1
|
Naik M, Khan SR, Owusu D, Alsafi A, Palazzo F, Jackson JE, Harvey CJ, Barwick TD. Contemporary Multimodality Imaging of Primary Hyperparathyroidism. Radiographics 2022; 42:841-860. [PMID: 35427174 DOI: 10.1148/rg.210170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary hyperparathyroidism (PHPT) is a disorder characterized by hypercalcemia and an elevated or inappropriately normal parathyroid hormone level. Classic features include bone pain, fractures, renal impairment, nephrolithiasis, and mental disturbance. However, most cases of PHPT are now asymptomatic at diagnosis or associated with nonspecific neurocognitive changes. The most frequent cause of PHPT is a solitary adenoma that secretes parathyroid hormone without the normal suppressive effect of serum calcium. A smaller number of cases can be attributed to multigland disease. Parathyroidectomy is curative and is considered for nearly all affected patients. Although PHPT is primarily a clinical and biochemical diagnosis, imaging is key to the localization of adenomas, which can lie in conventional locations adjacent to the thyroid gland or less commonly at ectopic sites in the neck and mediastinum. In addition, accurate localization facilitates the use of a minimally invasive or targeted surgical approach. Frequently used localization techniques include US, parathyroid scintigraphy, and four-dimensional CT. Second- and third-line modalities such as MRI, PET/CT, and selective venous sampling with or without parathyroid arteriography can increase confidence before surgery. These localization techniques, along with the associated technical aspects, relative advantages, and drawbacks, are described. Local expertise, patient factors, and surgeon preference are important considerations when determining the type and sequence of investigation. A multimodality approach is ultimately desirable, particularly in challenging scenarios such as multigland disease, localization of ectopic adenomas, and persistent or recurrent PHPT. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Mitesh Naik
- From the Department of Radiology (M.N., S.R.K., A.A., J.E.J., C.J.H., T.D.B.) and Department of Endocrine and Thyroid Surgery (F.P.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, England; Department of Radiology, Dartford and Gravesham NHS Trust, Kent, England (D.O.); and Department of Surgery and Cancer, Imperial College London, London, England (T.D.B.)
| | - Sairah R Khan
- From the Department of Radiology (M.N., S.R.K., A.A., J.E.J., C.J.H., T.D.B.) and Department of Endocrine and Thyroid Surgery (F.P.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, England; Department of Radiology, Dartford and Gravesham NHS Trust, Kent, England (D.O.); and Department of Surgery and Cancer, Imperial College London, London, England (T.D.B.)
| | - Desmond Owusu
- From the Department of Radiology (M.N., S.R.K., A.A., J.E.J., C.J.H., T.D.B.) and Department of Endocrine and Thyroid Surgery (F.P.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, England; Department of Radiology, Dartford and Gravesham NHS Trust, Kent, England (D.O.); and Department of Surgery and Cancer, Imperial College London, London, England (T.D.B.)
| | - Ali Alsafi
- From the Department of Radiology (M.N., S.R.K., A.A., J.E.J., C.J.H., T.D.B.) and Department of Endocrine and Thyroid Surgery (F.P.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, England; Department of Radiology, Dartford and Gravesham NHS Trust, Kent, England (D.O.); and Department of Surgery and Cancer, Imperial College London, London, England (T.D.B.)
| | - Fausto Palazzo
- From the Department of Radiology (M.N., S.R.K., A.A., J.E.J., C.J.H., T.D.B.) and Department of Endocrine and Thyroid Surgery (F.P.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, England; Department of Radiology, Dartford and Gravesham NHS Trust, Kent, England (D.O.); and Department of Surgery and Cancer, Imperial College London, London, England (T.D.B.)
| | - James E Jackson
- From the Department of Radiology (M.N., S.R.K., A.A., J.E.J., C.J.H., T.D.B.) and Department of Endocrine and Thyroid Surgery (F.P.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, England; Department of Radiology, Dartford and Gravesham NHS Trust, Kent, England (D.O.); and Department of Surgery and Cancer, Imperial College London, London, England (T.D.B.)
| | - Chris J Harvey
- From the Department of Radiology (M.N., S.R.K., A.A., J.E.J., C.J.H., T.D.B.) and Department of Endocrine and Thyroid Surgery (F.P.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, England; Department of Radiology, Dartford and Gravesham NHS Trust, Kent, England (D.O.); and Department of Surgery and Cancer, Imperial College London, London, England (T.D.B.)
