Focused Practice Designation
The Adult Complex Thyroid and Parathyroid Surgery Focused Practice Designation was developed jointly by the American Board of Surgery and the American Board of Otolaryngology — Head and Neck Surgery, and first examined in 2025. It recognises surgeons whose practice concentrates on complex thyroid and parathyroid disease. This guide covers the published blueprint, the case requirements and how to prepare.
Content reviewed 26 August 2026 against current guidelines.
Adult complex thyroid and parathyroid surgery covers the care of patients with benign or malignant, functional or non-functional tumours of the thyroid and parathyroid glands. It explicitly encompasses locally advanced thyroid cancer, aggressive histological subtypes and inherited endocrine syndromes.
The designation is unusual in being awarded jointly across two boards: general surgeons and otolaryngologists — head and neck surgeons sit the same examination against the same blueprint, which was written by a committee drawn from both.
Attaining it requires meeting case requirements in both number and complexity, demonstrating participation in multidisciplinary care, passing the written examination, and reverifying through continuing certification activities.
Written Examination
Every item reflects both a content category and a secondary classification — so a question is not simply "about follicular carcinoma", it is about its pathology, or its diagnosis, or its surgical management. Revising by disease alone leaves gaps the blueprint will find.
Thyroid Diseases — 34%
Thyroid nodule evaluation; benign disease including nontoxic multinodular goitre, benign nodules, thyrotoxicosis with and without nodules including Graves disease, and thyroiditis; and malignant disease including papillary, follicular, oncocytic, medullary, anaplastic and poorly differentiated carcinoma, lymphoma and metastases to the thyroid.
Surgical Concepts — 31%
Primary and reoperative thyroidectomy, central and lateral neck dissection, and primary and reoperative parathyroidectomy.
Parathyroid Diseases — 27%
General concepts of hyperparathyroidism; primary hyperparathyroidism including adenoma, hyperplasia and carcinoma; and secondary and tertiary hyperparathyroidism, both renal and non-renal.
Anatomy and Physiology — 8%
Thyroid and parathyroid anatomy, including the surgically critical relationships, and the physiology underpinning functional disease.
The examination is offered once a year in the spring, with the application deadline falling in the preceding December.
Dates, fees and case-volume requirements change between cycles — confirm the current requirements with the American Board of Surgery (absurgery.org) or ABOHNS before applying.
Outcomes in thyroid and parathyroid surgery are strongly volume-dependent, and the complications that matter — recurrent laryngeal nerve injury and permanent hypoparathyroidism — are precisely the ones that fall with concentration of practice. The designation makes that concentration visible and verifiable.
It also sits at a genuine interface: general surgeons and head and neck surgeons operate on the same glands from different training routes. A shared blueprint and a shared examination give both a common standard, which is unusual and valuable.
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.
Yes — a free account includes 50 practice questions with no credit card required.
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.
SurgBoardsQ&A provides more than 800 practice questions mapped to the exam syllabus, each with a detailed explanation and guideline citation.
Start practising
50 questions free, no credit card required. Filter by board, topic, or difficulty. Explanations cite ESMO and NCCN.