Live book 11

Candidate Shift — Persistent Lymphadenopathy: Core First, Excise Intact When Lymphoma Is in Play (Addendum Summary, Ch 5)Triage persistent unexplained lymphadenopathy with ultrasound-guided core biopsy, and excise the largest node intact — fresh and in formalin — whenever lymphoma is suspected or the core is non-diagnostic.Candidate Shift — Salivary Tumours: Never Enucleate or Incise a Parotid Pleomorphic Adenoma (Addendum Summary, Ch 5)Work up salivary neoplasms with Milan-classified FNA and MRI, and remove parotid pleomorphic adenoma by superficial parotidectomy or extracapsular dissection with a cuff — never enucleation or open biopsy.Candidate Shift — Thermal Ablation for Benign Thyroid Nodules (§5.4 Item 3)Offer ultrasound-guided radiofrequency or microwave ablation as a scarless outpatient option for symptomatic, twice-confirmed benign thyroid nodules.Candidate Shift — Thyroglossal & Branchial Cysts: Sistrunk, Not Simple Cystectomy (Addendum Summary, Ch 5)Excise a thyroglossal duct cyst with the formal Sistrunk procedure — never simple cystectomy — after confirming a normal orthotopic thyroid and settling any infection.Practice Shift — Adrenal Incidentaloma, MACS & Pheochromocytoma: Phenotype + Targeted Hormonal Workup, Alpha-Blockade First (Table 5.1)Evaluate every adrenal incidentaloma by imaging phenotype plus targeted hormonal testing — a 1-mg DST for all, metanephrines whenever the lesion is not a classic ≤10 HU adenoma — and always block alpha before beta in pheochromocytoma.Practice Shift — Bethesda III/IV Nodules & NIFTP: Prevalence-Aware Molecular Testing, Histology-Only NIFTP (Table 5.1)Use reflex molecular testing to inform Bethesda III/IV decisions — reading its predictive values against your local prevalence — and never diagnose NIFTP on cytology alone.Practice Shift — DTC >2.0 to ≤4.0 cm (cT2, cN0): Shared Decision Between Lobectomy and Total Thyroidectomy (Table 5.1)Treat low-risk cT2 (2–4 cm) cN0 DTC as a shared-decision category — weigh lobectomy against total thyroidectomy with the patient, and default to neither as a universal rule.Practice Shift — DTC ≤2.0 cm: Initial Lobectomy, No Routine Prophylactic Central Neck Dissection or RAI (Table 5.1)Start with lobectomy for selected unilateral intrathyroidal cN0 DTC ≤2.0 cm — drop routine total thyroidectomy with prophylactic central neck dissection and empiric RAI ablation.Practice Shift — IONM, NIRAF vs. ICG, and PHPT Localization: Device-Specific Protocols and Modality Discipline (Table 5.1)Run IONM on device-specific protocols with the full troubleshooting-and-staging algorithm, keep NIRAF (tissue identification) and ICG (perfusion) apart, and choose PHPT localization selectively — never by a universal EMG cutoff or a mandatory 4D-CT default.Practice Shift — Low-Risk Papillary Microcarcinoma (T1a ≤1.0 cm): Structured Active Surveillance as an Option Beside Lobectomy (Table 5.1)Offer strictly eligible low-risk T1a microcarcinoma a shared choice between structured active surveillance and initial lobectomy — neither surveillance for every ≤1 cm tumor nor surgery for all of them.Stepwise Clinical Decision Pathway — Endocrine Surgery (§5.2)Keep active surveillance inside its strict boundaries, size the thyroidectomy by tumour size, and never skip the pheochromocytoma rule.

