The characteristics of concomitant thyroid nodules cause false-positive ultrasonography results in primary hyperparathyroidism

Barbaros, Umut; Erbil, Yeşim; Salmashoğlu, Artür; İşsever, Halim; Aral, Feríhan; Tunacı, Mehtap; Özarmağan, Selçuk

doi:10.1016/j.amjoto.2008.06.007

Cited by 33 publications

(31 citation statements)

References 24 publications

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“…This is considerably lower than reported in first-time surgery, reflecting that this patient subgroup is more likely to have multigland disease, smaller volume disease or concurrent thyroid disease, which are all known to lower the efficacy of localisation studies. [11][12][13][14] Over a quarter (28%) of the patients in our series had concurrent thyroid disease. 4D CT is currently the second-line investigation for patients with negative conventional parathyroid imaging.…”

Section: Discussionmentioning

confidence: 80%

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

McIntyre

Allen

Constantinides

et al. 2015

annals

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INTRODUCTIONReoperative parathyroidectomy is required when there is persistent or recurrent hyperparathyroidism following the initial surgery (at least 5% of parathyroidectomies nationally). By convention, 'persistent disease' is defined as the situation where the patient has not been cured by the first operation. The term 'recurrent hyperparathyroidism' is used when the patient was confirmed to be biochemically cured for six months from the first operation but has hyperparathyroidism after this date. Reoperative surgery is associated with higher rates of postoperative complications as well as a greater rate of failure to cure. The aim of our study was to review our departmental experience of reoperative parathyroidectomy, with a view to identify patterns of disease persistence and recurrence. METHODS Using a departmental database, patients were identified who had undergone reoperative parathyroidectomy between 2006 and 2014. All the pre, intra and postoperative information was documented including the operative note so as to record the location of the abnormal parathyroid gland found at reoperation. RESULTS Almost two-thirds (63%) of patients had negative, equivocal or discordant conventional imaging so secondary investigative tools were required frequently. The majority of abnormal glands were found in eutopic locations. The most common locations for ectopic glands were intrathyroidal, mediastinal and intrathymic. A third (33%) of the patients had multigland disease and over a quarter (28%) had coexisting thyroid disease. CONCLUSIONS Persistent hyperparathyroidism represents a challenging patient subgroup for which access to all radiological modalities and intraoperative parathyroid hormone monitoring are required. Patient selection for reintervention is a key determinant in the reoperation cure rate. Primary hyperparathyroidism (HPT) is caused by a single adenoma in approximately 90%, multigland disease including adenomas or hyperplasia in 10% and parathyroid carcinoma in under 1% of cases.1 Parathyroidectomy remains the definitive cure of primary HPT and the procedure of choice in refractory tertiary HPT in renal failure patients both before and after renal transplantation. Failure to cure HPT at the first operation (persistent HPT) is reported to occur in 5% of cases, both in the literature and in national registry data, but this is very probably underreported.2,3 In contrast, patients with recurrent HPT will have been biochemically cured (normal serum calcium and accommodated parathyroid hormone) for more than six months since the initial operation.Patients who have ongoing HPT despite a previous operation are candidates for a reoperative parathyroidectomy. This surgery is associated with higher rates of postoperative complications as well as a lower chance of being cured. 4,5 The aim of our study was to review our departmental experience of reoperative parathyroidectomy with a view to identifying patterns of disease persistence and recurrence.

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Section: Discussionmentioning

confidence: 80%

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

McIntyre

Allen

Constantinides

et al. 2015

annals

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“…The low sensitivity and specificity of preoperative parathyroid localization techniques in coexisting thyroid disease is well known (36,38): the MIBI false-positives could originate by accumulation of the radioactive tracer in thyroid nodules or nodular Hashimoto's thyroiditis, whereas the false negative ones seem to be the result of the low weight of the enlarged gland(s), superior adenomas or low rate of oxyphil cells (38,39).…”

Section: Discussionmentioning

confidence: 99%

“…During US exploration, thyroid nodules, especially in multinodular goiters, can be mistaken for parathyroid glands; moreover, they can cause a posterior displacement of adenomas and change in ultrasound tissue penetration; posterior and/or exophytic thyroid nodules and enlarged lymph nodes can look like enlarged parathyroid glands (38,39).…”

Section: Discussionmentioning

confidence: 99%

The coexistence of primary hyperparathyroidism and thyroid nodules: should the preoperative work-up of the parathyroid and the thyroid diseases be specifically adjusted?

Scerrino¹

2016

GCHIR

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“…In particular, hypoechoic thyroid nodules located posteriorly might mimic a parathyroid adenoma. 29 False-positive findings can also occur in cases of concomitant chronic Hashimoto's thyroiditis, a condition in which it can be difficult to distinguish the hypoechoic lobular parenchyma from an adenoma. Moreover, lymph nodes located in the central neck might be misinterpreted as parathyroid lesions (see Figure 35.5).…”

Section: Clinical Aspects Of Primary Hyperparathyroidismmentioning

confidence: 99%

Preoperative Localization of Abnormal Parathyroid Glands

et al. 2015

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The characteristics of concomitant thyroid nodules cause false-positive ultrasonography results in primary hyperparathyroidism

Cited by 33 publications

References 24 publications

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

The coexistence of primary hyperparathyroidism and thyroid nodules: should the preoperative work-up of the parathyroid and the thyroid diseases be specifically adjusted?

Preoperative Localization of Abnormal Parathyroid Glands

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