The coexistence of primary hyperparathyroidism and thyroid nodules: Should the preoperative work-up of the parathyroid and the thyroid diseases be specifically adjusted?

Gaspare Gulotta, Sebastiano Bonventre, Clotilde Lo Piccolo, Giuseppina Irene Melfa, Andrea Attard, Cristina Raspanti, Maurizio Zarcone, Sergio Mazzola, Gregorio Scerrino, Bonventre, Gulotta, Attard, Raspanti, Andrea Attard, Lo Piccolo, Mazzola, Melfa, Zarcone

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Abstract

Introduction and objectives. Primary hyperparathyroidism (PHPT) can be found in concomitance with thyroid disease (TD) in a high frequency of cases. In this context the diagnostic exams for localizing the enlarged parathyroid(s) gland(s) could be less reliable or nonconclusive. Moreover, the thyroid carcinoma seems to be more frequent compared to that isolated thyroid desease and, therefore, carefully investigated. The main goal of the present study is to evaluate which diagnostic tool (US, MIBI) is more reliable for localizing the site of the PTH hypersecretion and to confirm if it is always advantageous a combination of both exams. Besides, we evaluated the incidence of thyroid carcinoma in our series of patients. Patients and methods. A review of available data of 73 patients who underwent total thyroidectomy + parathyroidectomy from 2003 and 2014 was performed. The preoperative workup included systematically US and MIBI whose results were considered true positive when at least the side (left/right) of the parathyroid affected were concordant with the surgical report, settled as the gold standard, according to the Cox nonnested model. The connection between the diagnostic results of US versus MIBI was calculated with the Cohen K index for evaluating their overlap. The average of the thyroid carcinoma were also calculated. Results. The difference between respectively US versus surgical report (p value=0.73) and MIBI versus surgical report (p value=0.81) were not significant. The low Cohen K index showed that both US and MIBI are complementary. In 23 patients (32,9%) a thyroid carcinoma was found. Conclusions. The association of MIBI and neck US is mandatory in the first evaluation of patients undergoing thyroidectomy and parathyroid excision simultaneously. The high prevalence of thyroid carcinoma in this specific context suggests a more aggressive diagnostic and surgical behaviour.
Original languageEnglish
Pages (from-to)123-129
Number of pages7
JournalIL GIORNALE DI CHIRURGIA
Volume37
Publication statusPublished - 2016

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Parathyroid Diseases
Thyroid Nodule
Primary Hyperparathyroidism
Thyroid Diseases
Thyroid Neoplasms
Thyroidectomy
Parathyroidectomy
Parathyroid Glands
Proportional Hazards Models
Thyroid Gland
Neck
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{396d80c2191a4978858feda62f37a6b2,
title = "The coexistence of primary hyperparathyroidism and thyroid nodules: Should the preoperative work-up of the parathyroid and the thyroid diseases be specifically adjusted?",
abstract = "Introduction and objectives. Primary hyperparathyroidism (PHPT) can be found in concomitance with thyroid disease (TD) in a high frequency of cases. In this context the diagnostic exams for localizing the enlarged parathyroid(s) gland(s) could be less reliable or nonconclusive. Moreover, the thyroid carcinoma seems to be more frequent compared to that isolated thyroid desease and, therefore, carefully investigated. The main goal of the present study is to evaluate which diagnostic tool (US, MIBI) is more reliable for localizing the site of the PTH hypersecretion and to confirm if it is always advantageous a combination of both exams. Besides, we evaluated the incidence of thyroid carcinoma in our series of patients. Patients and methods. A review of available data of 73 patients who underwent total thyroidectomy + parathyroidectomy from 2003 and 2014 was performed. The preoperative workup included systematically US and MIBI whose results were considered true positive when at least the side (left/right) of the parathyroid affected were concordant with the surgical report, settled as the gold standard, according to the Cox nonnested model. The connection between the diagnostic results of US versus MIBI was calculated with the Cohen K index for evaluating their overlap. The average of the thyroid carcinoma were also calculated. Results. The difference between respectively US versus surgical report (p value=0.73) and MIBI versus surgical report (p value=0.81) were not significant. The low Cohen K index showed that both US and MIBI are complementary. In 23 patients (32,9{\%}) a thyroid carcinoma was found. Conclusions. The association of MIBI and neck US is mandatory in the first evaluation of patients undergoing thyroidectomy and parathyroid excision simultaneously. The high prevalence of thyroid carcinoma in this specific context suggests a more aggressive diagnostic and surgical behaviour.",
author = "Gaspare Gulotta and Sebastiano Bonventre and {Lo Piccolo}, Clotilde and Melfa, {Giuseppina Irene} and Andrea Attard and Cristina Raspanti and Maurizio Zarcone and Sergio Mazzola and Gregorio Scerrino and Bonventre and Gulotta and Attard and Raspanti and Andrea Attard and {Lo Piccolo} and Mazzola and Melfa and Zarcone",
year = "2016",
language = "English",
volume = "37",
pages = "123--129",
journal = "IL GIORNALE DI CHIRURGIA",

}

TY - JOUR

T1 - The coexistence of primary hyperparathyroidism and thyroid nodules: Should the preoperative work-up of the parathyroid and the thyroid diseases be specifically adjusted?

