THYROID SURGICAL DISEASES (ROJOSON, 1986)
PREFACE
This manual was thought of mainly because of the confusion plaguing students of thyroid disease. The confusion is caused by the ever lingering if not increasing controversies in the management of thyroid diseases. The confusion has reached a point that a physician can treat any patient with a thyroid problem in any manner he feels is good enough and not in a way that he thinks is ideal and should be done.
This manual will attempt to clear this confusion. Controversial issues will be presented, clarified, and analyzed. The objective really is not to resolve completely the controversies, for this is impossible, but to see how these issues may be properly utilized in the formulation of a rational approach in the management of an individual with thyroid disease. The author believes that at present, nobody can be dogmatic about anything with regard to thyroid disease. The most realistic objective is to have a rational management scheme for each individual patient based on the patient’s unique set of problems as well as based on the present state of knowledge.
The second reason why this manual was thought of was that the endemic proportion of Filipino patients which thyroid disease dictates that they be protected from unnecessary, faulty, and irrational surgical treatment. If there is such a thing as unnecessary appendectomy, there is also such a thing as unnecessary thyroidectomy. Thus, included in this manual is a chapter on the pitfalls in the management of a thyroid problem.
This book is primarily intended for the surgical trainees and the practicing general surgeons. For this reason, it is entitled “Thyroid Surgical Diseases.” Although it contains predominantly discussions on the surgical aspects of thyroid diseases, it also contains discussions on non-surgical aspect, like medical suppressive therapy and radioactive iodine therapy. Thus, considering its contents, this book may very well serve as a reference volume for the surgeons in their care for patients with thyroid problem. Needless to say, the medical students can also find this book useful in their understanding of thyroid surgical diseases.
There are four major divisions in this book. The first division, chapters 1 to 17, contains discussions on basic knowledge that a surgical trainee should know regarding anatomy, physiology, pathology, diagnosis, and management thyroid surgical diseases. In this division, constant attempts were made by the author to refrain from invoking or provoking discussions on controversial issues. This is in keeping with the prime objective of the book to avoid or clear up confusion.
The first division offers practical approach to the understanding, diagnosis, management of thyroid surgical diseases based on the author’s personal experience, on the Philippine General Hospital experience, and on an analysis of literature. It will be a sufficient reading material for the busy medical student or surgical trainee before he starts managing a patient with thyroid disease. If he has some more time to spare for his own deeper understanding of the disease, then he can proceed to the second, third, and fourth divisions of the book.
The second division, chapter 18 and its subchapter, deals with the major controversial issues in thyroid diseases. They are presented, clarified and analyzed as to how they can be utilized in the formulation of a rational management plan for a patient with thyroid disease.
The third division, chapter 19, contains the Philippine General Hospital experience on thyroid surgical diseases. Illustrative cases are presented to reinforce the reader’s understanding of the disease.
The fourth division , chapter 20, contains a number of excerpts and abstracts of papers selected by the author for the reader who wants more readings on the controversies of thyroid diseases. With this type of presentation, the author hopes that he has cleared up and not added confusion to the subject matter. If the former be the result, then the objective of the book will have been fulfilled.
The author thanks Dr. Jaime Zamuco and Dr. Marimin Abad-Lapuebla of the Department of Pathology of the University of the Philippine College of Medicine for permission to gather data from the Surgical Pathology Record of the Philippine General Hospital.
Likewise, special acknowledgement is given to Dr. Lisa Manalang, Marites Angulo and Ma. Lilibeth Ramos on whom the greatest burden of editing and publishing this book fell.
REYNALDO O. JOSON, MD