Ryan S, et al. - An appraisal was performed of the surgical management of primary hyperparathyroidism with the aid of a retrospective chart review of 200 parathyroidectomy procedures performed over a 12 year period. The yielded findings reported that the synchronous thyroid surgery was conducted in a quarter of all parathyroidectomy procedures performed for treatment of primary hyperparathyroidism. Coincidental thyroid pathology appeared as a common occurrence. The data illustrated limitations of pre-operative imaging in reliably locating involved parathyroid tissue, along with the significance of regarding the possible requirement of carrying out the thyroid surgery during parathyroidectomy and obtaining appropriate informed consent.

Methods

• A scrutiny was conducted of the epidemiological data and accuracy of radiological investigations used in determining the pathological parathyroid tissue location.
• The frequency of simultaneous removal of thyroid tissue that was required during parathyroidectomy and the associated pathology was assessed.
• Screening was performed of the radiology reports for ascertaining if confirmed thyroid pathology from histological specimens were referenced pre-operatively.

Results

• During this study, open parathyroid surgery was performed in 71%, the remainder endoscopically.
• Herein, 95% of parathyroid specimens were affirmed as benign adenomas, with eight cases of hyperplasia and two parathyroid carcinomas.
• Pre-operative ultrasound and SPECT-CT imaging exhibited a sensitivity of 55% and 73% respectively in terms of correct adenoma localisation.
• It was reported that 49 patients (25%) underwent simultaneous partial thyroidectomy, 45 (92%) with dual pathology confirmed.
• The detection of malignant thyroid lesions was noted in 18% (n = 8), Graves’ disease 2% (n = 1), thyroiditis 9% (n = 4), multinodular goitre 56% (n = 25), unilateral nodule 4% (n = 2), hyperplasia 7% (n = 3) and intra-thyroid adenoma 4% (n = 2).
• It was disclosed that the reference to such thyroid lesions was made in only 36% of preoperative imaging reports.