed. Node-positive patients had greater variability in stimulated 1-year Tg levels after higher doses of RAI. CLND may identify the patients most likely to have persistently elevated stimulated Tg after initial therapy for PTC.

Prior work shows pregnancy during surgical residency may negatively impact career satisfaction and increase risk of attrition. We sought to gain deeper insight into the experience of childbearing trainees. An electronic survey with three open-ended questions was sent to surgeons who had ≥1 pregnancy during a US general surgery training program. Transcripts were analyzed using directed content analysis and the constant comparative approach. Six themes characterized the pregnancy experience of 219 surgeons in residency. Respondents: 1)desired work modifications during the late stages of pregnancy due to health concerns; 2)regarded maternity leave as too short; 3)perceived stigma related to pregnancy; 4)expressed need for greater lactation and childcare support; 5)desired mentorship on work-family integration; 6)placed value on supportive colleagues and faculty. Pregnancy is challenging during surgical residency. These findings may inform policy changes to improve retention and recruitment of women trainees who wish to begin families during residency. •Rigorous rotations close to term may cause health concerns for pregnant residents.•Residents desire written program maternity leave policies.•Pregnant surgical residents are concerned about stigma related to childbearing.•Residents who go through pregnancy desire mentorship on work-life integration.•Pregnant residents place value on supportive faculty and colleagues.

Background There has been renewed interest in extensive lymph node dissection for papillary thyroid cancer (PTC), and a number of reports have been published concerning compartment‐oriented dissection of regional lymph nodes in PTC. A comprehensive review of this body of literature using evidence‐based methodology is pending. Methods Systematic review of the literature using evidence‐based criteria. Results Issue 1: Systematic compartment‐oriented central lymph node dissection (CLND) may decrease recurrence of PTC (Levels IV and V data, no recommendation) and likely improves disease‐specific survival (grade C recommendation). Limited level III data suggest survival benefit with the addition of prophylactic dissection to thyroidectomy (grade C recommendation). The addition of CLND to total thyroidectomy can significantly reduce levels of serum thyroglobulin and increase rates of athyroglobulinemia (level IV data, no recommendation). Issue 2: There may be a higher rate of permanent hypoparathyroidism and unintentional permanent nerve injury when CLND is performed with total thyroidectomy than for total thyroidectomy alone (grade C recommendation). Issue 3: Reoperation in the central neck compartment for recurrent PTC may increase the risk of hypoparathyroidism and unintentional nerve injury when compared with total thyroidectomy with or without CLND (grade C recommendation), supporting a more aggressive initial operation. Conclusion Evidence‐based recommendations support CLND for PTC in patients under the care of experienced endocrine surgeons.