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Thyroid Surgery
Principles and Practice

Edited by
Madan Laxman Kapre
First edition published 2020
by CRC Press
6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742

and by CRC Press

2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN

© 2020 Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, LLC

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Library of Congress Cataloging-in-Publication Data

Names: Kapre, Madan, editor.

Title: Thyroid surgery : principles and practice / edited by Madan Kapre.
Other titles: Thyroid surgery (Kapre)
Description: First edition. | Boca Raton : CRC Press, 2020. | Includes bibliographical references and index. |
Summary: “This book will bridge a gap between the huge platform of literature available on the subject of thyroid
surgery and the pratical working reality. The pearls in techniques and surgical procedures will be exhaustively
detailed with authors’ individual experience enriched with quality photographs”-- Provided by publisher.
Identifiers: LCCN 2020006268 (print) | LCCN 2020006269 (ebook) | ISBN 9781138483781 (hbk) | ISBN 9780429086076 (ebk)
Subjects: MESH: Thyroid Diseases--surgery | Thyroid Gland--surgery | Thyroid Neoplasms--surgery | Thyroidectomy
Classification: LCC RD599.5.T46 (print) | LCC RD599.5.T46 (ebook) | NLM WK 280 | DDC 617.5/39--dc23
LC record available at https://lccn.loc.gov/2020006268
LC ebook record available at https://lccn.loc.gov/2020006269

ISBN: 9781138483781 (hbk)

ISBN: 9780429086076 (ebk)

Typeset in Minion
by Nova Techset Private Limited, Bengaluru & Chennai, India
 CONTENTS

Preface vii
Acknowledgments ix
Editor xi
Contributors xiii
Introduction xvii

CHAPTER 1 HISTORY AND EVOLUTION OF THYROID SURGERY 1

Cheerag Patel and Subhaschandra Shetty

CHAPTER 2 SURGICAL ANATOMY OF THE THYROID 7

Ashutosh Mangalgiri and Deven Mahore

CHAPTER 3 CLINICAL ASSESSMENT OF THE THYROID NODULE 15

Madan Laxman Kapre, Shripal Jani, and Priya Dubey

CHAPTER 4 IMAGING OF THE THYROID 21

Alka Ashmita Singhal

CHAPTER 5 PATHOLOGY OF THE THYROID 45

R. Ravi

CHAPTER 6 MEDICAL MANAGEMENT OF THYROID DISORDERS 51

Himanshu Patil and Shailesh Pitale

CHAPTER 7 ANESTHESIA FOR THYROID SURGERY 57

Vidula Kapre, Shubhada Deshmukh, Pratibha Deshmukh, Meghna Sarode, and Rajashree Chaudhary

CHAPTER 8 SAFE THYROIDECTOMY 67

Madan Laxman Kapre, Sankar Viswanath, Rajendra Deshmukh, and Neeti Kapre Gupta

CHAPTER 9 SURGERY FOR MULTINODULAR GOITER 75

Madan Laxman Kapre, Sanoop Elambassery, Neeti Kapre Gupta, M. Abdul Amjad Khan, and Gauri Kapre Vaidya

CHAPTER 10 MANAGEMENT OF RETROSTERNAL GOITER 79

Belayat Hossain Siddiquee

CHAPTER 11 REMOTE ACCESS ENDOSCOPIC AND ROBOTIC THYROIDECTOMY 83

Kyung Tae

CHAPTER 12 ROBOTIC THYROIDECTOMY 91

Neil S. Tolley and Christian Camenzuli

CHAPTER 13 INTRA-OPERATIVE NEURAL MONITORING 97

Rahul Modi

v
CHAPTER 14 SURGICAL MANAGEMENT OF DIFFERENTIATED THYROID CANCERS 105
Anil D’cruz and Richa Vaish

