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 ultra-sonography (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.
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Arici, C., Cheah, W.K., Ituarte, P.H., Morita, E., Lynch, T.C., Siperstein, A.E., Duh, Q.Y., Clark, O.H., 2001. Can localization studies be used to direct focused parathyroid operation? Surgery, 129(6):720–729. [doi:10.1067/msy.2001.114556]
Bentrem, D.J., Angelos, P., Talamonti, M.S., Nayar, R., 2002. Is preoperative investigation of the thyroid justified in patients undergoing parathyroidectomy for hyperpara-thyroidism? Thyroid, 12(12):1109–1112. [doi:10.1089/105072502321085207]
Coakley, A.J., Kettle, A.G., Wells, C.P., O’Doherty, M.J., Collins, R.E., 1989. 99mTc sestamibi—a new agent for parathyroid imaging. Nucl. Med. Commun., 10(11): 791–794. [doi:10.1097/00006231-198911000-00003]
d’Amico, A., Szczucka, K., Borys, D., Gorczewski, K., Steinhof, K., 2006. SPECT-CT fusion: a new diagnostic tool for endocrinology. Endokrynol. Pol., 57(Suppl. A):71–74.
Eigelberger, M.S., Clark, O.H., 2000. Surgical approaches to primary hyperparathyroidism. Endocrinol. Metab. Clin. North Am., 29(3):479–502. [doi:10.1016/S0889-8529(05)70147-X]
Kaplan, E., Yashiro, T., Salti, G., 1992. Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann. Surg., 215(4):300–317. [doi:10.1097/00000658-199204000-00002]
Kosem, M., Algun, E., Kotan, C., Harman, M., Ozturk, M., 2004. Coexistent thyroid pathologies and high rate of papillary cancer in patients with primary hyperparathyroidism: controversies about minimal invasive parathyroid surgery. Acta Chir. Belg., 104(5):568–571.
Masatsugu, T., Yamashita, H., Noguchi, S., Nishii, R., Watanabe, S., Uchino, S., Kuroki, S., Tanaka, M., 2005. Significant clinical differences in primary hyperparathyroidism between patients with and those without concomitant thyroid disease. Surg. Today, 35(5):351–356. [doi:10.1007/s00595-004-2952-9]
Pino Rivero, V., Marques Rebollo, L., Ambel Albarran, A., Trinidad Ruiz, G., Pardo Romero, G., Blasco Huelva, A., 2003. Hyperparathyroidism associated with thyroid disease. Retrospective study of 15 patients treated in 11 years. An. Otorrinolaringol. Ibero. Am., 30(5):459–466.
Prager, G., Czerny, C., Ofluoglu, S., Kurtaran, A., Passler, C., Kaczirek, K., Scheuba, C., Niederle, B., 2003. Impact of localization studies on feasibility of minimally invasive parathyroidectomy in an endemic goiter region. J. Am. Coll. Surg., 196(4):541–548. [doi:10.1016/S1072-7515(02)01897-5]
Prinz, R.A., Barbato, A.L., Braithwaite, S.S., Brooks, M.H., Emanuele, M.A., Gordon, D.L., Lawrence, A.M., Paloyan, E., 1982. Simultaneous primary hyperparathyroidism and nodular thyroid disease. Surgery, 92(3):454–458.
Schiffmann, L., Mann, B., Hotz, H., Buhr, H.J., 2003. Minimal invasive surgery for pHPT-which patients will profit? Zentralbl. Chir., 128(7):561–565 (in German). [doi:10.1055/s-2003-40813]
Seehofer, D., Rayes, N., Klupp, J., Nussler, N.C., Ulrich, F., Graef, K.J., Schindler, R., Steinmuller, T., Frei, U., Neuhaus, P., 2005. Prevalence of thyroid nodules and carcinomas in patients operated on for renal hyperparathyroidism: experience with 339 consecutive patients and review of the literature. World J. Surg., 29(9):1180–1184. [doi:10.1007/s00268-005-7859-0]
Sidhu, S., Campbell, P., 2000. Thyroid pathology associated with primary hyperparathyroidism. Aust. N. Z. J. Surg., 70(4):285–287. [doi:10.1046/j.1440-1622.2000.01799.x]
van der Schaar, H., Mulder, H., 1985. Lesions of the thyroid gland in patients with primary hyperparathyroidism. Surg. Gynecol. Obstet., 160(5):407–408.
Wagner, B., Begic-Karup, S., Raber, W., Schneider, B., Waldhausl, W., Vierhapper, H., 1999. Prevalence of primary hyperparathyroidism in 13387 patients with thyroid diseases, newly diagnosed by screening of serum calcium. Exp. Clin. Endocrinol. Diabetes., 107(7):457–461.
Xiao, H., Yu, B., Wang, S., Chen, G., 2002. Concomitant Graves’ disease and primary hyperparathyroidism: the first case report in mainland of China and literature review. Chin. Med. J. (Engl.), 115(6):939–941.
Xu, S., Wang, P., Zheng, Y.X., Yu, Z.G., Chen, J., 2001. Clinical research of primary hyperparathyroidism. Natl. Med. J. China, 81(23):1453–1455 (in Chinese).
Xu, S.M., Wu, Z.R., Wang, P., Chen, J., Liu, Y.B., 2006. Minimally invasive direct parathyroidectomy for primary hyperparathyroidism in 34 cases. Chin. J. Surg., 44(5):337–338 (in Chinese).
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Project (No. 2007C34001) supported by the Science and Technology Research Foundation of Zhejiang Province, China
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Zheng, Yx., Xu, Sm., Wang, P. et al. Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease. J. Zhejiang Univ. - Sci. B 8, 626–631 (2007). https://doi.org/10.1631/jzus.2007.B0626
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DOI: https://doi.org/10.1631/jzus.2007.B0626