Controversies in thyroid and parathyroid surgery.

BACKGROUND/PURPOSE: Clinicians involved in thyroid and parathyroid surgical care can harbor strongly held beliefs meant to achieve the best outcomes, sometimes based on erroneous or outdated evidence. This article will clarify some common practices that can be refuted by critical analysis of the literature.

METHODS

Observations in clinical practice of the most strongly communicated practice patterns were compared to review of published literature. Those practice patterns most discordant with evidence were included in the list of myths.

RESULTS

Eligible clinical practices were organized by source: Surgeon, Anesthesiologist, Endocrinologist, and Institution. Examples of practices that can be disputed by evidence included the avoidance of muscle relaxants during recurrent nerve monitoring, awake fiberoptic airway management during induction for large or retrosternal goiter surgery, avoidance of contrast for CT imaging, and utilization of neural monitor technicians during surgery. Overall, 10 practice patterns that are discordant with published evidence were identified as appropriate for myth-busting.

DISCUSSION: All clinicians caring for thyroid and parathyroid surgery patients share a desire for highest quality outcomes, especially since the patient may have many years to live with the consequences of complications. It is understandable that practice patterns can be strongly adhered to even if evidence suggests alternatives. This project identified some of the more controversial or heterogeneously applied practice patterns.

CONCLUSIONS

Identification of 10 practice patterns that can be altered based on high quality evidence may provide an opportunity for clinicians to reflectively modify what they do, possibly resulting in better, less complex, or more precise clinical care.