CHAPTER 15 MANAGEMENT OF NODAL METASTASIS IN THYROID CANCER 113

Neeti Kapre Gupta, Ashok Shaha, Madan Laxman Kapre, Nirmala Thakkar, and Harsh Karan Gupta

CHAPTER 16 COMPLICATIONS OF THYROID SURGERY 119

Gregory W. Randolph, Dipti Kamani, Cristian Slough, and Selen Soylu

CHAPTER 17 LOCALLY ADVANCED THYROID CANCER 127

Amit Agarwal and Roma Pradhan

CHAPTER 18 SURGICAL MANAGEMENT OF MEDULLARY THYROID CANCERS 135

Anuja Deshmukh and Anand Thomas

CHAPTER 19 SURGICAL MANAGEMENT OF ANAPLASTIC THYROID CANCERS 147

Deepa Nair and K.S. Rathan Shetty

CHAPTER 20 POST-TREATMENT SURVEILLANCE OF THYROID CANCER 151

Abhishek Vaidya

CHAPTER 21 APPLICATIONS OF RADIOISOTOPES IN THE DIAGNOSIS AND

TREATMENT OF THYROID DISORDERS 161
Chandrasekhar Bal, Meghana Prabhu, Dhritiman Chakraborty, K. Sreenivasa Reddy, and Saurabh Arora

CHAPTER 22 SYSTEMIC THERAPY (TARGETED THERAPY AND IMMUNOTHERAPY)

FOR THYROID CANCERS 173
Abhishek Vaidya and Amol Dongre

CHAPTER 23 SURGICAL MANAGEMENT OF PARATHYROID DISORDERS 179

Neeti Kapre Gupta, Gregory W. Randolph, and Dipti Kamani

CHAPTER 24 PEDIATRIC THYROID SURGERY 187

Rajendra Saoji

Index 191

vi Contents
 PREFACE

The seeds of this book were sown by the students getting off the bus It was then that, quite unexpectedly, Miss Shivangi from Taylor &
returning from their annual Thyroid Surgical Camp of Chikhaldara, Francis approached us and very kindly offered to take the thread of
Melghat. Armed with the art and craft of thyroid surgery, they this new book forward.
wanted more insight into the science of it. I soon realized the magnitude of the task. Some unforeseen health
Our first book Atlas of Thyroid Surgery answered the question of issues almost stalled the process, and I am grateful to my publishers
“how?” but there were more questions, like “when?,” “why?,” and for graciously bearing with the delay.
“how much?” that remained unanswered. With this book we have endeavored to bring forth a blend of
Thyroid surgery has undergone several paradigm shifts, from being surgical rationale, multidisciplinary decision-making, basic surgical
a life-threatening exercise to a minimally invasive procedure. More principles, and techniques for both the novice and the expert alike.
than any other surgery, it highlights the need to respect tissues, We have tried to include authors from across the globe to present a
nerves, and vessels. Skill, precision, and the fine line between holistic viewpoint on thyroid management.
aggression and conservatism in surgery is nowhere as important as
Thyroid surgery can be performed with some grams of steel but
it is in the management of thyroid disease. To do justice to all this
needs nerves of steel.
was well beyond the scope of an atlas or a workshop.

vii
 ACKNOWLEDGMENTS

What worth is your knowledge if it does not dispel the darkness how difficult it must have been for them to draw that extra ounce of
of ignorance? What worth is your skill if it does not make others energy and precious time to painstakingly write their chapters. I am
skillful? What worth is a teacher’s greatness if their students do not grateful to all of them.
become greater than themselves? And I wish to express my gratitude to my colleagues in my own
I have been fortunate to find worthy colleagues, “Men and Women institute, fellows who worked with us, and the secretarial backup
of Wisdom,” and worthy publishers, CRC Press, Taylor & Francis I received. Running the risk of missing a few names inadvertently
Group, who came together to disseminate the wisdom, skill, and and asking for their pardon, I am grateful to my fellows who have
great clinical prowess in the field of thyroid surgery. been burdened by tasks beyond their working hours. Dr. Neeti
First, I wish to thank Miss Shivangi Pramanik and Miss Himani has been great in gathering bits and pieces provided by Amjad,
Dwivedi who had the faith and patience to bear with us, the authors Sankar, Sanoop, Shripal, and Priya. She has been my real support
and the editor. It was their disciplined approach that laid the in compiling this book.
foundation for this book, given to us by the publisher CRC Press, Finally, I am in great debt to my family, my wife Vidula, my
Taylor & Francis Group. daughters Neeti and Gauri, and my sons-in-law Abhishek and
All my colleague authors who penned the chapters are the worthy Harsh for their unconditional support and sufferings in the making
men and women of wisdom. I am appreciative and conscious of of this book.

