The Adult Complex Thyroid and Parathyroid Surgery Focused Practice Designation, developed jointly by the American Board of Surgery and the American Board of Otolaryngology — Head and Neck Surgery, is examined as a single written paper of roughly 150 questions across two 120-minute sessions. Thyroid disease and surgical concepts together account for around two-thirds of the blueprint. Practise with thyroid and parathyroid vignettes referenced to the American Thyroid Association and AAES guidelines.
Content reviewed 26 August 2026 against current guidelines.
Start practising freeTaken from the bank, not written for this page. Answer it in your head, then open the explanation.
A 62-year-old woman with sporadic primary hyperparathyroidism, an adjusted calcium of 2.88 mmol/L and normal renal function undergoes bilateral neck exploration because ultrasound and sestamibi were discordant. At operation all four glands are identified and all four are enlarged, weighing between 600 and 900 mg, with no single dominant gland. Frozen section of a biopsied gland confirms hypercellular parathyroid tissue. There is no family history of endocrine neoplasia, no personal history of pituitary or pancreatic disease, no lithium exposure and no renal impairment. Intraoperative parathyroid hormone monitoring is available and the patient is stable. What is the appropriate operation?
Correct answer: E
Four uniformly enlarged glands in a patient with no hereditary or renal cause represent sporadic four-gland hyperplasia, and the operation must address all the abnormal tissue. Subtotal parathyroidectomy leaving a marked remnant of roughly 50 mg on a preserved vascular pedicle, or total parathyroidectomy with immediate autotransplantation to the forearm or sternocleidomastoid, are both accepted; transcervical thymectomy removes supernumerary glands that cause later recurrence. Option A: removing the largest gland alone leaves three hyperfunctioning glands and is the classic cause of early persistence. Option B: total resection with no remnant and no graft creates permanent hypoparathyroidism and is indefensible. Option C: frozen section reliably confirms that tissue is parathyroid but cannot distinguish adenoma from hyperplasia, so the decision is made on gross findings and hormone dynamics, not on the pathologist's verdict. Option D: intrathyroidal disease is not suggested by four uniformly enlarged glands.
Teaching point. Frozen section tells you it is parathyroid, never whether it is hyperplasia - your eyes and the hormone curve make that call.
Referenced to AAES Guidelines for Definitive Management of Primary Hyperparathyroidism; ESE Position Statement on Primary Hyperparathyroidism
Every question is explained like this — start with 50 free ›Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
Scope of authorship. ACTPS FPD sits outside the author’s own subspecialty practice, which is surgical oncology — peritoneal malignancy, sarcoma, hepatopancreatobiliary and complex pelvic surgery. No diplomate of this board has signed these questions off. What they offer is traceability rather than personal authority: every answer names the current guideline or trial it rests on, so you can check it at the source before you trust it. Found an error? Tell us — it gets corrected or withdrawn.
It is a single written examination of approximately 150 multiple-choice questions lasting about four and a half hours, delivered as two 120-minute sessions with an optional break between them. It is offered once a year in the spring, with a maximum of three attempts within five years.
The published blueprint weights thyroid diseases at 34 per cent, surgical concepts including primary and reoperative thyroidectomy, parathyroidectomy and neck dissection at 31 per cent, parathyroid diseases at 27 per cent, and anatomy and physiology at 8 per cent.
The non-fellowship pathway requires at least 120 thyroid or parathyroid cases over three consecutive years, including at least 24 complex cases. Surgeons who completed an AAES, ACGME or AHNS accredited fellowship may qualify with 80 cases including 16 complex within their first two years of practice. Both pathways require demonstrated participation in multidisciplinary care.
SurgBoardsQ&A provides 518 thyroid and parathyroid practice questions covering nodule evaluation, differentiated and medullary carcinoma, hyperparathyroidism and reoperative neck surgery, each with a guideline-referenced explanation.
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