Preoperative Thyroid Ultrasound Is Indicated in Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism

• Type of Material: Article
• Authors: Cletus Arciero, Emory University; Zita S. Shiue, University of Washington; Jeremy D. Gates, Martin Army Community Hospital; George E. Peoples, Brooke Army Medical Center; Alan P.B. Dackiw, Johns Hopkins University; Ralph P. Tufano, Johns Hopkins University; Steven K. Libutti, Albert Einstein College of Medicine; Martha A. Zeiger, Johns Hopkins University; Alexander Stojadinovic, United States Military Cancer Institute
• Language: English
• Date: 2012-01-01
• Publisher: Ivyspring International Publisher
• Publication Version: Final Published Version
• Copyright Statement: © Ivyspring International Publisher.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.7150/jca.3.1
• Title of Journal or Parent Work: Journal of Cancer
• ISSN: 1837-9664
• Volume: 3
• Issue: 1
• Start Page: 1
• End Page: 6
• Keywords: ultrasound; NODULES; thyroid cancer; hyperparathyroidism; Oncology; thyroid; Life Sciences & Biomedicine; GLAND; surgery
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Background: Primary hyperaparathyroidism (pHPT) is often accompanied by underlying thyroid pathology that can confound preoperative parathyroid localization studies and com-plicate intra-operative decision making. The aim of this study was to examine the utility of preoperative thyroid ultrasonography (US) in patients prior to undergoing parathyroidec-tomy for pHPT. Methods: An Institutional Review Board approved prospective study was undertaken from January 2005 through July 2008. All patients with pHPT meeting inclusion criteria (n=94) underwent preoperative thyroid ultrasound in addition to standard 99mTc-sestamibi scintig-raphy for parathyroid localization. Demographics, operative management and final pathology were examined in all cases. Results: Fifty-four of the 94 patients (57%) were noted to have a thyroid nodule on pre-operative US, of which 30 (56%) underwent further examination with fine needle aspiration biopsy. Alteration of the operative plan attributable to underlying thyroid pathology occurred in 16 patients (17%), with patients undergoing either total thyroidectomy (n=9) or thyroid lobectomy (n=7). Thyroid cancer was noted in 33% of patients undergoing thyroid resection, and 6% of all patients with HPT. Conclusions: The routine utilization of preoperative thyroid ultrasound in patients prior to undergoing parathyroid surgery for pHPT is indicated. The added information from this non-invasive modality facilitates timely management of co-incidental, and sometimes malig-nant, thyroid pathology.