Codes 55

END-THY-CALC-01 — Transient hypocalcaemia~20–30% · 10–20% — Published split by definition — never merged (see Disputed Figures Table B)END-THY-CALC-02 — Permanent hypocalcaemia1–3% · Definition context (added 2026-11-06, external-build audit): · Owner decision 2026-11-06: patient figure remains 1–3% — Permanent hypocalcaemia requiring ongoing managementEND-THY-COMP-01 — Postoperative haemorrhage<2% — Bleeding requiring attention/intervention as reported in source seriesEND-THY-COMP-02 — Wound infection<1% — Wound infection as reported in source seriesEND-THY-COMP-03 — Temporary voice weakness / transient RLN palsy2–5% — By clinical voice assessment (method qualifier mandatory — see Disputed Figures Table A)END-THY-COMP-04 — Permanent RLN palsy1–2% · per patient · per nerve at risk — Permanent recurrent laryngeal nerve palsyNCK-LN-DIAG-01 — FNA performance — excellent for metastasis, insufficient alone for lymphomaMetastatic lymphadenopathy diagnosed in 39/39 (100%) · correct lymphoma diagnosis in 73% · of 77 malignant aspirates, 35 (45%) were false-negative — 83% of those false negatives were lymphoid malignancies — by FNAC with immunocytochemistry; (94% if "suspicious of lymphoma" counts) — yet ALL lymphoma patients still required surgical (excisional) biopsy for full subtyping (Bosch QDU, expert cytopathology unit). Corroboration of the gap: in Chau's all-comer clinic, FNAC sensitivity for malignancy was only 49%, andNCK-LN-PREV-01 — Malignancy in unexplained lymphadenopathy, primary careMalignancy 1.1% (29/2,556) overall · ~4% if ≥40 years vs 0.4% if <40 years — Final cancer diagnosis among patients presenting to family practice with unexplained lymphadenopathyNCK-LN-PREV-02 — Causes distribution in a referred cohortReactive 30% (110/372) · infections 24% (91/372, incl. TB 7%, 26/372) · malignancy 32% (120/372) — Final diagnostic categories, adults referred with unexplained PERIPHERAL lymphadenopathyNCK-LN-RISK-01 — Site, extent, sex, age, consistencySupraclavicular site: RR 3.72 (95% CI 1.52–9.12) · RR 4.72 (3.02–6.79) · ≥2 node regions: RR 6.41 (2.82–14.58) · Hard & fixed node: RR 15.36 (13.27–17.61) · Size ≥1 cm: RR 4.43 (2.77–6.48) — Multivariable predictors of a malignant final diagnosis in referred unexplained lymphadenopathyNCK-LN-TB-01 — TB share of superficial/cervical lymphadenopathy in endemic settingsTB lymphadenitis 56.0% (354/632) · 54% (83/155) — of superficial lymphadenopathy FNAC diagnoses (reactive hyperplasia 38.3%, metastatic 3.6%, Hodgkin 1.6%, NHL 0.5%); cervical nodes = 85.4% of cases (Islamabad, Pakistan, 2017–2019, ages 15–70). Corroborating series (secondary-reported): TB of enlarged neck nodes in an ENT cohort, Kathmandu, Nepal (Maharjan 2009)NCK-LN-THR-01 — When a neck mass is at increased risk — act, don't watch (AAO-HNS 2017 CPG, adults ≥18 y)≥2 weeks · fixation, firm consistency, size >1.5 cm, overlying ulceration · FNA instead of open biopsy — Increased malignancy risk if: mass present without significant fluctuation AND no infectious explanation, or duration uncertain (KAS 2a); or any of: (KAS 2b). At increased risk: contrast CT/MRI (strong recommendation); when diagnosis uncertain (KAS 7); cystic mass — keep evaluating, never assume benign (KAS 8); EUA of upper aerodigestive tract before open biopsy if still undiagnosed (KAS 10); do NOT routinely prescribe antibiotics without bacterial signs (KAS 1)SAL-PAR-COMP-01 — Transient facial nerve palsySuperficial parotidectomy 26% (95% CI 17–37) · Extracapsular dissection 5% (95% CI 3–8) — Any postoperative facial weakness recovering thereafter; ascertainment per primary studySAL-PAR-COMP-02 — Permanent facial nerve palsySP 4% (95% CI 2–5) · ED 3% (95% CI 2–4) · difference NOT significant — Weakness persisting at last follow-up (definitions vary by study)SAL-PAR-COMP-03 — Facial nerve palsy after total parotidectomytransient 59.8%, permanent 4.0% · permanent 20.5% — Transient / permanent, mixed benign+malignant case-mix in the