The impact of office neck ultrasonography on reducing unnecessary thyroid surgery in patients undergoing parathyroidectomy.
BACKGROUND
Some have suggested that thyroid disease is even more prevalent among patients with hyperparathyroidism (HPT) than in the general population. We sought to define the incidence and optimal management strategies of thyroid disease in patients undergoing surgery for HPT.


METHODS
Clinical characteristics were reviewed for 1200 consecutive HPT patients treated at two endocrine surgery referral centers from 1992-2003. Both centers practice bilateral neck exploration, and one routinely obtains preoperative neck ultrasound (US) performed by surgeons.


RESULTS
Forty percent (477/1195) of HPT patients had coexisting thyroid disease, whether identified at parathyroidectomy (39%; 327/845) or by US (43%; 150/350). Colloid nodules/goiters accounted for nearly half of thyroid pathology, followed by follicular adenomas, papillary cancer, thyroiditis, and intrathyroidal parathyroids. Thyroid malignancy was found in 4.6% of HPT patients versus less than 1% in autopsy reports. Thyroid pathology was similar among single adenomas, multigland, and renal HPT. Unexpected thyroid disease first encountered at parathyroidectomy required partial or total thyroidectomy in 30% (257/845). US-detected thyroid nodules prompted fine-needle biopsy in 20%, which was cost effective in limiting concomitant thyroid surgery to fewer patients (6%; 21/350). Overall low incidence (<0.5%) of persistent/recurrent HPT, nerve injury, and neck hematoma was unaffected by thyroid abnormalities.


CONCLUSIONS
The high prevalence of thyroid disease, especially malignancies, among HPT patients mandates vigilant diagnosis and preparation for possible simultaneous parathyroid-thyroid surgery. Without appropriate preoperative screening, focal explorations for HPT may be prone to delayed diagnosis of thyroid tumors. Ultrasound performed by surgeons or endocrinologists preoperatively is an excellent diagnostic tool and minimizes unnecessary thyroidectomy in patients with subclinical thyroid disease.
Milas
Mira
M
The Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. milasm@ccf.org
Mensah
Angela
A
Alghoul
Mohammed
M
Berber
Eren
E
Stephen
Antonia
A
Siperstein
Allan
A
Weber
Collin J
CJ
D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging; D016105:Parathyroidectomy; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013959:Thyroid Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013961:Thyroid Gland / Q000601:surgery*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging; D014463:Ultrasonography
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi