title: Primary hyperparathyroidism with a history of head and neck irradiation: the consequences of associated thyroid tumors.
abstract: BACKGROUND
  Information on thyroid tumors is scant in patients with primary hyperparathyroidism (HPT) and history of head and neck irradiation. The study objective was to investigate thyroid pathology in primary HPT patients with irradiation history presenting for parathyroidectomy.
  
  
  METHODS
  A prospective database of 1,020 parathyroidectomy patients was analyzed. 916 consecutive HPT patients were identified. History of radiation, neck ultrasound results, thyroid operations, and pathology was assessed. Patients with radiation history were compared to those with no radiation.
  
  
  RESULTS
  Of the 916 HPT patients, 49 (5%) had a history of radiation and were more likely to have nodular thyroid disease (95% vs 52%), undergone a prior thyroidectomy (29% vs 4%), or had concurrent thyroidectomy (49% vs 26%). Nine of 49 (24%) had thyroid cancer. Of the 867 patients with no history of radiation, 259 underwent thyroid resection (32 prior and 227 concurrent) and 32 (12%) had thyroid cancer.
  
  
  CONCLUSIONS
  Primary HPT patients with head and neck irradiation presenting for parathyroidectomy had marked increase in nodular thyroid disease: nearly 1 in 2 had concurrent thyroidectomy, and nearly 1 in 4 had thyroid carcinoma. High resolution ultrasound prior to parathyroidectomy detects associated thyroid pathology and allows the surgeon to plan the extent of thyroid resection.
authors: Department of Surgery, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI 53226, USA. swilson@mcw.edu
authors: Stuart D
authors: SD
authors: Wilson
authors: Kara M
authors: KM
authors: Doffek
authors: Tracy S
authors: TS
authors: Wang
authors: Elizabeth A
authors: EA
authors: Krzywda
authors: Douglas B
authors: DB
authors: Evans
authors: Tina W F
authors: TW
authors: Yen
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle; D016208:Databases, Factual; D005260:Female; D006257:Head / Q000528:radiation effects; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000528:radiation effects; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D016105:Parathyroidectomy; D011446:Prospective Studies; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013965:Thyroidectomy; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi