Down the Rabbit Hole: Evaluation of Internet Information Quality in Parathyroid and Thyroid Surgery

Published:October 15, 2022DOI:



      Patients often discuss information obtained from Internet sources during clinic visits, which can be of variable quality and depth. We sought to review and assess information on the Internet regarding common operations within endocrine surgery.


      Using Google's search engine, the top 100 websites from the search phrase “parathyroid surgery,” and the top 100 websites from the phrase “thyroid surgery” were identified. Each website was evaluated for accessibility, accuracy, and completeness of information about gland hormone function, associated disease processes, and surgery itself. Results were stratified based on the website type, and bivariate analysis was performed to determine accuracy by category. Presence of author credentials, last webpage update, and presence of advertisements were also assessed. Inter-rater reliability was calculated for each variable.


      For parathyroid surgery, at least two-thirds of all websites included information about surgery, hormone function, and disease processes. For thyroid surgery, 71% of websites included procedure information, but only 52% included information about hormone function and 56% about disease processes. Less than 30% of all websites included advertisements and less than 25% listed author credentials or provided references. Academic or research-affiliated sources were most likely to have zero inaccuracies, but 44% of all websites had at least one potential inaccuracy. Inter-rater reliability achieved at least moderate agreement (>0.41) for 56% of variables.


      There is a wide array of information available to patients online, and accuracy varies based on multiple factors including the type of website. Endocrine surgeons and related practitioners must be cognizant of this fact when discussing treatment plans with patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gentry Z.L.
        • Ananthasekar S.
        • Chen H.
        • Fazendin J.M.
        “Finding a general surgeon: self-referral in the digital era”.
        Am Surg. 2022; 88: 177-180
        • Gentry Z.L.
        • Chen H.
        • Fazendin J.
        Finding a cancer surgeon: how hospital websites make this difficult for their patients.
        Am J Surg. 2021; 221: 431-432
        • O'Mathúna D.P.
        How should clinicians engage with online health information?.
        AMA J Ethics. 2018; 20: E1059-E1066
        • Cohen R.A.
        • Adams P.F.
        Use of the Internet for health information: United States, 2009. NCHS data brief, no 66.
        National Center for Health Statistics, Hyattsville, MD2011
        • Chang K.
        • Berthelet E.
        • Grubbs E.
        • et al.
        Websites, websites everywhere: how thyroid cancer patients use the internet.
        J Cancer Educ. 2020; 35: 1177-1183
        • Finney Rutten L.J.
        • Blake K.D.
        • Greenberg-Worisek A.J.
        • Allen S.V.
        • Moser R.P.
        • Hesse B.W.
        Online health information seeking among US adults: measuring progress toward a healthy people 2020 objective.
        Public Health Rep. 2019; 134: 617-625
        • Fox S.
        • Jones S.
        Health online 2013.
        (Available at:)
        Date: 2013
        Date accessed: September 20, 2021
        • Wong C.
        • Harrison C.
        • Britt H.
        • Henderson J.
        Patient use of the internet for health information.
        Aust Fam Physician. 2014; 43: 875-877
        • Rai R.
        • Landsberg A.
        • Nguyen A.
        • Wiseman S.M.
        Online educational materials for appendectomy patients have good quality but poor readability.
        Am J Surg. 2021; 221: 1203-1210
        • Beredjiklian P.K.
        • Bozentka D.J.
        • Steinberg D.R.
        • Bernstein J.
        Evaluating the source and content of orthopaedic information on the Internet. The case of carpal tunnel syndrome.
        J Bone Joint Surg Am. 2000; 82A: 1540-1543
        • Biermann J.S.
        • Golladay G.J.
        • Greenfield M.L.
        • Baker L.H.
        Evaluation of cancer information on the Internet.
        Cancer. 1999; 86: 381-390
        • Griffiths K.M.
        • Christensen H.
        Quality of Web based information on treatment of depression: cross sectional survey.
        BMJ. 2000; 321: 1511-1515
        • Jejurikar S.S.
        • Rovak J.M.
        • Kuzon Jr., W.M.
        • Chung K.C.
        • Kotsis S.V.
        • Cederna P.S.
        Evaluation of plastic surgery information on the Internet.
        Ann Plast Surg. 2002; 49: 460-465
      1. AAES.
        (Available at:)
        Date accessed: August 11, 2021
        • Chang K.L.
        • Grubbs E.G.
        • Ingledew P.A.
        AN analysis of the quality of thyroid cancer websites.
        Endocr Pract. 2019; 25: 1003-1011
        • McGill J.F.
        • Moo T.A.
        • Kato M.
        • et al.
        World wide what? The quality of information on parathyroid disease available on the Internet.
        Surgery. 2009; 146: 1123-1129
        • Ramonell K.M.
        • Fazendin J.
        • Lindeman B.
        • Chen H.
        My surgical practice: radioguided parathyroid surgery, how and why we use it.
        Am J Surg. 2022; 223: 203-205
        • McDow A.D.
        • Sippel R.S.
        Should symptoms Be considered an indication for parathyroidectomy in primary hyperparathyroidism?.
        Clin Med Insights Endocrinol Diabetes. 2018; 11 (1179551418785135)
        • Wilhelm S.M.
        • Wang T.S.
        • Ruan D.T.
        • et al.
        The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism.
        JAMA Surg. 2016; 151: 959-968
        • National Comprehensive Cancer Network
        Thyroid carcinoma (version 2.2021).
        (Available at:)
        • Barczyński M.
        • Konturek A.
        • Hubalewska-Dydejczyk A.
        • et al.
        Five-year follow-up of a randomized clinical trial of total thyroidectomy versus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter.
        World J Surg. 2010; 34: 1203
        • Wilhelm S.M.
        • McHenry C.R.
        Total thyroidectomy is superior to subtotal thyroidectomy for management of Graves' disease in the United States.
        World J Surg. 2010; 34: 1261
        • Hessman C.
        • Fields J.
        • Schuman E.
        Outpatient thyroidectomy: is it a safe and reasonable option?.
        Am J Surg. 2011; 201: 565-568
        • Sanabria A.
        • Carvalho A.L.
        • Silver C.E.
        • et al.
        Routine drainage after thyroid surgery--a meta-analysis.
        J Surg Oncol. 2007; 96: 273