Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

Abstract

Abstract:The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study. Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultrasonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of associated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.

Institutional experience of PTH evaluation on fine-needle washing after aspiration biopsy to locate hyperfunctioning parathyroid tissue

“…The main diagnostic limitation of PTH-FNAB sampling is posed by a small and/or unclear target. All available techniques are sequentially justified in order to improve surgical outcome when thyroid abnormalities are concomitant (Zheng et al, 2007).…”

Imaging diagnostics for primary hyperparathyroidism

“…Also, a limited preparation area allows a reduced risk of complications, which shortens the time of postoperative care and helps to lower the costs of treatment [10][11][12].…”

Diagnostic accuracy of parathyroid hormone levels in washout samples of suspicious parathyroid adenomas: A single‐centre retrospective cohort study

“…Most of the studies claimed that preoperative localization was heavily influenced by coexistence of a nodular thyroid disorder. 7,9,[13][14][15][16][17] We also concluded on such an observation because of the significant difference between FNA-PTH-negative and FNA-PTH-positive groups for multinodularity (P = 0.01), but not for single nodules.…”

“…mm versus 13(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) mm in washout-negative group. The previous studies 10 reported a positive correlation between the size of lesion, PTH-FNAB and peripheral PTH values which we could not observe.…”