Medical College of Wisconsin
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Impact of preoperative thyroid ultrasonography on the surgical management of primary hyperparathyroidism. Br J Surg 2008 Aug;95(8):957-60

Date

06/25/2008

Pubmed ID

18574846

DOI

10.1002/bjs.6097

Scopus ID

2-s2.0-48249112680 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: Primary hyperparathyroidism (PHPT) with coexisting thyroid disease has been considered a contraindication to minimally invasive parathyroidectomy (MIP). This study assessed the impact of thyroid ultrasonography and guided fine-needle aspiration (FNA) biopsy with cytological review of the aspiration in distinguishing patients eligible for MIP from those requiring open parathyroidectomy with thyroid surgery.

METHODS: The records of 194 consecutive patients who had minimally invasive or open parathyroidectomy for sporadic PHPT were reviewed retrospectively. Thyroid ultrasonographic findings and FNA results were compared with surgical and pathology records.

RESULTS: A total of 163 patients (84.0 per cent) were eligible for MIP based on ultrasonographic findings with or without FNA results. Ultrasonography detected concurrent thyroid disease in 163 patients (84.0 per cent). Thirty-nine (23.9 per cent) underwent FNA, of whom 16 had benign findings and were eligible for MIP; the remaining 23 had suspicious FNA results and had open parathyroidectomy combined with thyroid surgery. Postoperative thyroid histopathology confirmed malignancy in nine patients, eight of whom had disease detected ultrasonographically. Micronodular thyroid disease (less than 1 cm) accounted for four of nine malignancies.

CONCLUSION: Most patients with PHPT are eligible for MIP. Experienced ultrasonographers can diagnose coexisting micronodular and macronodular thyroid disease, and identify patients eligible for MIP.

Author List

Monroe DP, Edeiken-Monroe BS, Lee JE, Evans DB, Perrier ND

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Biopsy, Fine-Needle
Contraindications
Humans
Hyperparathyroidism, Primary
Parathyroidectomy
Preoperative Care
Retrospective Studies
Thyroid Diseases
Thyroidectomy
Ultrasonography, Interventional