Surgical therapy for primary hyperparathyroidism in patients with previous thyroid surgery.
BACKGROUND
In patients with primary hyperparathyroidism (HPTH) and previous thyroid operations, complications of parathyroidectomy are more frequent than in patients undergoing initial neck surgery. The aim of this study was to investigate the value of preoperative imaging with regard to its influence on the surgical strategy.


METHODS
We retrospectively analyzed 17 patients with primary HPTH and previous thyroid surgery. Preoperatively 16 patients underwent sonography and/or scintigraphy.


RESULTS
Sonography had an overall accuracy to correctly localize enlarged parathyroid glands of 80%, and scintiscanning had overall accuracy of 78.6%. The accuracy of localization was increased up to 84.6% if both diagnostic procedures were applied. In patients with normal thyroid residues the accuracy of sonography was 85.7%, and it was 100% if scintiscanning was used.


CONCLUSIONS
Preoperative localization techniques in patients with primary HPTH and previous thyroid surgery have high accuracy. This allows for an imaging-directed operative strategy, thus preventing unnecessary bilateral neck explorations, which carry a high risk of recurrent laryngeal nerve injury.
Profanter
C
C
Department of General Surgery, University of Innsbruck, Austria.
Klingler
A
A
Strolz
S
S
Wetscher
G J
GJ
Prommegger
R
R
Bodner
E
E
Riccabona
G
G
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D061224:Laryngeal Nerve Injuries; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D011379:Prognosis; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery*; D014463:Ultrasonography