Molecular influences in thyroid and parathyroid surgery

Recent progress in molecular biology and genetics has made a major impact o n the management of patients with multiple endocrine neoplasia syndromes ME N-1 and MEN-2. The understanding of the mechanisms involved in inherited th yroid and parathyroid rumours also offered valuable answers for other model s of neoplasia. In addition, parathyroid surgery has witnessed rapid progre ss, from the cloning of the calcium receptor to the development of calcimim etics, a new class of drugs that could shift the management of hyperparathy roidism from surgical intervention to medical treatment. Laboratory techniq ues initially designed for research are more and more being used for clinic al diagnosis. For example, the use of the polymerase chain reaction is curr ently being evaluated in the early diagnosis of metastatic thyroid carcinom a by identifying specific gene products in the local lymph nodes. This chap ter attempts to convince the reader that molecular biology is no longer res tricted to the laboratory but has an increasing impact on clinical decision s to which an endocrine surgeon is exposed.