THYROID AND PARATHYROID DISEASES: DIAGNOSIS, TREATMENT AND SURGERY WITH CURRENT APPROACHES

thyroid_and_parathyroid_diseasesnevinsakoglukapak1-0-25

CLINICAL EVALUATION AND DIAGNOSIS

Adem Şentürk

Sakarya Training and Research Hospital, Department of Surgical oncology, Sakarya, Türkiye

Şentürk A. Clinical Evaluation and Diagnosis. Kesici U, ed. Thyroid and Parathyroid Diseases: Diagnosis, Treatment and Surgery with Current Approaches. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.29-46.

ABSTRACT

The chapter titled “Clinical Evaluation and Diagnosis” in the book “Thyroid and Parathyroid Diseases: Diagnosis, Treatment, and Surgery with Current Approaches” provides a comprehensive framework for the clinical evaluation, diagnostic methods, and approaches to thyroid and parathyroid diseases. This chapter emphasizes a systematic methodology for accurate and timely diagnosis by integrating anatomy, physiology, and pathology in the assessment of endocrine dysfunctions.

Thyroid diseases, including hypothyroidism, hyperthyroidism, thyroid nodules, and malignancies, are examined in detail. Clinical evaluation focuses on symptoms such as metabolic disturbances, cardio- vascular effects, and physical changes. Diagnostic tools, including thyroid function tests (TSH, free T3, and free T4), antibody tests (anti-TPO, anti-Tg), and imaging methods such as ultrasonography and scintigraphy, are discussed. Additionally, risk stratification systems like TIRADS and Bethesda are highlighted as essential guides in distinguishing benign from malignant nodules and in developing patient-centered management strategies.

Parathyroid diseases, particularly hyperparathyroidism and hypoparathyroidism, are addressed with an emphasis on their systemic effects on skeletal, renal, and neuromuscular systems. The evaluation of serum calcium, parathyroid hormone (PTH), and vitamin D levels, along with advanced imaging techniques such as sestamibi scintigraphy and 4D-CT, are explained for their pivotal roles in detecting adenomas, hyperplasia, or ectopic parathyroid glands and in preoperative planning.

The chapter underscores the importance of a multidisciplinary approach in the clinical diagnosis and evaluation of thyroid and parathyroid diseases. Ultimately, this chapter provides clinicians with a foun- dational resource to navigate the complexities of these conditions, offering valuable insights into con- temporary diagnostic practices and their clinical implications.

Keywords: Thyroid diseases, parathyroid diseases, hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoparathyroidism

Referanslar

  1. Bliss RD, Gauger PG, Delbridge LW. Surgeon's approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg. 2000;24(8):891-897. [Crossref]  [PubMed]
  2. Pankow BG, Michalak J, McGee MK. Adult human thyroid weight. Health Phys. 1985;49(6):1097-1103. [Crossref]  [PubMed]
  3. Maravall FJ, Gómez-Arnáiz N, Gumá A, Abós R, Soler J, Gómez JM. Reference values of thyroid volume in a healthy, non-iodine-deficient Spanish population. Horm Metab Res. 2004;36(9):645-649. [Crossref]  [PubMed]
  4. Braun EM, Windisch G, Wolf G, Hausleitner L, Anderhuber F. The pyramidal lobe: clinical anatomy and its importance in thyroid surgery. Surg Radiol Anat. 2007;29(1):21-27. [Crossref]  [PubMed]
  5. Batsakis JG, El-Naggar AK, Luna MA. Thyroid gland ectopias. Ann Otol Rhinol Laryngol. 1996;105(12):996-1000. [Crossref]  [PubMed]
  6. Brent GA. Mechanisms of thyroid hormone action. J Clin Invest. 2012;122(9):3035-3043. [Crossref]  [PubMed]  [PMC]
  7. Jewel AM, Rumana SN, Rahman M, Hossain MA, et al. Gender Differences In Thyroid Cancer In A Tertiary Care Hospital Bangladesh. IOSR journal of dental and medical sciences. 2024;23(9):15-20. [Crossref]
  8. Chaker L, Cooper DS, Walsh JP, Peeters RP. Hyperthyroidism. Lancet. 2024;403(10428):768-780. [Crossref]  [PubMed]
  9. Bezerra LMR, Costa BMM, et al. Hipotireoidismo: uma revisão bibliográfica sobre as etiologias, diagnóstico e condutas terapêuticas. Recima21, 2024;5(4):e545100-e545100. [Crossref]
  10. Campos GD, Lopes B G, et al. Hipotireoidismo - aspectos epidemiológicos, fisiopatológicos e manejo terapêutico. Brazilian Journal of Health Review. 2024. [Crossref]
  11. Seco EM. Anamnesis de antecedentes familiares en prevención. FMC - Formación Médica Continuada en Atención Primaria, 2020;27(3):115-120. [Crossref]
  12. Marqusee E, Benson CB, Frates MC, et al. Usefulness of ultrasonography in the management of nodular thyroid disease. Ann Intern Med. 2000;133(9):696-700. [Crossref]  [PubMed]
  13. Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev. 2003;24(1):102-132. [Crossref]  [PubMed]
  14. Hegedüs L. Thyroid ultrasound. Endocrinol Metab Clin North Am. 2001;30(2):339-ix. [Crossref]  [PubMed]
  15. Blum M, Biller BJ, Bergman DA. The thyroid cork. Obstruction of the thoracic inlet due to retroclavicular goiter. JAMA. 1974;227(2):189-191. [Crossref]  [PubMed]
  16. Aw TC, Clementine Yf. Thyroid Function Tests. 2011;20(2):132-137. [Crossref]
  17. Burger AG. Thyroid Function Tests. 2004:442-452. [Crossref]
  18. Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab. 2006;91(11):4295-4301. [Crossref]  [PubMed]
  19. Haymart MR, Repplinger DJ, Leverson GE, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab. 2008;93(3):809-814. [Crossref]  [PubMed]  [PMC]
  20. McLeod DS, Cooper DS, Ladenson PW, et al. Prognosis of differentiated thyroid cancer in relation to serum thyrotropin and thyroglobulin antibody status at time of diagnosis. Thyroid. 2014;24(1):35-42. [Crossref]  [PubMed]  [PMC]
  21. Vargas-Uricoechea H, Nogueira JP, Pinzón-Fernández MV, Schwarzstein D. The Usefulness of Thyroid Antibodies in the Diagnostic Approach to Autoimmune Thyroid Disease. Antibodies (Basel). 2023;12(3):48. [Crossref]  [PubMed]  [PMC]
  22. Hopwood NJ, Rabin BS, Foley TP Jr, Peake RL. Thyroid antibodies in children and adolescents with thyroid disorders. J Pediatr. 1978;93(1):57-61. [Crossref]  [PubMed]
  23. Solbiati L, Volterrani L, Rizzatto G, et al. The thyroid gland with low uptake lesions: evaluation by ultrasound. Radiology. 1985;155(1):187-191. [Crossref]  [PubMed]
  24. Shambaugh GE 3rd, Quinn JL, Oyasu R, Freinkel N. Disparate thyroid imaging. Combined studies with sodium pertechnetate Tc 99m and radioactive iodine. JAMA. 1974;228(7):866-869. [Crossref]  [PubMed]
  25. Tennvall J, Cederquist E, Möller T, Naversten Y, Akerman M. Preoperative scintigraphy with correlation to cytology and histopathology in carcinoma of the thyroid. Acta Radiol Oncol. 1983;22(3):183-191. [Crossref]  [PubMed]
  26. Giovanella L, Avram A, Clerc J. Molecular Imaging for Thyrotoxicosis and Thyroid Nodules. Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. 2021;62(Suppl 2):20S-25S. [Crossref]  [PubMed]
  27. Tessler FN, Middleton WD, Grant EG, et al. ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. J Am Coll Radiol. 2017;14(5):587-595. [Crossref]  [PubMed]
  28. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. [Crossref]  [PubMed]  [PMC]
  29. Ali SZ, Baloch ZW, Cochand-Priollet B, et al. The 2023 Bethesda System for reporting thyroid cytopathology. Thyroid 2023; 33:1039. [Crossref]  [PubMed]
  30. Subekti I, Pramono LA. Current Diagnosis and Management of Graves' Disease. Acta Med Indones. 2018;50(2):177-182. [Link]
