Thyroid cancer incidence in simultaneous thyroidectomy with parathyroid surgery

Abstract

Objective: Primary hyperparathyroidism (PHPT) is often seen in conjunction with an underlying thyroid disorder. Imaging methods that are used to localize the parathyroid adenoma also detect associated thyroid nodules and thyroid cancer. The aim of this study was to detect the rate of thyroid cancer identified while performing parathyroidectomy and thyroidectomy in patients with PHPT. Material and Methods:Files of all patients who were operated for PHPT and who underwent simultaneous thyroidectomy were analyzed. Data regarding parathyroid pathology, surgical procedures, indications of thyroid surgery, and pathology results were retrospectively recorded. The indications for thyroid surgery included presence of suspicious thyroid nodules in ultrasonography, increase in size of thyroid nodules in follow-up ultrasound, or presence of suspicious thyroid fine needle aspiration biopsy (FNAB) findings. Rates of thyroid cancer detection were investigated according to definite pathology reports.Results: Eighty-three patients who underwent parathyroidectomy with a diagnosis of PHPT with concurrent thyroidectomy in Department of General Surgery, İstanbul University İstanbul Faculty of Medicine were included in the study. Eighteen patients were male (22%) and 65 were female (78%). The median age was 53 (18-70) years. The primary indication for parathyroidectomy was primary hyperparathyroidism in all patients. The thyroid procedures applied in addition to parathyroidectomy were lobectomy + isthmusectomy in 29 patients (35%), bilateral subtotal thyroidectomy in 20 patients (24%), bilateral total thyroidectomy in 23 patients (28%), and total thyroidectomy on one side and near total thyroidectomy to the other side in 11 patients (13%). The only indication for thyroidectomy was the presence of thyroid nodules until 2000 (20 patients, 24%). Indications in the remaining 63 patients included the presence of multiple nodules that cannot be followed up by ultrasonography in 25 patients (30%), presence of a suspicious nodule on ultrasonography in 33 patients (40%), growth in nodule size in 2 patients (2%), and detection of suspicious findings on FNAB in 3 patients (4%). Five patients (6%) were diagnosed with papillary thyroid cancer, four of whom were micropapillary cancer. Conclusion:Imaging methods performed to localize the pathological parathyroid gland for a diagnosis of PHPT are useful in estimating other accompanying pathologies. Presence of thyroid nodules should be evaluated before all parathyroid procedures, and if the nodule has an indication for surgery, thyroid surgery should be considered at the same operation with parathyroid surgery.

Coexistent papillary thyroid carcinoma diagnosed in surgically treated patients for primary versus secondary hyperparathyroidism: same incidence, different characteristics

“…The most frequent type of thyroid surgery performed concomitantly in HPT was reported to be either total/subtotal thyroidectomy [17, 37] or unilateral lobisthmectomy [33]. Total thyroidectomy was commonly used in our study, justified by the high frequency of nodular disease in a region previously known for iodine deficient disorders [38].…”

Simultaneous Operational Interventions in Patients with Thyroid Pathology

“…Появление новых методов исследования, которые не требуют больших затрат на их выполнение и при этом обладают высоким уровнем специфичности и чувствительности, позволяет в кратчайшие сроки качественно обследовать пациента с целью диагностики сочетанных хирургических заболеваний [7].…”

Primary hyperparathyroidism and non-medullary thyroid cancer- A review

“…A third were multifocal and one microcarcinoma of 2mm had nodal metastases [15]. Micropapillary thyroid carcinoma was also the most common malignant pathology associated with PHPT in several other studies [3,[14][15][16][17][18], showing multifocality in more than half of cases [17], and presence of concomitant lymph node metastases in other cases [17,19].…”

“…The association between thyroid disease and primary hyperparathyroidism was first described in 1947 by Kissin et al [14,15]. In 1982, Prinz et al studied 351 cases who underwent parathyroidectomy (PTX), and 70 patients (20%) were found to have nodular thyroid disease at time of surgery, of whom 14 (20%) had a DTC [15].…”