[Detection of thyroid pathology during surgical exploration of the neck for primary hyperthyroidism].
OBJECTIVE
Our objective was to determine prevalence of incidental thyroid pathology during surgical treatment of primary hyperparathyroidism and to compare sensitivity and specificity of surgical neck exploration with histologic study of resected thyroid gland to confirm unsuspected pathologies.


METHODS
This was prospective cohort study performed at the Specialty Hospital's Department of Endocrine Surgery at the Mexican Institute of Social Security's (IMSS's) Centro Médico de Occidente in Guadalajara, Jalisco State between 1995 and 2003. All were submitted to bilateral neck exploration under general anesthesia. According to the surgeon's criteria, any suspected thyroid anomaly was resected for transoperative frozen sections as well as definite histopathologic study.


RESULTS
Preoperatively from a total of 44 cases of hyperparathyroidism, only four cases with thyroid anomalies were detected with neck ultrasound and/or computer tomography (CT) scan; additionally, 13 patients had thyroid anomalies found during neck exploration according to surgeon criteria. All were biopsied. Final study revealed thyroid disease in 16 cases; three had well-differentiated thyroid carcinoma and the remaining 13 patients had different benign entities. In one case, the thyroid specimen was considered normal. Sensitivity and specificity of surgeon criteria were 100 and 96%, respectively, to establish thyroid disease during neck exploration for another purpose.


CONCLUSIONS
Association of hyperparathyroidism and benign and malignant thyroid disease is a common phenomenon. Independently of the ability of preoperative imaging procedures to detect unsuspected findings, we suggest exploration neck bilaterally and resection of any suspicious lesion.
Mellado
David Merino y Vázquez
DM
Departamento de Cirugía Endocrina, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Av. Chapalita 1300, Col. Chapalita, 45000 Guadalajara, Jalisco, México. oafll@hotmail.com
Farías-Llamas
Oscar Alejandro
OA
Olivares-Becerra
Juan José
JJ
Pérez-Navarro
José Víctor
JV
González-Ojeda
Alejandro
A
D018263:Adenocarcinoma, Follicular / Q000175:diagnosis / Q000601:surgery; D000236:Adenoma / Q000150:complications / Q000601:surgery; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000601:surgery*; D033162:Incidental Findings; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013959:Thyroid Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014057:Tomography, X-Ray Computed
D010281:Parathyroid Hormone; D013972:Thyrotropin; D013974:Thyroxine; D002118:Calcium