Skip to Main Content


Key Points


  1. Total thyroidectomy should be performed for all primary thyroid malignancies with the exception of anaplastic thyroid cancer.

  2. Protection of the recurrent laryngeal nerves is critical in thyroid and parathyroid procedures. Understanding of the anatomy and its potential variations can help prevent iatrogenic injuries.

  3. Ectopic and supernumerary parathyroid glands can pose a significant challenge to the surgeon. The surgeon should be prepared with sufficient preoperative imaging and knowledge of where to search for missing parathyroid glands.

  4. Minimally invasive adrenalectomy is less painful and associated with a quicker recovery in appropriately selected patients.

  5. Pheochromocytoma needs to be ruled out prior to resection of an adrenal mass. Patients with a pheochromocytoma require specific preoperative management with alpha-blockade.




Functional endocrine neoplasms in the pediatric patient are rare; however, these lesions are the most frequent indication for surgical resection of endocrine glands. Oftentimes, the surgeon may need to perform a resection not only to alleviate symptoms due to hormone hypersecretion but to distinguish between benign and malignant neoplastic processes as well, particularly in this age where advanced radiographic imaging is bringing more incidental lesions to the clinician's attention. Other disorders of the endocrine glands may come to the surgeon's attention due to pathologic hyperfunction, enlargement, or for risk reduction. The surgeon should feel comfortable in the technical aspects of the surgical management of endocrine neoplasms and other endocrinopathies. In this chapter we focus on operative techniques for the management of thyroid, parathyroid, and adrenal neoplasms and endocrinopathies.


Thyroid Gland


Essentials of Diagnosis


  1. While thyroid nodules are less common in childhood compared to adults, the incidence of malignancy is higher.

  2. Medullary thyroid carcinoma may be indicative of multiple endocrine neoplasia syndrome IIA or IIB and pheochromocytoma should be ruled out in these patients.

  3. Ultrasound-guided fine needle aspiration is useful to evaluate a thyroid nodule in the adolescent but sampling error makes it a less useful diagnostic test in the pre-adolescent.

  4. The MACIS score is a prognostic tool for papillary and follicular variant thyroid cancers that is well established in adults. Its utility in the pediatric patient is not well studied.




During the third fetal week, the thyroid gland originates as an outpouching from the foramen cecum at the base of the tongue. This outpouching solidifies into a bilobed structure as it descends below the cricoid cartilage, anterior to the trachea. Fibrous connective tissue, known as the ligament of Berry, anchors the thyroid gland to the trachea. The fourth branchial pouch gives rise to the para-follicular C-cells which will produce calcitonin. These cells are found laterally at the junction of the upper two-thirds of the thyroid gland, and for this reason, medullary thyroid carcinomas (which arise from the para-follicular C-cells) tend to be localized to this region.




The thyroid gland is a bilobed ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.