  31. Vitti P, Rago T, Tonacchera M, Pinchera A. Toxic multinodular goiter in the elderly. J Endocrinol Invest. 2002;25(10Suppl):16-18. [PubMed]
  32. Bourquard C, Mornex R. L'adénome toxique [Toxic adenoma]. Rev Prat. 1982;32(29). [PubMed]
  33. Mundy-Baird G, Kyriacou A, Syed AA. De Quervain subacute thyroiditis. CMAJ. 2021;193(26):E1007. [Crossref]  [PubMed]  [PMC]
  34. Ozawa Y. Nihon Rinsho. 1999;57(8):1770-1774., [Link]
  35. Ralli M, Angeletti D, Fiore M, et al. Hashimoto's thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmun Rev. 2020;19(10):102649. [Crossref]  [PubMed]
  36. BILLINGS FT. Iatrogenic hypothyroidism. Am J Med Sci.1951;221(5):495-500. [Crossref]  [PubMed]
  37. Lania A, Persani L, Beck-Peccoz P. Central hypothyroidism. Pituitary. 2008;11(2):181-186. [Crossref]  [PubMed]
  38. Salabè GB. Pathogenesis of thyroid nodules: histological classification?. Biomed Pharmacother. 2001;55(1):39-53. [Crossref]  [PubMed]
  39. Ban Y, Ban Y, Fukunari N. Nihon Rinsho. 2006;Suppl 1:465-468. [Link]
  40. Suster S. Controversies Regarding the Interpretation of Follicular Thyroid Nodules. Arch Pathol Lab Med. 2019;143(12):1472-1476. [Crossref]  [PubMed]
  41. Harmantepe AT, Kocer B, Bayhan Z, Gonullu E, Dulger UC. The unexpected effect of parathyroid adenoma on inflammation. Updates Surg. 2024;76(2):589-593. [Crossref]  [PubMed]
  42. Basolo F, Macerola E, Poma AM, Torregrossa L. The 5th edition of WHO classification of tumors of endocrine organs: changes in the diagnosis of follicular-derived thyroid carcinoma. Endocrine. 2023;80(3):470-476. [Crossref]  [PubMed]  [PMC]
  43. Yamazaki H, Sugino K, Katoh R, et al. Management of follicular thyroid carcinoma. Eur Thyroid J. 2024;13(5):e240146. Published 2024 Oct 16. [Crossref]  [PubMed]  [PMC]
  44. Kim M, Kim BH. Current Guidelines for Management of Medullary Thyroid Carcinoma. Endocrinol Metab (Seoul). 2021;36(3):514-524. [Crossref]  [PubMed]  [PMC]
  45. Bible KC, Kebebew E, Brierley J, et al. 2021 American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer [published correction appears in Thyroid. 2021;31(10):1606-1607. Thyroid. 2021;31(3):337-386. [Crossref]
  46. Bliss RD, Gauger PG, Delbridge LW. Surgeon's approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg. 2000;24(8):891-897. [Crossref]  [PubMed]
  47. Harmantepe AT, Bas E, Akdeniz Y, Kucuk A, Bayhan Z, Kocer HB. A novel index to predict postoperative hypocalcemia in primary hyperparathyroidism. Ir J Med Sci. 2024;193(3):1261-1266. [Crossref]  [PubMed]
  48. Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res. 2022;37(11):2293-2314. [Crossref]  [PubMed]
  49. Pasieka JL, Wentworth K, Yeo CT, et al. Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review. J Bone Miner Res. 2022;37(12):2586-2601. [Crossref]  [PubMed]  [PMC]
  50. Khan AA, Hanley DA, Rizzoli R, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28(1):1-19. [Crossref]  [PubMed]  [PMC]
  51. Hundahl SA, Cady B, Cunningham MP, et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer. 2000;89(1):202-217. [Crossref]  [PubMed]
  52. El-Hajj Fuleihan G, Chakhtoura M, Cipriani C, et al. Classical and Nonclassical Manifestations of Primary Hyperparathyroidism. J Bone Miner Res. 2022;37(11):2330-2350. [Crossref]  [PubMed]
  53. Gulati S, Damle NA, Spalkit S, Chumber S, Das C, Puri G. Multi-modality parathyroid imaging: A shifting paradigm. World Journal of Radiology, 2023;15(3):69-82. [Crossref]  [PubMed]  [PMC]
  54. Minisola S, Arnold A, Belaya Z, et al. Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism. J Bone Miner Res. 2022;37(11):2315-2329. [Crossref]  [PubMed]  [PMC]
  55. Vakiti A, Anastasopoulou C, Mewawalla P. Malignancy-Related Hypercalcemia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 16, 2023., [Link]
  56. Lee JY, Shoback DM. Familial hypocalciuric hypercalcemia and related disorders. Best Pract Res Clin Endocrinol Metab. 2018;32(5):609-619. [Crossref]  [PubMed]  [PMC]
  57. Hakami Y, Khan A. Hypoparathyroidism. Front Horm Res. 2019;51:109-126. [Crossref]  [PubMed]
  58. Linglart A, Levine MA, Jüppner H. Pseudohypoparathyroidism. Endocrinol Metab Clin North Am. 2018;47(4):865-888. [Crossref]  [PubMed]  [PMC]
  59. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline [published correction appears in J Clin Endocrinol Metab. 2011;96(12):3908] [published correction appears in J Clin Endocrinol Metab. 2024 Sep 16;109(10):e1991. J Clin Endocrinol Metab. 2011;96(7):1911-1930. [Crossref]  [PubMed]
  60. Rosner MH, Ha N, Palmer BF, Perazella MA. Acquired Disorders of Hypomagnesemia. Mayo Clin Proc. 2023;98(4):581-596. [Crossref]  [PubMed]