| | - Tara D Barwick
- From the Department of Radiology (M.N., S.R.K., A.A., J.E.J., C.J.H., T.D.B.) and Department of Endocrine and Thyroid Surgery (F.P.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, England; Department of Radiology, Dartford and Gravesham NHS Trust, Kent, England (D.O.); and Department of Surgery and Cancer, Imperial College London, London, England (T.D.B.)
| |
Collapse
|
2
|
Hargitai L, Schefner M, Traub-Weidinger T, Haug A, Arikan M, Scheuba C, Riss P. Accessing the influence of 99mTc-Sesta-MIBI-positive thyroid nodules on preoperative localisation studies in patients with primary hyperparathyroidism. Langenbecks Arch Surg 2022; 407:1183-1191. [PMID: 35061094 PMCID: PMC9151570 DOI: 10.1007/s00423-022-02442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
Purpose Curative treatment for primary hyperparathyroidism (PHPT) is parathyroidectomy (PTX) with removal of the hyperfunctioning gland(s). In an endemic goitre region, 35–78% of PHPT patients show concomitant thyroid disease. This study aimed to evaluate if 99mTc-sestamibi (MIBI)-positive thyroid nodules decrease sensitivity in regard to localising the hyperfunctioning parathyroid gland(s) in PHPT patients. Methods Within 5 years, 497 consecutive patients with biochemically proven PHPT were included in this study. The data was analysed retrospectively. Results In total, 198 patients underwent PTX with thyroid surgery and 299 patients underwent sole PTX. Sensitivity of MIBI scan for PTX with and without thyroid surgery was 72.1% and 73.6%, respectively. A statistically significant difference in sensitivity of ultrasound for PTX with and without thyroid surgery (57.0% and 70.9%, respectively) was observed (p = 0.029). Thyroid nodule histology did not have a significant effect on the MIBI scan. Unilateral neck exploration (UNE) was performed in 110 patients and bilateral neck exploration (BNE) in 177 patients. The probability of surgical conversion from UNE to BNE due to incorrect localisation was 1.733 times higher in patients with thyroid nodules. Conclusions Concomitant benign thyroid nodules did not influence MIBI sensitivity. No correlation between thyroid carcinoma and MIBI uptake was determined. However, MIBI detection of thyroid malignancy is important in patients initially being considered for minimal invasive parathyroidectomy. Sensitivity and positive predictive value of ultrasound were significantly lower in patients with thyroid nodules. The probability of conversion from UNE to BNE due to incorrect localisation was 1.733 times higher in patients with thyroid nodules.
Collapse
Affiliation(s)
- Lindsay Hargitai
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
| | - Maria Schefner
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Alexander Haug
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Melisa Arikan
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Christian Scheuba
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Philipp Riss
- Endocrine Surgery, Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| |
Collapse
|
3
|
Preda C, Branisteanu D, Armasu I, Danila R, Velicescu C, Ciobanu D, Covic A, Grigorovici A. Coexistent papillary thyroid carcinoma diagnosed in surgically treated patients for primary versus secondary hyperparathyroidism: same incidence, different characteristics. BMC Surg 2019; 19:94. [PMID: 31311533 PMCID: PMC6636032 DOI: 10.1186/s12893-019-0556-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coexistence of hyperparathyroidism and thyroid cancer presents important diagnostic and management challenges. With minimally invasive parathyroid surgery trending, preoperative thyroid imaging becomes more important as concomitant thyroid and parathyroid lesions are reported. The aim of the study was to evaluate the rate of thyroid cancer in patients operated for either primary (PHPT) or secondary hyperparathyroidism (SHPT). METHODS Our retrospective study included PHPT and SHPT patients submitted to parathyroidectomy and, when indicated, concomitant thyroid surgery between 2010 and 2017. RESULTS Parathyroidectomy was performed in 217 patients: 140 (64.5%) for PHPT and 77 (35.5%) for SHPT. Concomitant thyroid surgery was performed in 75 patients with PHPT (53.6%), and 19 papillary thyroid carcinomas (PTC) were found, accounting for 13.6% from all cases with PHPT and 