Merino y Vázquez MD, Farías-Llamas OA, Olivares-Becerra JJ, Pérez-Navarro JV, González-Ojeda A

Language: Spanish
References: 23
Page: 89-92
PDF size: 46.27 Kb.

ABSTRACT

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. Material and 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. Forty four patients with biochemically presented primary hyperparathyroidism were included. 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.

REFERENCES

1. Spelsberg F, Peller-Sautter RH. Operative technique in primary hyperparathyroidism. Der Chirurg 1999;70:1102-1112.

2. Monchik JM, Barellini L, Langer P, Kahaya A. Minimally invasive parathyroid surgery in 103 patients with local/regional anesthesia, without exclusion criteria. Surgery 2002;131:502-508.

3. Strichartz SD, Giuliano AE. The operative management of coexisting thyroid and parathyroid disease. Arch Surg 1990;125:1327-1331.

4. Rubello D, Toniato A, Pelizzo MR, Casara D. Papillary thyroid carcinoma assoaciated with parathyroid adenoma detected by pertechnetate MIBI subtraction scintigraphy. Clin Nucl Med 2000;25:898-900.

5. Carnaille BM, Pattou FN, Oudar C, Lecomete-Houcke MC, Rocha JE, Proye AC. Parathyroid incidentalomas in normocalcemic patients during thyroid surgery. World J Surg 1996;20:830-834.

6. Katz AD, Kong LB. Incidental preclinical hyperparathyroidism identified during thyroid operations. Am Surg 1992;58:747-749.

7. Sianesi M, Del Río P, Arcuri MF, Iapichino G, Giuseppe R. Hyperparathyroidism associated with thyroid pathology. Am J Surg 2003; 185:58-60.

8. Krausz Y, Lebensart PD, Klein M, Weininger J, Blachar A, Chisin R. Preoperative localization of parathyoid adenoma in patients with concomitant thyroid nodular disease. World J Surg 2000;24:1573-1578.

9. Leitha T, Staudenherz A. Concomitant hyperparathyroidism and nonmedullary thyroid cancer, with a review of the literature. Clin Nucl Med 2003;28:113-117.

10. Ikeda Y, Takami H, Tajima G, Sasaki Y, Takayama J, Kurihara H, et al. Direct mini-incision parathyroidectomy. Biomed Phamacother 2002;56:14-17.

11. Prager G, Czerny C, Ofluoglu S, Kurtaran A, Passler C, Kaczirek K, et al. Impact of localization studies on feasibility of minimally invasive parathyroidectomy in an endemic goiter region. J Am Coll Surg 2003;196:541-548.

12. Ishiguro K, Ohgi S. Minimally invasive parathyroidectomy under local anesthesia. Biomed Pharmacother 2002;56:31-33.

13. Suzuki S, Fukushima T, Ami H, Asahi S, Takenoshita S. Video-assisted parathyroidectomy. Biomed Pharmacother 2002;56:18-21.

14. Khati N, Adamson T, Johnson KS, Hill MC. Ultrasound of the thyroid and parathyroid glands. Ultrasound Q 2003;19:162-176.

15. Westreich RW, Brandwein M, Mechanick JL, Bergman DA, Urken ML. Properative parathyroid localization: correlating false negative technetium 99m Sestamibi scans with parathyroid disease. Laryngoscope 2003;113:567-572.

16. Henry JF, Sebag F, Maweja S, Hubbard J, Misso C, Da Costa V, Tardivet L. Video-assisted parathyroidectomy in the management of patients with primary hyperparathyroidism. Ann Chir 2003;128:379-384.

17. Fujii H, Kubo A. Sestamibi scintigraphy for application of minimally invasive surgery of hyperfunctioning parathyroid lesions. Biomed Pharmacother 2002;56:7-13.

18. Berger H, Zimmermann T, Ockert D, Alldinger I, Kersting S, Saeger HD. Intraoperative chemiluminometric assay for simplified localization of parathyroid adenomas during surgery for primary hyperparathyroidism. Talanta 2003;60:617-621.

19. Ohshima A, Simizu S, Okido M, Shimada K, Kuroki S, Tanaka M. Endoscopic neck surgery: current status for thyroid and parathyroid diseases. Biomed Pharmacother 2002;56:48s-52s.

20. Miccoli P, Berti P. Consultant: minimal invasive parathyroid surgery. Best Pract Res Clin Endocrinol Metab 2001;15:139-147.

21. Maeda S, Shimizu K, Minami S, Hayashida N, Kuroki T, Furuichi A, et al. Video assisted neck surgery for thyroid and parathyroid disease. Biomed Pharmacother 2002;56:92s-95s.

22. Ikeda Y, Takami H, Tajima G, Sasaki Y, Takayama J, Kurihara H, et al. Total endoscopic parathyroidectomy. Biomed Pharmacother 2002;56: 22-25.

23. Fahy BN, Bold RJ, Beckett L, Schneider P. Modern parathyroid surgery: a cost benefit analysis of localizing strategies. Arch Surg 2002; 137:917-923.