underlying seriesSAL-PAR-COMP-04 — Gustatory sweating (Frey) after parotidectomy(a) Pooled clinical: SP 13% (95% CI 7–25); ED 4% (3–6) · (b) Paired (Choi 2013, same 59 patients, same visit): subjective symptoms 33.9% (20/59) vs MSIT-positive 50.8% (30/59) — Two ascertainment layers, never blended: (a) pooled CLINICAL/symptomatic rates by technique; (b) paired same-patient comparison of symptoms vs Minor starch-iodine test (MSIT)SAL-PAR-PREV-01 — Pleomorphic adenoma (PA) sharePA = 70% of benign tumours (n=2,621); PA = 45% of ALL SGT — PA as % of benign salivary gland tumours (SGT) and of ALL SGTSAL-PAR-PREV-02 — PA site distributionParotid 84% · submandibular 8% · minor glands 6.5% · sublingual 0.5% — Where PAs arise, by glandSAL-PAR-REC-01 — Extracapsular dissection (ED) vs superficial parotidectomy (SP)ED 3% (37/1,359; 95% CI 2–9) vs SP 4% (26/1,032; 95% CI 3–6) — no significant difference — Primary, unifocal, unilateral PA of the superficial lobe, <4 cm, adults; single-arm pooled proportionsSAL-PAR-REC-02 — Historical intracapsular enucleation ("shell-out")Recurrence 20–45% — Early-20th-century enucleation retaining the (pseudo)capsule — NOT modern extracapsular dissectionSAL-PAR-RISK-01 — Malignancy share by gland (the classic gradient)20–25% · 40–50% · 70–90% · >50% · sole adopted set — % of tumours at each gland that are malignantSAL-SMG-COMP-01 — Marginal mandibular branch injuryTransient 9%; permanent paresis <1% (1 patient) · 2.7% at long-term follow-up · 1–7% — Transient vs permanent lower-lip depressor weaknessSAL-SMG-COMP-02 — Lingual nerve injury0.5–4.4% — Sensory disturbance / paralysis of the anterior tongue, as defined per seriesSAL-SMG-COMP-03 — Hypoglossal nerve injuryNo defensible point estimate exists in the verified material — —SAL-SMG-PREV-01 — Distribution of salivary stones by glandSubmandibular duct/gland >80% · parotid 6–15% · sublingual + minor ~2% — Site of stone among patients with sialolithiasisSAL-SMG-SUC-01 — Interventional sialendoscopy (± combined approach)For sialoliths specifically: 89.6% — Symptom-free / obstruction resolved, as defined per primary studySAL-SMG-SUC-02 — ESWL (shock-wave lithotripsy) aloneOverall 47.15% (67/142): parotid 60.9% (39/64) vs submandibular 35.9% (28/78) · 30–50% — Complete success = stone-free AND symptom-freeEND-PTH-DIS-01 — Pathology distributionADOPTED (guideline): single adenoma ~85% · multigland disease ~15% (of which double adenomas ~4–5%, hyperplasia ~10%) · carcinoma <1% — Cause of sporadic pHPT at surgery/pathologyEND-PTH-EPI-01 — Incidence & prevalence of pHPT66 per 100,000 person-years (women) · 25 (men) · 196 (women) / 95 (men) · 233 per 100,000 women (0.23%) · 85 per 100,000 men — Biochemically defined PHPT (hypercalcaemia + raised/inappropriately normal PTH)END-PTH-MEN-01 — Inherited-syndrome share of pHPT3%–5% — pHPT occurring as part of an inherited syndrome (MEN1, MEN2A, HPT-JT, familial isolated)END-PTH-MEN-02 — MEN1 → pHPT penetrance>90% by age 50 — pHPT in MEN1 gene carriers by age 50END-PTH-NOR-01 — Normocalcaemic pHPT — progressionADOPTED: ≈1 in 10 over 3–4 years in recent cohorts — Development of frank hypercalcaemia during follow-up of normocalcaemic pHPT (raised PTH, persistently normal total + ionised calcium, secondary causes excluded)END-PTH-NOR-02 — Normocalcaemic pHPT — prevalenceNo single figure issued: · 0.18%–8.9% — As aboveEND-PTH-SUC-01 — Cure — focused (minimally invasive) parathyroidectomyCure 97%–99% — Normocalcaemia ≥6 months after focused resection guided by preoperative imaging + intraoperative PTH monitoring (IPM)END-THY-CAN-AS-01 — Tumour enlargement under active surveillance4.7% at 10 y · 6.6% at 20 y — Increase ≥3 mm vs baseline, confirmed on successive USEND-THY-CAN-AS-02 — Novel nodal metastasis under AS; hard endpoints1.0% at 10 y · 1.6% at 20 y · recurrence · Zero deaths from thyroid cancer in all 5,646 patients · 12.3% (AS) vs 100% (IS) — New clinically apparent nodal metastasis during AS; DTC death; distant