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Surgical management of primary hyperparathyroidism

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Abstract

We reviewed the surgical management of primary hyperparathyroidism through a retrospective chart review of 200 parathyroidectomy procedures performed over a 12 year period. Epidemiological data and accuracy of radiological investigations used in identifying pathological parathyroid tissue location were assessed. We determined how often simultaneous removal of thyroid tissue was required during parathyroidectomy and the associated pathology. Radiology reports were screened to determine if confirmed thyroid pathology from histological specimens were referenced pre-operatively. Open parathyroid surgery was performed in 71%, the remainder endoscopically. 95% of parathyroid specimens were confirmed as benign adenomas, with eight cases of hyperplasia and two parathyroid carcinomas. Pre-operative ultrasound and SPECT-CT imaging demonstrated sensitivity of 55% and 73% respectively with regards correct adenoma localisation. Forty-nine patients (25%) underwent simultaneous partial thyroidectomy, 45 (92%) with dual pathology confirmed. Malignant thyroid lesions were identified 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). Reference to these thyroid lesions was made in only 36% of preoperative imaging reports. In conclusion, synchronous thyroid surgery was carried out in a quarter of all parathyroidectomy procedures performed for treatment of primary hyperparathyroidism. Coincidental thyroid pathology was common. The limitations of pre-operative imaging in reliably locating involved parathyroid tissue are demonstrated and the importance of considering the potential need to perform thyroid surgery during parathyroidectomy and obtaining appropriate informed consent.

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Authors and Affiliations

  1. Departments of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin 2, Ireland

    Stephen Ryan, Julia Moriariu & Conrad Timon

  2. Departments of Otolaryngology, St James’s University Hospital, Dublin, Ireland

    Stephen Ryan, Danielle Courtney & Conrad Timon

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  1. Stephen Ryan
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  2. Danielle Courtney
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  3. Julia Moriariu
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  4. Conrad Timon
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Correspondence to Stephen Ryan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare they have no conflict of interest.

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No informed consent was obtained or required as this was a retrospective study.

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Ryan, S., Courtney, D., Moriariu, J. et al. Surgical management of primary hyperparathyroidism. Eur Arch Otorhinolaryngol 274, 4225–4232 (2017). https://doi.org/10.1007/s00405-017-4776-4

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  • DOI: https://doi.org/10.1007/s00405-017-4776-4

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