Surgery of the Thyroid and Parathyroid Glands

DESCRIPTION: This course is a 2 1/2 -day update of surgery of the thyroid and parathyroid glands, and has been offered since 1996. Preoperative workup of both thyroid and parathyroid surgical disease will be discussed, with an emphasis on fine needle aspiration and preoperative parathyroid localization imaging options. Surgical techniques will be reviewed (recurrent laryngeal nerve monitoring, parathyroid identification and preservation, intraoperative PTH analysis) and minimally invasive surgical techniques will be discussed. Molecular genetic analysis for medullary carcinoma and advances in oncogene research will also be presented. Surgical philosophy regarding bilateral thyroid surgery, its risks, surgical treatment of the neck, and surgical treatment of invasive tracheal disease will be presented, and we will also review recognition and treatment of postoperative complications along with new advances in their treatment. Panel discussions will center on expert targeted management pearls focusing on a variety of surgical management scenarios along with a second panel of difficult cases, both of which will include audience participation. LEARNING OBJECTIVES: Upon completion of this course, participants will be able to: • Describe thyr oid nodule preoperative FNA cytopathologic categories, molecular testing options and their relationship to other preoperative information such as ultrasound in the preoperative evaluation, and surgical selection in patients with thyroid nodular disease. • Acquire an in-depth compr ehension of voice and laryngeal function both before and after surgery • Explore re cently published voice and laryngeal examination guidelines, especially as they relate to patients with thyroid cancer and potential invasive disease. • Discuss the advantages and limita tions of various options in preoperative imaging for patients with hyperparathyroidism to formulate a discriminating preoperative surgical plan. This will include ultrasound, sestamibi scanning and 4D CT scanning. • Identify standard metho ds and algorithms of application of intraoperative neural monitoring to assure high quality accurate neural monitoring, and monitoring data to optimize the surgical plan. • Evalua te the use of intraoperative PTH management strategies for secondary hyperparathyroidism and renal patients • Optimize surgical outcome in patients with small par athyroid adenoma in primary hyperparathyroidism. TARGET AUDIENCES: The course is intended to target physicians involved in the management of thyroid and parathyroid disease with a focus on surgeons and endocrinologists. Targeted clinicians include both general surgeons, endocrine surgeons, otolaryngologists and head and neck surgeons. In 2012 our audience was made up of 51% general surgeons, 41% otolaryngologists, and 8% endocrinologists. Other associated specialists would include radiologists, pathologists, cytopathologists and nuclear medicine physicians. The audience would also include fellows, residents, associated nurse practitioners and physician assistants. The geographic focus includes US/Northeast as well as abroad. ACCREDITATION: The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Harvard Medical School designates this live activity for a maximum of 21 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. AMA PRA Category 1 Credits™ claimed by physicians attending live events certified and organized in the United States for AMA PRA Category 1 Credits™ can be claimed through the agreement on mutual recognition of credits between UEMS and AMA, considered as being equal to the European Continuous Medical Education Credits (ECMEC©) granted by the UEMS. One AMA PRA Category 1 Credits™ is equivalent to one (1) hour of European EACCME Credit (ECMEC©), therefore up to 21 ECMEC© Credits are available. Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. ACGME COMPETENCIES: This course is designed to meet one or more of the following Accreditation Council of Graduate Medical Education competencies: Patient care, Medical knowledge, Practice-based learning and improvement, Professionalism and Systems-based practice.