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"Man's natural instinct, in fact, is never toward what is sound and true. It is toward what is specious and false . . . The ideas that conquer the race most rapidly and arouse the wildest enthusiasm and are held most tenaciously are precisely the ideas that are most insane. This has been true since the first 'advanced' gorilla put on underwear, cultivated a frown and began his first lecture tour, . . . " H. L. Mencken, from Meditation On Meditation in the Smart Set, June, 1920 pp 45-46 In our opinion there is no field of clinical medicine in such a state of dynamic disequilibrium as clin ical thyroidology. Thyroid diseases are very common. The moderately complex but easily understandable physiological interrelationships between the thyroid, pituitary and hypothalamus have provided stimuli for the application of mod ern technology in the development of an array of diagnostic procedures. Although therapeutic methods have been more stable, and recent advances more limited, their application by phy- Joel I. Hambufl~er. M. D. sicians representing different disciplines has pro vided an ample basis for the expression of differ ing viewpoints. Unfortunately there are few opportunities for in-depth exploration of different attitudes and experience relevant to issues of current interest. The review process employed by medical journals often seems to stifle the expression of controver sial viewpoints.
"Man's natural instinct, in fact, is never toward what is sound and true. It is toward what is specious and false . . . The ideas that conquer the race most rapidly and arouse the wildest enthusiasm and are held most tenaciously are precisely the ideas that are most insane. This has been true since the first 'advanced' gorilla put on underwear, cultivated a frown and began his first lecture tour, . . . " H. L. Mencken, from Meditation On Meditation in the Smart Set, June, 1920 pp 45-46 In our opinion there is no field of clinical medicine in such a state of dynamic disequilibrium as clin ical thyroidology. Thyroid diseases are very common. The moderately complex but easily understandable physiological interrelationships between the thyroid, pituitary and hypothalamus have provided stimuli for the application of mod ern technology in the development of an array of diagnostic procedures. Although therapeutic methods have been more stable, and recent advances more limited, their application by phy- Joel I. Hambufl~er. M. D. sicians representing different disciplines has pro vided an ample basis for the expression of differ ing viewpoints. Unfortunately there are few opportunities for in-depth exploration of different attitudes and experience relevant to issues of current interest. The review process employed by medical journals often seems to stifle the expression of controver sial viewpoints.
This book provides a practical, evidence-based approach to controversies in the management of thyroid nodules and differentiated thyroid cancer (DTC). Thyroid nodules are a commonly encountered clinical entity, identified in 2-6% of the population by palpation, and 20-35% by ultrasound. DTC is the solid organ cancer with the most rapidly increasing incidence (>50,000 new cases in the U.S. annually). Despite extensive research and multiple published comprehensive practice guidelines, numerous controversies remain within this field covering a wide range of issues, including incidence and epidemiology, radiographic evaluation, criteria for needle biopsy, cytopathologic and molecular diagnostics, active surveillance vs. operation for low-risk tumors, extent of surgery, indications for radioactive iodine treatment and external beam radiation, and optimal protocols for follow-up. The book takes a case-based approach: each chapter will begin with a patient presentation highlighting a particular controversial subject in thyroid nodules and DTC. The remainder of the chapter discusses the controversy within the context of current scientific understanding and clinical practice, using the latest evidence-based practice guidelines. Chapters conclude with a final review and discussion of the opening case, with options and recommendations for next steps provided. The recommendations are evidence-based and practical, intended to help guide practitioners in their ongoing care of patients with thyroid nodules and DTC. Each chapter was written by a recognized expert in the area of controversy, including endocrine surgeons, endocrinologists, radiologists, medical oncologists, and nuclear medicine specialists. Controversies in Thyroid Nodules and Differentiated Thyroid Cancer: A Case-Based Approach is an excellent guide for oncologists, endocrinologists, otorhinolaryngologists, surgeons, and practitioners of all types that care for patients with thyroid nodules and DTC.
Diagnostic Methods in Clinical Thyroidology provides a forum for discussion of controversial issues in three major categories: diagnosis of thyroid function, non-invasive evaluation of structural abnormalities, and needle biopsy diagnosis of thyroid nodules. For each category, a free interchange of ideas based on extensive clinical experience is followed by a summary that strives to resolve these controversial issues within a framework of sound clinical practice. The volume will this serve as a ready reference for the many physicians who evaluate thyroid patients.
