Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P21

Panel Presentations

Endocrine Surgery
Advanced Thyroid Cancer: Molecular
Testing and Therapeutic Options
Elizabeth E. Cottrill, MD (Moderator); Gregory W.
Randolph, MD; David C. Shonka Jr, MD; Lori Wirth, MD
Session Description: Advanced thyroid cancer is often
encountered by otolaryngologists specializing in head and
neck surgery and occasionally by comprehensive otolaryngologists in the private practice setting. Management of
patients with advanced thyroid cancer can be challenging, and
there have been substantial changes in the available treatment
options in recent years. Making the appropriate diagnosis rapidly is important, and the first goal of this session is to define
advanced thyroid cancer and identify the diagnostic studies
that are indicated to confirm advanced disease. The second
goal is to discuss the specific mutations that can be identified
in thyroid cancer and the targeted and nontargeted treatment
options that are available depending on the results of molecular testing. Finally, the session will cover aspects of surgical
decision making and the role of adjuvant therapy. The session
will use case presentations to illustrate state-of-the-art management of patients with advanced thyroid cancer.
Outcome Objectives: (1) Define advanced thyroid cancer. (2)
Identify the specific mutations that drive advanced disease
and corresponding targeted treatment options. (3) Discuss the
role of perioperative adjuvant therapy in the management of
advanced thyroid cancer.
Beyond the Guidelines: Advanced Pediatric
Thyroid Cancer Evaluation and Management
Anthony Sheyn, MD (Moderator); Daniel C. Chelius Jr, MD;
Jeffrey C. Rastatter, MD; Lourdes Quintanilla-Dieck, MD
Session Description: Pediatric thyroid carcinoma accounts
for approximately 1.8% of all thyroid malignancies in the
United States and 3% of all pediatric malignancies, and it is
the second most common malignancy in adolescent girls.
Despite that, it is only within the past 5 to 10 years that any
pediatric-specific guidelines have been developed for the
evaluation and management of these patients. Although the
guidelines are a good starting point, they are not yet well
developed because of the relative infrequency of pediatric
disease relative to adult disease and the disparate approaches
to treatment among institutions. In addition, patients often
present with advanced disease that makes it difficult to follow the currently available guidelines. This session will use
the expertise of pediatric otolaryngologists who have a highvolume thyroid practice to discuss advanced pediatric thyroid carcinoma patients who do not fit the current guidelines.

The panelists will demonstrate how using a multidisciplinary
approach can improve treatment outcomes and what outcome measures need to be monitored to continue to develop
treatment pathways for even the most advanced disease.
Finally, the panelists will discuss pitfalls they encountered
when treating these patients and the steps necessary to avoid
them in the future.
Outcome Objectives: (1) Discuss how a multidisciplinary
approach can aid with pediatric thyroid carcinoma cases
within the current guidelines. (2) Discover advanced pediatric
thyroid carcinoma cases with treatment elements that fall outside the current guidelines. (3) Identify pitfalls and steps for
how to prevent them when patients present with difficult and
advanced disease.
Immediate Laryngeal Dysfunction After
Thyroid and Parathyroid Surgery: Early
Recognition, Laryngeal Exam, and
Treatment
Gregory W. Randolph, MD (Moderator);
Vaninder Dhillon, MD; Ralph P. Tufano, MD;
Catherine F. Sinclair, MBBS, FRACS
Session Description: Thyroid surgery is a procedure that
affects quality of life and function of the larynx. The most common neurologic complication of thyroid surgery is postoperative vocal fold palsy with motion impairment of 1 or both vocal
folds. The rates of transient and permanent unilateral vocal fold
palsy are underestimated secondary to heterogeneity in outcomes within the literature and the lack of direct visualization to
estimate true incidence. There have been associated morbidities
related to unilateral vocal fold palsy that are not insignificant if
left untreated. The terms transient and permanent vocal fold
paralysis are no longer sufficient to define varying states of
laryngeal function after thyroid surgery. Vocal fold immobility
that occurs in the immediate postoperative period should be
identified and visualized to allow early identification and treatment. Furthermore, partial laryngeal dysfunction in the form of
subclinical states of laryngeal dysfunction affect afferent and
efferent pathways, leading to postoperative morbidity, and they
are not delineated or identified fully. This panel aims to discuss
the importance of immediate vocal fold palsy identification and
treatment as well as subclinical states of laryngeal dysfunction
and aims to discuss how patients should be evaluated through
symptom evaluation and direct visualization of the larynx,
including flexible laryngoscopy and videostroboscopy, so that
they can be treated early.
Outcome Objectives: (1) Discuss the importance of defining
and identifying immediate vocal fold palsy after thyroid/parathyroid surgery. (2) Analyze the importance of identifying,
through symptom assessment and visualizing, states of partial
laryngeal dysfunction. (3) Describe the importance of videostroboscopy if symptom assessment is not consistent with
fiber-optic laryngoscopy.

Endocrine

technologies. (3) Analyze how these technologies are being
used in innovative ways.

P21

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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