Clinical Challenges in Endocrine Surgery: Endocrine Surgery Emergencies

Behind The Knife: The Surgery Podcast

Medicine, Health & Fitness, Education, Science

4.8 • 1.4K Ratings

🗓️ 25 December 2025

⏱️ 35 minutes

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Summary

Endocrine Surgery emergencies are rare. However, they can be clinically significant and understanding how to navigate them as a surgeon in timely fashion is critical.

Hosts:
Dr. Rebecca Sippel is an endowed professor of surgery and Division Chief of Endocrine Surgery at University of Wisconsin (UW) - Madison, and she is the most recent past president of the American Association of Endocrine Surgeons (AAES). She is an internationally recognized leader in the field of endocrine surgery with over 250 publications. She was the principal investigator for a hallmark randomized controlled trial which studied the need for prophylactic central neck dissections in thyroid cancer.

Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI. Her clinical interests are in robotic adrenalectomy, benign and malignant thyroid cancer and hyperparathyroidism.

Dr. Simon Holoubek is a fellowship trained endocrine surgeon affiliated with UW Health. His primary practice is with UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.

Learning Objectives:
1) Learn about thyroid storm in hyperthyroidism and treatment options.

2) Understand how to treat hypercalcemic crisis due to uncontrolled primary hyperparathyroidism.

3) Describe the modified surgical techniques required for thyroidectomy in patients with Graves’ disease to prevent recurrent laryngeal nerve traction injury.

4) Identify clinical and intraoperative indicators of parathyroid carcinoma and explain the necessity of en bloc resection to prevent parathyromatosis.

References:
1 Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: A meta-analysis. J Surg Res. 2000 May 15;90(2):161-5. doi: 10.1006/jsre.2000.5875. PMID: 10792958. https://pubmed.ncbi.nlm.nih.gov/10792958/

2 Yoshimura Noh J, Inoue K, Suzuki N, Yoshihara A, Fukushita M, Matsumoto M, Imai H, Hiruma S, Ichikawa M, Koshibu M, Sankoda A, Hirose R, Watanabe N, Sugino K, Ito K. Dose-dependent incidence of agranulocytosis in patients treated with methimazole and propylthiouracil. Endocr J. 2024 Jul 12;71(7):695-703. doi: 10.1507/endocrj.EJ24-0135. Epub 2024 May 3. PMID: 38710619. https://pubmed.ncbi.nlm.nih.gov/38710619/

3 Christopher L, Mellman M, Buicko JL. Management of Hypercalcemic Crisis due to Primary Hyperparathyroidism During Pregnancy. Am Surg. 2023 Aug;89(8):3638-3640. doi: 10.1177/00031348231162704. Epub 2023 Apr 27. PMID: 37102502. https://pubmed.ncbi.nlm.nih.gov/37102502/

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Transcript

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0:00.0	Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.
0:25.2	Today we're going to talk about endocrine surgery emergencies.
0:31.9	While most endocrine surgery is elective, there are a few rare emergencies that you may get consulted on in your practice,
0:36.9	which are time sensitive and therefore a general surgeon may need to know how to manage these critical cases.
0:43.6	We're going to get into the management and helping us to work through these scenarios today are Dr. Becky Sipple,
0:48.2	who is a world-renowned endocrine surgeon at the University of Wisconsin-Madison.
0:52.9	She's an endowed professor at UW Madison and chief of endocrine surgery.
0:58.0	She's the most recent past president of the American Association of Endocrine Surgeons and has co-authored over 250 manuscripts.
1:02.0	Dr. Amanda Doubleday and myself, Dr. Simon Holbeck, our fellowship trained
1:06.0	endocrine surgeons affiliated with UW Health, who focused endocrine surgery practices.
1:12.2	I, Simon Holbeck, and a paid consultant for Medtronic
1:14.6	who provides educational content for NID Vital,
1:17.2	the recurrent laryngeal nerve monitoring,
1:19.6	and PTIA auto fluorescence devices.
1:23.1	All right, let's get into our first chronicle scenario.
1:27.6	Thyroid storm for the patient who cannot tolerate methamazole.
1:31.4	Graves disease is the most common cause of hyperthyroidism.
1:35.0	Most patients present with symptoms that can be effectively managed initially with antithyroid medications.
1:40.9	However, in rare cases, patients can present acutely in thyroid storm.
1:46.0	Side effects from antithyroid medications such as methanolosol are common, and in rare cases,
1:53.1	patients can prevent life-threatening side effects such as agranial cytosis or acute liver failure.
1:58.7	Our objective is for the listener to learn about how to best manage a patient who cannot
	...

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