25.3% from PHPT cases with concomitant thyroid surgery. Thirty-one of operated SHPT patients (40.3%) also underwent thyroid surgery and 9 PTC cases were diagnosed (11.7% of all SHPT patients and 29% of patients with concomitant thyroid surgery). We found differences between PHPT and SHPT patients (p < 0.001) with respect to age (54.6 ± 13y versus 48.8 ± 12y), female-to-male ratio (8:1 versus ~ 1:1), surgical technique (single gland parathyroidectomy in 82.8% PHPT cases; versus subtotal parathyroidectomy in 85.7% SHPT cases) and presurgical PTH (357.51 ± 38.11 pg/ml versus 1020 ± 161.38 pg/ml). Morphopathological particularities, TNM classification and multifocality incidence of PTC were similar in the two groups. All PTC from patients with SHPT were thyroid microcarcinomas (TMC, i.e. tumors with a diameter smaller than 1 cm), whereas seven out of the 19 cases with PTC and PHPT were larger than 1 cm. CONCLUSIONS PTC was frequently and similarly associated with both PHPT and SHPT irrespective of presurgical PTH levels. Thyroid tumors above 1 cm were found only in patients with PHPT. Investigators should focus also on associated thyroid nodular pathology in patients with PHPT.
Collapse
Affiliation(s)
- Cristina Preda
- Faculty of Medicine, Department of Endocrinology, "Gr igore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Dumitru Branisteanu
- Faculty of Medicine, Department of Endocrinology, "Gr igore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania.
| | - Ioana Armasu
- Department of Morphofunctional Sciences, "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Radu Danila
- Faculty of Medicine, Department of Surgery, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Cristian Velicescu
- Faculty of Medicine, Department of Surgery, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Delia Ciobanu
- Faculty of Medicine, Department of Morphopathology, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Adrian Covic
- Faculty of Medicine, Department of Nephrology, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania.,Academy of Romanian Scientists, Bucuresti, Romania
| | - Alexandru Grigorovici
- Faculty of Medicine, Department of Surgery, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| |
Collapse
|
4
|
Concomitant thyroid lesions in patients with primary hyperparathyroidism. Asian J Surg 2017; 40:338-344. [DOI: 10.1016/j.asjsur.2015.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 01/25/2023] Open
|
5
|
Wright MC, Jensen K, Mohamed H, Drake C, Mohsin K, Monlezun D, Alsaleh N, Kandil E. Concomitant thyroid disease and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Gland Surg 2017; 6:368-374. [PMID: 28861377 DOI: 10.21037/gs.2017.04.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thyroid abnormalities have been found intraoperatively during parathyroidectomy and have resulted in concomitant thyroidectomy. The identification of concomitant disease is important prior to primary operation in order to minimize reoperations. This study investigates the incidence of concomitant primary hyperparathyroidism (PHPT) and thyroid nodular disease in patients undergoing thyroidectomy or parathyroidectomy. METHODS We performed a retrospective review of prospectively gathered data for 621 patients who underwent thyroidectomy, parathyroidectomy, or both at Tulane Medical Center. Information obtained included initial referral, initial thyroid stimulating hormone (TSH), initial parathyroid hormone (PTH), fine needle aspiration (FNA) results, ultrasound results, type of operation performed, final diagnosis, and final pathology. RESULTS Among the 400 patients referred primarily for thyroid disease, 13.50% underwent a thyroidectomy and parathyroidectomy (PTX) simultaneously and 10.75% received a final diagnosis of thyroid and concomitant parathyroid disease. Among the 103 patients referred primarily for parathyroid disease, 26.21% underwent a PTX and thyroidectomy and 24.27% received a final diagnosis of both thyroid and parathyroid disease. Patients referred primarily for parathyroid disease were more likely to receive a final diagnosis of both parathyroid and thyroid disease and were more likely to undergo a combined operation. CONCLUSIONS Concomitant thyroid and parathyroid disease occur and preoperative analysis is important to avoid increased complications from reoperations.
