title: Surgeon-driven thyroid interrogation of patients presenting with primary hyperparathyroidism.
abstract: BACKGROUND
  Primary hyperparathyroidism (pHPT) is an increasingly prevalent disease affecting all age groups. The authors sought to determine the impact of a "thyroid interrogation" practice protocol on the surgical treatment of patients with the diagnosis of pHPT referred to a single surgeon.
  
  
  METHODS
  We performed a retrospective review of prospectively gathered data on parathyroidectomy (PTX) patients undergoing both a prospective clinical thyroid evaluation and thyroid ultrasound between January 2008 and October 2012.
  
  
  RESULTS
  Only 5.6% of 468 PTX patients were referred to a single surgeon for both parathyroid and thyroid surgical evaluation; 31% of patients had known pre-existing thyroid disease (hypothyroidism most commonly), and 22% of patients had palpable thyroid abnormalities unrecognized in 67% of cases by the referring physician. Of the 468 patients, 2.6% had a history of classic head and neck radiation exposure, 2.6% a history of radio-iodine treatment, and 3% a family history of thyroid cancer. Thyroid abnormalities were found on ultrasound in 61% of patients, and 26% of patients underwent thyroid biopsies. Parathyroid and thyroid surgery was combined for 18.4% of patients; indications included obstructive symptoms (3.2%), hyperthyroidism (0.9%), intraoperative findings (5.1%), and concern for malignancy (9.2%). Malignancy was diagnosed in 23 patients (4.9%), only 8 of whom had been referred for thyroid evaluation.
  
  
  CONCLUSIONS
  The majority of patients referred for PTX had evidence of thyroid pathology. For an important minority of these patients, benign and malignant disease was identified that merited surgical treatment at the time of PTX. We recommend comprehensive thyroid evaluation of patients referred for PTX.
authors: Department of Surgery, University of Kentucky College of Medicine, Lexington, KY. Electronic address: dasloa0@uky.edu.
authors: David A
authors: DA
authors: Sloan
authors: Department of Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Daniel L
authors: DL
authors: Davenport
authors: Department of Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Roberta J
authors: RJ
authors: Eldridge
authors: Department of Surgery, University of Kentucky College of Medicine, Lexington, KY.
authors: Cortney Y
authors: CY
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D010808:Physical Examination; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013964:Thyroid Neoplasms; D013965:Thyroidectomy; D014463:Ultrasonography