ix
 EDITOR

Dr. Madan Laxman Kapre is the and Neck Oncology. He has been President of the Laryngology
Director at Neeti Clinics in Nagpur, and Voice Association of India and of the Maharashtra State ENT
India. He is the Founder and associations. For his work in tribal hills endemic for goiter, he has
Governing Council Member of the received lifetime achievement awards by two prestigious national
Asia Pacific Thyroid Society, Seoul, organizations: Foundation of Head and Neck Oncology and Indian
South Korea; Advisory Committee Academy of Otolaryngologist and Head and Neck Surgeons. His
of the Asia Pacific Society of Thyroid research work includes mandibular mucoperiosteal flap for closure
Surgery; and the Chairman of the of oral defects after surgery of oral cancers and intraoperative
Indian Subcontinent Symposium to cytology for clearance of surgical margins. He is very active
3rd WCTC, Boston, USA. He is the academically and has authored/edited many books including
Founder and President of the Indian Atlas of Thyroid Surgery (Jaypee Brothers Medical Publishers,
Society of Thyroid Surgeons, past 2013), Atlas on Surgery of Trismus of OSMF (Springer Singapore,
President of the Foundation of Head & Neck Oncology in India, 2018), and Essentials of Head and Neck Surgery (Byword Books,
and the Founding President of the Vidarbha Society for Head December 2011).

xi
 CONTRIBUTORS

Amit Agarwal Amol Dongre

Department of Endocrine Surgery Consultant Medical Oncologist
Sanjay Gandhi Post Graduate Institute Alexis Multispeciality Hospital
of Medical Sciences (SGPGIMS) Nagpur, India
Lucknow, India
Priya Dubey
Saurabh Arora Association of Otorhinolaryngologists and
Department of Nuclear Medicine Head and Neck Surgery (AOI-HNS)
All India Institute of Medical Sciences (AIIMS) Neeti Clinics
New Delhi, India Nagpur, India

Chandrasekhar Bal Sanoop Elambassery

Department of Nuclear Medicine ENT and Head and Neck Surgeon
All India Institute of Medical Sciences (AIIMS) Malabar Hospital
New Delhi, India Kozhikode, India

Christian Camenzuli Harsh Karan Gupta

Hammersmith Hospital Consultant ENT Surgeon
Imperial College NHS Trust Neeti Clinics
London, United Kingdom and
Consultant ENT Surgeon
Dhritiman Chakraborty American Institute of Oncology
Department of Nuclear Medicine Nagpur, India
All India Institute of Medical Sciences (AIIMS)
New Delhi, India Neeti Kapre Gupta
Consultant Head and Neck Surgeon
Rajashree Chaudhary Neeti Clinics
Consultant Anesthesiologist and
Neeti Clinics Consultant Head and Neck Surgeon
Nagpur, India American Institute of Oncology
Nagpur, India
Anil D’cruz
Consultant Head and Neck Surgeon Shripal Jani
Apollo Hospitals Foundation of Head and Neck Oncology (FHNO)
and Neeti Clinics
TATA Memorial Hospital Nagpur, India
Mumbai, India
Dipti Kamani
Anuja Deshmukh Division of Thyroid and Parathyroid Endocrine Surgery
Department of Head and Neck Surgery Department of Otolaryngology – Head and Neck Surgery
TATA Memorial Centre Massachusetts Eye and Ear Infirmary
Mumbai, India Harvard Medical School
Boston, Massachusetts
Pratibha Deshmukh
Department of Anesthesia Madan Laxman Kapre
Indira Gandhi Medical College Neeti Clinics
Nagpur, India and
Consultant Head and Neck Surgeon
Rajendra Deshmukh American Institute of Oncology
Visiting Consultant ENT Surgeon and
Neeti Clinics R.S.T. Regional Cancer Institute
Nagpur, India Nagpur, India

Shubhada Deshmukh Vidula Kapre

Department of Anesthesia Consultant Anesthesiologist
Lata Mangeshkar Medical College Neeti Clinics
Nagpur, India Nagpur, India

xiii
M. Abdul Amjad Khan R. Ravi
Department of ENT and Head and Neck Surgery Institute of Surgical Pathology
Citizens Specialty Hospital Nagpur, India
Hyderabad, India
K. Sreenivasa Reddy
Deven Mahore Department of Nuclear Medicine
Government Medical College All India Institute of Medical Sciences (AIIMS)
Gondia, India New Delhi, India

Ashutosh Mangalgiri Rajendra Saoji

Department of Anatomy Department of Pediatric Surgery
Chirayu Medical College Government Medical College
Bhopal, India Nagpur, India

Rahul Modi Meghna Sarode

ENT – Head and Neck Surgery Consultant Anesthesiologist
Dr. L H Hiranandani Hospital Neeti Clinics
Mumbai, India Nagpur, India

Deepa Nair Ashok Shaha

Head and Neck Oncosurgeon Senior Consultant Head and Neck Surgery
Tata Memorial Hospital Jatin P. Shah Chair in Head and Neck Surgery
Mumbai, India Memorial Sloan Kettering Cancer Center
New York, New York
Cheerag Patel
Department of Otorhinolaryngology, K.S. Rathan Shetty
Head and Neck Surgery Department of Head and Neck Oncology
Auckland District Health Board Kidwai Memorial Institute of Oncology
Auckland, New Zealand Bangalore, India

Himanshu Patil Subhaschandra Shetty

Consultant Endocrinologist ORL Head and Neck Surgery
Dew Hospital Middlemore Hospital
Nagpur, India Auckland, New Zealand

Shailesh Pitale Belayat Hossain Siddiquee

Consultant Endocrinologist Department of Otolaryngology
Trinity Institute and Dew Hospital Bangabandhu Sheikh Mujib Medical
Nagpur, India University (BSMMU)
Dhaka, Bangladesh
Meghana Prabhu
Department of Nuclear Medicine Alka Ashmita Singhal
All India Institute of Medical Sciences (AIIMS) Senior Consultant Radiology
New Delhi, India Medanta – The Medicity
New Delhi, India
Roma Pradhan
Department of Endocrine Surgery Cristian Slough
DR Ram Manohar Lohia Institute of Medical Sciences Otolaryngology – Head and Neck Surgery
Lucknow, India Willamette Valley Medical Center
McMinnville, Oregon
Gregory W. Randolph
The Claire and John Bertucci Endowed Chair Selen Soylu
in Thyroid Surgery Oncology Department of General Surgery
Harvard Medical School Istanbul University
and Cerrahpasa Medical Faculty
Division of Thyroid and Parathyroid Endocrine Surgery Istanbul, Turkey
Department of Otolaryngology – Head and Neck Surgery
Massachusetts Eye and Ear Infirmary Kyung Tae
Harvard Medical School Department of Otolaryngology – Head and
and Neck Surgery
Department of Surgery, Endocrine Surgery Service College of Medicine
Massachusetts General Hospital Hanyang University
Boston, Massachusetts Seoul, Korea

xiv Contributors