AU - Gulotta, Gaspare

AU - Bonventre, Sebastiano

AU - Lo Piccolo, Clotilde

AU - Melfa, Giuseppina Irene

AU - Attard, Andrea

AU - Raspanti, Cristina

AU - Zarcone, Maurizio

AU - Mazzola, Sergio

AU - Scerrino, Gregorio

AU - Bonventre, null

AU - Gulotta, null

AU - Attard, null

AU - Raspanti, null

AU - Attard, Andrea

AU - Lo Piccolo, null

AU - Mazzola, null

AU - Melfa, null

AU - Zarcone, null

PY - 2016

Y1 - 2016

N2 - Introduction and objectives. Primary hyperparathyroidism (PHPT) can be found in concomitance with thyroid disease (TD) in a high frequency of cases. In this context the diagnostic exams for localizing the enlarged parathyroid(s) gland(s) could be less reliable or nonconclusive. Moreover, the thyroid carcinoma seems to be more frequent compared to that isolated thyroid desease and, therefore, carefully investigated. The main goal of the present study is to evaluate which diagnostic tool (US, MIBI) is more reliable for localizing the site of the PTH hypersecretion and to confirm if it is always advantageous a combination of both exams. Besides, we evaluated the incidence of thyroid carcinoma in our series of patients. Patients and methods. A review of available data of 73 patients who underwent total thyroidectomy + parathyroidectomy from 2003 and 2014 was performed. The preoperative workup included systematically US and MIBI whose results were considered true positive when at least the side (left/right) of the parathyroid affected were concordant with the surgical report, settled as the gold standard, according to the Cox nonnested model. The connection between the diagnostic results of US versus MIBI was calculated with the Cohen K index for evaluating their overlap. The average of the thyroid carcinoma were also calculated. Results. The difference between respectively US versus surgical report (p value=0.73) and MIBI versus surgical report (p value=0.81) were not significant. The low Cohen K index showed that both US and MIBI are complementary. In 23 patients (32,9%) a thyroid carcinoma was found. Conclusions. The association of MIBI and neck US is mandatory in the first evaluation of patients undergoing thyroidectomy and parathyroid excision simultaneously. The high prevalence of thyroid carcinoma in this specific context suggests a more aggressive diagnostic and surgical behaviour.

AB - Introduction and objectives. Primary hyperparathyroidism (PHPT) can be found in concomitance with thyroid disease (TD) in a high frequency of cases. In this context the diagnostic exams for localizing the enlarged parathyroid(s) gland(s) could be less reliable or nonconclusive. Moreover, the thyroid carcinoma seems to be more frequent compared to that isolated thyroid desease and, therefore, carefully investigated. The main goal of the present study is to evaluate which diagnostic tool (US, MIBI) is more reliable for localizing the site of the PTH hypersecretion and to confirm if it is always advantageous a combination of both exams. Besides, we evaluated the incidence of thyroid carcinoma in our series of patients. Patients and methods. A review of available data of 73 patients who underwent total thyroidectomy + parathyroidectomy from 2003 and 2014 was performed. The preoperative workup included systematically US and MIBI whose results were considered true positive when at least the side (left/right) of the parathyroid affected were concordant with the surgical report, settled as the gold standard, according to the Cox nonnested model. The connection between the diagnostic results of US versus MIBI was calculated with the Cohen K index for evaluating their overlap. The average of the thyroid carcinoma were also calculated. Results. The difference between respectively US versus surgical report (p value=0.73) and MIBI versus surgical report (p value=0.81) were not significant. The low Cohen K index showed that both US and MIBI are complementary. In 23 patients (32,9%) a thyroid carcinoma was found. Conclusions. The association of MIBI and neck US is mandatory in the first evaluation of patients undergoing thyroidectomy and parathyroid excision simultaneously. The high prevalence of thyroid carcinoma in this specific context suggests a more aggressive diagnostic and surgical behaviour.

UR - http://hdl.handle.net/10447/206982

UR - http://www.giornalechirurgia.it/common/php/portiere.php?ID=afb5ebfb8ad06d76439b86700377b708

M3 - Article

VL - 37

SP - 123

EP - 129

JO - IL GIORNALE DI CHIRURGIA

JF - IL GIORNALE DI CHIRURGIA

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