Thyroid carcinoma is an uncommon malignan ing the available non-human lines, as models cy. In the vast majority of patients, if treated for cell cycle studies and oncogene/anti appropriately, it is associated with a benign oncogene regulation, because they are unaware clinical course. Why then does it hold a con of the often fundamental dichotomy between tinuing fascination for so many physicians? thyroid malignancy and prognosis. Third, the The answer is probably directly dependent very nature of the benign clinical course has suggested to the major health research fund on the very benign nature of most thyroid ing agencies that thyroid cancer is not worthy maligllancies. While there are terrible excep of study in a time of scarce resources. tions, the follicular and papillary thyroid can Nothing could be further from the truth. cers behave in a way quite alien to "common" This gratifying clinical course is the very reason neoplasia, since they grow and metastasize why the study of human thyroid cancer has the slowly. We believe that if only we could under potential for contributing further to our fun stand such a transformed state, we would be able to learn a great deal about the normal and damental understanding of malignancy and, abnormal regulation of the cell cycle and im perhaps more importantly, the mechanisms by prove our understanding of cancer. which the human body can resist neoplastic However, recent advances in the biology of cells.
Thyroid carcinoma is an uncommon malignan ing the available non-human lines, as models cy. In the vast majority of patients, if treated for cell cycle studies and oncogene/anti appropriately, it is associated with a benign oncogene regulation, because they are unaware clinical course. Why then does it hold a con of the often fundamental dichotomy between tinuing fascination for so many physicians? thyroid malignancy and prognosis. Third, the The answer is probably directly dependent very nature of the benign clinical course has suggested to the major health research fund on the very benign nature of most thyroid ing agencies that thyroid cancer is not worthy maligllancies. While there are terrible excep of study in a time of scarce resources. tions, the follicular and papillary thyroid can Nothing could be further from the truth. cers behave in a way quite alien to "common" This gratifying clinical course is the very reason neoplasia, since they grow and metastasize why the study of human thyroid cancer has the slowly. We believe that if only we could under potential for contributing further to our fun stand such a transformed state, we would be able to learn a great deal about the normal and damental understanding of malignancy and, abnormal regulation of the cell cycle and im perhaps more importantly, the mechanisms by prove our understanding of cancer. which the human body can resist neoplastic However, recent advances in the biology of cells.
This book encompasses many different diagnoses as well as several specialties of practicing surgeons in the United States. Over the last ten years many advances have been made in preoperative assessment including imaging and diagnostic techniques, operative approaches including “minimally invasive” and robotic surgery, and post operative care. Controversies in Thyroid Surgery explores some of the controversies that arise as the result of these new findings and applications. The book is divided into the two categories of benign diagnosis and cancer topics. Both of these areas lend themselves to separate analysis of specific problems in the areas mentioned above. The text reviews recent data about advances in diagnostic techniques as well as outcomes with specific regards to the newer operative techniques. The textbook will serve as a resource for medical and surgical colleagues involved in the treatment of a wide variety of thyroid diseases. Authors that are experts in their field and have published extensively provide balanced and non-biased views of topics that are admittedly controversial. Controversies in Thyroid Surgery will be of great value and utility to practicing endocrinologists, general surgeons and otolaryngologists.
This text encompasses many different thyroid diagnoses as well as several specialties of practicing surgeons in the United States. Over the last ten years many advances have been made in preoperative assessment including imaging and diagnostic techniques, operative approaches including ĺlminimally invasiveĺl and robotic surgery, and post-operative care. This volume also explores some of the controversies that arise as the result of these new findings and applications. The book℗lis divided into two categories of℗lbenign diagnosis and cancer topics. Both of these areas lend themselves to separate analysis of specific problems in the areas mentioned above. The℗ltext reviews recent data about advances in diagnostic techniques as well as outcomes with specific regards to the newer operative techniques in thyroid surgery. Controversies in Thyroid Surgery will serve as a resource for medical and surgical colleagues involved in the treatment of a wide variety of thyroid diseases.>.