Book Review

Diseases of the Thyroid: Pathophysiology and management

N Engl J Med 1995; 332:67January 5, 1995

Article

Diseases of the Thyroid: Pathophysiology and management
Edited by Malcolm H. Wheeler and John H. Lazarus. 432 pp., illustrated. New York, Chapman & Hall, 1994. $110. ISBN: 0-412-43030-4

The medical community does not suffer from a lack of textbooks on thyroid disorders (several of which are bulkier than a large multinodular goiter). Yet Wheeler and Lazarus have given us a book that is unique in concept and role. This concise textbook of clinical thyroid medicine, aimed at the practicing endocrine physician and surgeon, places refreshing emphasis on current concepts of pathophysiology, especially as they relate to management issues. Despite its relative brevity (432 pages), the book covers topics of considerable current interest, such as the molecular genetics of thyroid cancer and radiation-associated thyroid carcinoma (a discussion of the Chernobyl reactor accident is included).

The book was born of the long-standing association between the editors (an endocrine surgeon and an endocrinologist) as codirectors of the Thyroid Clinic at the University Hospital of Wales in Cardiff. The contents reflect this collaboration; a full 142 pages are dedicated to thyroid cancer (approximately one third of the total). In contrast, each of the standard textbooks devotes fewer pages (and a much smaller fraction of the total text) to this clinically important area. This book takes a fresh approach to the discussion of the pathophysiology of thyroid cancer, with excellent sections on growth factors and oncogenes. The role of the determination of DNA ploidy in establishing the prognosis in differentiated thyroid carcinoma is explored, and a summary of recent work in this area is presented. In addition, the clinician and surgeon will appreciate the clearly written and useful sections on fine-needle aspiration biopsy and the evaluation and management of metastatic thyroid cancer.

Unlike encyclopedic textbooks, which include every relevant topic and catalogue all the minutiae, this book is selective. As a result, some topics of potential interest and importance to the practicing endocrinologist are perhaps underemphasized. In these subject areas, at least, the book is more appropriate for the general internist, since it contains insufficiently detailed information to meet the specialist's needs. For example, it does not include a full discussion of the multifactorial pathogenesis of abnormal thyroid function in systemic illness, including the roles of cytokines and effects of various drugs on thyroid function. Such information would be useful and enlightening to endocrinologists, who are often called on to interpret abnormal results of thyroid-function tests in seriously ill patients. Another frequently encountered topic that might have been expanded is thyroxine therapy, including monitoring, clinical conditions requiring dose adjustment, and issues related to subclinical hypothyroidism.

In providing up-to-date information in areas of active research or current controversy, one runs the risk of presenting as fact a particular view that does not yet have sufficient support to warrant being “written in stone.” Examples of this tendency can be found occasionally in sections of the book covering areas under active investigation. To counter this potential shortcoming, frequent updates of the book could allow modification as trends evolve and controversial issues are settled.

I will continue to consult the standard thyroidology textbooks for detailed information and to search the medical literature to keep abreast of current thought. However, I will turn to Diseases of the Thyroid for a fresh, enjoyable, and readable approach to management, based on current concepts of pathophysiology and presented by a wide range of international experts. In fact, the book is so readable and interesting that a thyrophile might even choose to read it from cover to cover.

Rebecca S. Bahn, M.D.
Mayo Clinic, Rochester, MN 55905