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1. initial evaluation of thyroid disease - AAES GUIDELINES

Thyroidectomy is most commonly performed to treat thyroid cancer,  an overactive thyroid gland, or a benign goitre causing pressure symptoms. Asymptomatic benign thyroid nodules are very common  being present in  over 50% of the population and most do  to need any treatment. The incidence of thyroid cancer is rising rapidly, mostly due to increased detection of small papillary microcarcinomas on imaging studies.  These are all curable so there has not been any increase in death rates form thyroid cancer.

The AAES recommendations for initial evaluation emphasise the need for history and examination, voice assessment, and assessment of hormonal status.

Recommendation 1: Evaluation of thyroid disease should include specific inquiry about personal history, family history, clinical characteristics, and symptoms.

Comments: Most thyroid problems do not require surgery hence the need for careful evaluation to avoid unnecessary operations as well as to reduce the risk of complications.  All patients undergo a comprehensive evaluation with personal and family history as well as examination of the neck and thyroid gland. Voice assessment is now performed using the Voice Handicap Index (VHI), a validated assessment tool for any pre-existing damage to the nerves controlling the voice box. An abnormal result will require a subsequent laryngoscopy but most patients can now avoid that invasive investigation. 

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