Collapse
Affiliation(s)
| | - Kelly Jensen
- Tulane University School of Medicine, New Orleans, LA, USA.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Hossam Mohamed
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Carolyn Drake
- Tulane University School of Medicine, New Orleans, LA, USA.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Khuzema Mohsin
- Department of Surgery, Tulane University Medical Center, New Orleans, LA, USA
| | - Dominique Monlezun
- Tulane University School of Medicine, New Orleans, LA, USA.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Nuha Alsaleh
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University Medical Center, New Orleans, LA, USA.,Department of Surgery, Breast and Endocrine Unit, College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University Medical Center, New Orleans, LA, USA
| |
Collapse
|
6
|
Emirikçi S, Özçınar B, Öner G, Omarov N, Ağcaoğlu O, Soytaş Y, Aksakal N, Yanar F, Barbaros U, Erbil Y. Thyroid cancer incidence in simultaneous thyroidectomy with parathyroid surgery. ULUSAL CERRAHI DERGISI 2015; 31:214-7. [PMID: 26668529 DOI: 10.5152/ucd.2015.2666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 01/18/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) is often seen in conjunction with an underlying thyroid disorder. Imaging methods that are used to localize the parathyroid adenoma also detect associated thyroid nodules and thyroid cancer. The aim of this study was to detect the rate of thyroid cancer identified while performing parathyroidectomy and thyroidectomy in patients with PHPT. MATERIAL AND METHODS Files of all patients who were operated for PHPT and who underwent simultaneous thyroidectomy were analyzed. Data regarding parathyroid pathology, surgical procedures, indications of thyroid surgery, and pathology results were retrospectively recorded. The indications for thyroid surgery included presence of suspicious thyroid nodules in ultrasonography, increase in size of thyroid nodules in follow-up ultrasound, or presence of suspicious thyroid fine needle aspiration biopsy (FNAB) findings. Rates of thyroid cancer detection were investigated according to definite pathology reports. RESULTS Eighty-three patients who underwent parathyroidectomy with a diagnosis of PHPT with concurrent thyroidectomy in Department of General Surgery, İstanbul University İstanbul Faculty of Medicine were included in the study. Eighteen patients were male (22%) and 65 were female (78%). The median age was 53 (18-70) years. The primary indication for parathyroidectomy was primary hyperparathyroidism in all patients. The thyroid procedures applied in addition to parathyroidectomy were lobectomy + isthmusectomy in 29 patients (35%), bilateral subtotal thyroidectomy in 20 patients (24%), bilateral total thyroidectomy in 23 patients (28%), and total thyroidectomy on one side and near total thyroidectomy to the other side in 11 patients (13%). The only indication for thyroidectomy was the presence of thyroid nodules until 2000 (20 patients, 24%). Indications in the remaining 63 patients included the presence of multiple nodules that cannot be followed up by ultrasonography in 25 patients (30%), presence of a suspicious nodule on ultrasonography in 33 patients (40%), growth in nodule size in 2 patients (2%), and detection of suspicious findings on FNAB in 3 patients (4%). Five patients (6%) were diagnosed with papillary thyroid cancer, four of whom were micropapillary cancer. CONCLUSION Imaging methods performed to localize the pathological parathyroid gland for a diagnosis of PHPT are useful in estimating other accompanying pathologies. Presence of thyroid nodules should be evaluated before all parathyroid procedures, and if the nodule has an indication for surgery, thyroid surgery should be considered at the same operation with parathyroid surgery.
Collapse
Affiliation(s)
- Selman Emirikçi
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Beyza Özçınar
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Gizem Öner
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Nail Omarov
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Orhan Ağcaoğlu
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Yiğit Soytaş
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Nihat Aksakal
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Fatih Yanar
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Umut Barbaros
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Yeşim Erbil
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| |
Collapse
|
7
|
Phillips DJ, Kutler DI, Kuhel WI. Incidental thyroid nodules in patients with primary hyperparathyroidism. Head Neck 2015; 36:1763-5. [PMID: 25548812 DOI: 10.1002/hed.23533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND It is desirable to detect neoplastic thyroid disease before proceeding with surgical therapy for hyperparathyroidism so that both conditions can be treated with a single operation. METHODS Between March 1998 and June 2009, 227 patients with primary hyperparathyroidism were treated with surgical therapy. Of these, 217 were evaluated preoperatively with a modified 4-dimensional CT and ultrasonography. The medical records of these patients were reviewed in order to document the incidence and significance of thyroid pathology in this cohort of patients. RESULTS Thyroid nodules were identified in 159 of the 217 patients (73.3%). Nine of 217 patients (4.1%) were treated with either a partial or a total thyroidectomy at the time of parathyroidectomy. Three of these patients had papillary thyroid carcinoma, 1 had a Hurthle cell carcinoma, and 1 had an incidental micropapillary thyroid carcinoma. CONCLUSION The rate of clinically significant thyroid malignancy in patients undergoing surgical treatment of primary hyperparathyroidism was 1.8%.