recurrence; surgery exposureEND-THY-CAN-DIS-01 — Histology distributionPapillary 89.4% · Follicular 4.6% · Oxyphilic (Hürthle cell) 2.0% · Medullary 1.7% · Anaplastic 0.8% · 96% — Share of all histologically confirmed thyroid cancersEND-THY-CAN-DIS-02 — Latent reservoir: incidental DTC at autopsy11.2% · 4.1% — DTC found incidentally at autopsy in people with no known thyroid diseaseEND-THY-CAN-SUR-01 — 5-year relative survival by SEER stageAll stages 98.3% · Localised 99.9% (63% of cases) · Regional 98.1% (31%) · Distant 48.3% (3%) — Relative survival, all histologies combinedEND-THY-CAN-SUR-02 — 5-year relative survival by histology & stagedistant 71% · 62% · 50% · 45% / 14% / 5% — Relative survival within histologyEND-THY-INC-01 — ACR workup thresholds for incidental thyroid nodules (ITN)age <35 y and nodule ≥1 cm · age ≥35 y and nodule ≥1.5 cm · no further evaluation — ITN on CT, MRI, or extrathyroidal US, without suspicious features and with normal life expectancyEND-THY-INC-02 — How often are ITNs found?~16–18% of neck CT/MRI — ITN reported on cross-sectional neck/chest imagingEND-THY-NOD-BET-01 — Bethesda System 2023 — implied risk of malignancy by category (I–VI)13% (5–20) — 2023 edition — the risks are computed counting NIFTP as not malignant. Category I is the headline value; categories II–VI are in variants (one coded unit spanning the whole table, as the dossier prints it).END-THY-NOD-GRO-01 — Significant growth of a benign nodule15.4% of patients · 18.5% · 9.3% · 0.3% of the original nodules — ≥20% increase in ≥2 diameters with ≥2 mm increase, over 5 yearsEND-THY-NOD-MAL-01 — Malignancy share of nodules7%–15% — Proportion of clinically evaluated thyroid nodules that prove malignantEND-THY-NOD-MOL-01 — ThyroSeq v3 genomic classifier94% · 82% · NPV 97% · PPV 66% — Prospective, blinded, multicentre (10 centres); 257 informative indeterminate nodules (154 III, 93 IV, 10 V)END-THY-NOD-MOL-02 — Afirma GSC (genomic sequencing classifier)91% · 68% · NPV 96% · PPV 47% — Prospective, blinded validation (49 centres); 190 nodules in performance set (45 malignant, 145 non-malignant)END-THY-NOD-PREV-01 — Nodule prevalence — palpation~5% of women; ~1% of men — Nodule detectable on physical examinationEND-THY-NOD-PREV-02 — Nodule prevalence — ultrasound19%–68% — Any sonographic nodule in randomly selected individualsEND-THY-NOD-PREV-03 — Nodule prevalence — autopsyMethod-split — no single figure adopted: · 6.4% — Nodules found at post-mortem examinationEND-THY-NOD-RISK-01 — Female sexWomen 36.5% · men 23.5% — US/imaging-detected nodule prevalence by sexEND-THY-NOD-RISK-02 — Ageing<30 y: 10.6% · 30–39: 17.3% · 40–49: 24.9% · 50–59: 33.4% · 60–69: 42.0% · >70 y: 44.7% — Nodule prevalence by age bandEND-THY-NOD-TIR-01 — ACR TI-RADS (points-based): TR1 / TR2 / TR3 / TR4 / TR50.3% / 1.5% / 4.8% / 9.1% / 35%END-THY-NOD-TIR-02 — EU-TIRADS (pattern-based): EU2 / EU3 / EU4 / EU5~0% / 2–4% / 6–17% / 26–87%END-THY-NOD-TIR-03 — ATA sonographic patterns: high / intermediate / low / very low / benign>70–90% / 10–20% / 5–10% / ≤3% / <1%

Memory 13

Stones, bones, groans and (psychic) moansHypercalcaemia / primary hyperparathyroidism features3 Ps / 2 Ps + 1 M / 1 P + 2 MsMEN component devicesRule of 10s (pheochromocytoma) — VERSIONS DISPUTEPhaeochromocytoma traditional facts — kept as a versions-dispute cardThe 5 PsPhaeochromocytoma spells (clinical features)PHE triadPhaeochromocytoma symptom triad (first three letters of "phaeochromocytoma")GFRLayers of the adrenal cortex, superficial → deepGo Find Rex, Make Good SexAdrenal cortex layers + their hormonesSalt, Sugar, Sex — the deeper you go, the sweeter it getsAdrenal cortex products by depth (phrase device)Papi and Moma adopted Orphan AnniePapillary thyroid carcinoma histologyNO SPECSSeverity of Graves' orbitopathy (Werner classification)PFMA — "Pappu Football Match Attend"Thyroid cancer typesWhipple's triadInsulinoma / hypoglycaemiaTI-RADSThyroid nodule imaging reporting (name-device)