Application of Ultrasound by the Surgeon in Thyroid-Parathyroid Surgery

  • Güldeniz Karadeniz Çakmak


In general ultrasound (USG) serves as the first-line imaging modality for diseases of the thyroid and parathyroid gland. Currently, in the hands of a surgeon, USG not only provides invaluable data about nodular thyroid disease and parathyroid adenomas but plays a crucial role in the preoperative and intraoperative setting to design minimal-sized incisions for the best cosmetic effect and to guide invasive procedures with higher diagnostic accuracy. Moreover, routine use of USG after positioning results in designing the most appropriate incision for focused parathyroidectomy. The confirmatory USG scanning of the neck region by the surgeon after removal of the predicted lesion is of paramount importance acting as an insurance policy for the surgeon. Beyond the initial diagnosis, in recurrent malignant cases, the surgeon-performed intraoperative USG is a safe way to detect and visualize nonpalpable, subcentimeter lymph nodes in an adequate fashion which is otherwise a great dilemma for the surgeon. As for the issue of recurrence in a previously dissected compartment, surgeon-performed intraoperative USG directed focused dissection is one of the best approaches warranted. The most critical point to be emphasized is that surgeon-performed thyroid, and parathyroid USG requires training, validation, experience, and establishment of competency.


Surgeon Ultrasound FNA Thyroid Parathyroid Recurrent 


  1. 1.
    Coltera MD. Clinician-performed thyroid ultrasound. Otolaryngol Clin N Am. 2014;47:491–507. Scholar
  2. 2.
    Karadeniz Cakmak G, Emre AU, Tascilar O, Gultekin FA, Ozdamar SO, Comert M. Diagnostic adequacy of surgeon-performed ultrasound-guided fine needle aspiration biopsy of thyroid nodules. J Surg Oncol. 2013;107:206–10. Scholar
  3. 3.
    Ruda JM, Hollenbeak CS, Stack BC. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005;132:359–72.CrossRefGoogle Scholar
  4. 4.
    Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011;253:585–91.CrossRefGoogle Scholar
  5. 5.
    Laird AM, Libutti SK. Minimally invasive parathyroidectomy versus bilateral neck exploration for primary hyperparathyroidism. Surg Oncol Clin N Am. 2016;25:103–18.CrossRefGoogle Scholar
  6. 6.
    Untch BR, Adam MA, Scheri RP, Bennett KM, Dixit D, Webb C, et al. Surgeon-performed ultrasound is superior to 99Tc-sestamibi scanning to localize parathyroid adenomas in patients with primary hyperparathyroidism: results in 516 patients over 10 years. J Am Coll Surg. 2011;212:522–9. discussion 529–31. Scholar
  7. 7.
    Solorzano CC, Carneiro-Pla DM, Irvin GL 3rd. Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg. 2006;202:18–24.CrossRefGoogle Scholar
  8. 8.
    Morita SY, Somervell H, Umbricht CB, Dackiw AP, Zeiger MA. Evaluation for concomitant thyroid nodules and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Surgery. 2008;144:862–6. [discussion: 866–8].CrossRefGoogle Scholar
  9. 9.
    Suliburk JW, Sywak MS, Sidhu SB, Delbridge LW. 1000 minimally invasive parathyroidectomies without intra-operative parathyroid hormone measurement: lessons learned. ANZ J Surg. 2011;81:362–5.CrossRefGoogle Scholar
  10. 10.
    Solorzano CC, Carneiro-Pla D. Minimizing cost and maximizing success in the preoperative localization strategy for primary hyperparathyroidism. Surg Clin North Am. 2014;94:587–605.CrossRefGoogle Scholar
  11. 11.
    Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–68. Scholar
  12. 12.
    Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132:658–65.CrossRefGoogle Scholar
  13. 13.
    Stulak JM, Grant CS, Farley DR, Thompson GB, van Heerden JA, Hay ID. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg. 2006;141:489–94. [discussion: 494–6].CrossRefGoogle Scholar
  14. 14.
    Sturgeon C, Yang A, Elaraj D. Surgical management of lymph node compartments in papillary thyroid cancer. Surg Oncol Clin N Am. 2016;25:17–40. Scholar
  15. 15.
    Agcaoglu O, Aliyev S, Taskin HE, Aksoy E, Siperstein A, Berber E. The utility of intraoperative ultrasound in modified radical neck dissection: a pilot study. Surg Innov. 2014;21:166–9.CrossRefGoogle Scholar
  16. 16.
    McCoy KL, Yim JH, Tublin ME, Burmeister LA, Ogilvie JB, Carty SE. Same-day ultrasound guidance in reoperation for locally recurrent papillary thyroid cancer. Surgery. 2007;142:965–72.CrossRefGoogle Scholar
  17. 17.
    Yoo JY, Stang MT. Current guidelines for postoperative treatment and follow-up of well-differentiated thyroid cancer. Surg Oncol Clin N Am. 2016;25:41–59. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Güldeniz Karadeniz Çakmak
    • 1
  1. 1.Division of Breast and Endocrin SurgeryBülent Ecevit ÜniversityZonguldakTurkey

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