1. Eisenhower Army Medical Center, Fort Gordon, GA, USA
2. University of Washington, Seattle WA, USA
3. Martin Army Community Hospital, Fort Benning, GA, USA
4. Brooke Army Medical Center, Fort Sam Houston, TX, USA
5. United States Military Cancer Institute, Washington, D.C. , USA
6. Uniformed Services University of the Health Sciences, Bethesda, MD, USA
7. Johns Hopkins University School of Medicine, Baltimore, MD, USA
8. Albert Einstein College of Medicine / Montefiore Medical Center, New York City, NY, USA
9. Walter Reed National Military Medical Center, Bethesda, MD, USA
Background: Primary hyperaparathyroidism (pHPT) is often accompanied by underlying thyroid pathology that can confound preoperative parathyroid localization studies and complicate intra-operative decision making. The aim of this study was to examine the utility of preoperative thyroid ultrasonography (US) in patients prior to undergoing parathyroidectomy 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 scintigraphy 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 preoperative 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 malignant, thyroid pathology.
Keywords: hyperparathyroidism, thyroid, ultrasound, surgery, thyroid cancer.