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Surgery of the Thyroid and Parathyroid Glands

Arch Surg. 1984;119(7):867. doi:10.1001/archsurg.1984.01390190103029.
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What is the role of fine-needle aspiration biopsy in evaluating solitary thyroid nodules? Should it be used in most cases? Does it pose a threat by seeding cancer cells? Do false-negative results (6.6% to 27.5%) justify using this procedure at all? Which operation should the surgeon perform when he finds four hyperplastic parathyroid glands: subtotal excision or total excision with transplantation of a gland remnant? What are the best tests to differentiate malignancy-associated hypercalcemia from primary hyperparathyroidism? Authors from both sides of the Atlantic discuss these and many other practical questions.

As expected with multiple authors, their answers do not always agree. For example, Stewart and Broadus favor the assay of nephrogenic cyclic adenosine monophosphate (AMP) levels in the diagnosis of primary hyperparathyroidism, while Clark and Arnaud prefer serum parathyroid hormone level assays, and rank nephrogenic cyclic AMP level assays at the bottom of their list of diagnostic tests.



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