Collapse
|
8
|
Riss P, Kammer M, Selberherr A, Scheuba C, Niederle B. Morbidity Associated with Concomitant Thyroid Surgery in Patients with Primary Hyperparathyroidism. Ann Surg Oncol 2014; 22:2707-13. [DOI: 10.1245/s10434-014-4283-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Indexed: 11/18/2022]
|
9
|
Role of cervical ultrasound in detecting thyroid pathology in primary hyperparathyroidism. J Surg Res 2014; 190:575-8. [DOI: 10.1016/j.jss.2014.03.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/08/2014] [Accepted: 03/12/2014] [Indexed: 11/19/2022]
|
10
|
He Y, Liu S, Guo H, Shi B. Incidental finding of papillary thyroid carcinoma with BRAFV600E mutation in a patient with coexistent primary hyperparathyroidism and Graves' hyperthyroidism. BMJ Case Rep 2014; 2014:bcr-2013-203436. [PMID: 24879726 DOI: 10.1136/bcr-2013-203436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The simultaneous occurrence of hyperthyroidism and hyperparathyroidism was previously reported to be rare, but it was recognised more and more clearly by effective evaluations. Recent studies also mentioned the coexistence of parathyroid adenoma and papillary thyroid carcinoma (PTC). The potential mechanism is still unknown. We report a case of a 46-year-old man coexisted with primary hyperparathyroidism, Graves' hyperthyroidism and occult PTC. The patient had a 6-month history of polyphagia and irritability. Blood examinations showed elevated serum calcium and parathyroid hormone levels. Serum phosphate was lower. Thyroid function evaluation indicted Graves' hyperthyroidism. Ultrasound showed a solitary hyperchoic thyroid nodule in the right gland. Parathyroid radioisotope scanning found a mild enhancement of 99mTc absorption in the lower part of the right parathyroid gland. A surgical exploration was carried out and the parathyroid adenoma resection was performed. An occult micro-PTC with BRAF(V600E) mutation was also detected.
Collapse
Affiliation(s)
- Yayi He
- Department of Endocrinology, First Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi Province, China
| | - Shu Liu
- Department of Endocrinology, First Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi Province, China
| | - Hui Guo
- Department of Endocrinology, First Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi Province, China
| | - Bingyin Shi
- Department of Endocrinology, First Affiliated Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi Province, China
| |
Collapse
|
11
|
Surgeon-driven thyroid interrogation of patients presenting with primary hyperparathyroidism. J Am Coll Surg 2013; 218:674-83. [PMID: 24529807 DOI: 10.1016/j.jamcollsurg.2013.12.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/13/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (pHPT) is an increasingly prevalent disease affecting all age groups. The authors sought to determine the impact of a "thyroid interrogation" practice protocol on the surgical treatment of patients with the diagnosis of pHPT referred to a single surgeon. STUDY DESIGN We performed a retrospective review of prospectively gathered data on parathyroidectomy (PTX) patients undergoing both a prospective clinical thyroid evaluation and thyroid ultrasound between January 2008 and October 2012. RESULTS Only 5.6% of 468 PTX patients were referred to a single surgeon for both parathyroid and thyroid surgical evaluation; 31% of patients had known pre-existing thyroid disease (hypothyroidism most commonly), and 22% of patients had palpable thyroid abnormalities unrecognized in 67% of cases by the referring physician. Of the 468 patients, 2.6% had a history of classic head and neck radiation exposure, 2.6% a history of radio-iodine treatment, and 3% a family history of thyroid cancer. Thyroid abnormalities were found on ultrasound in 61% of patients, and 26% of patients underwent thyroid biopsies. Parathyroid and thyroid surgery was combined for 18.4% of patients; indications included obstructive symptoms (3.2%), hyperthyroidism (0.9%), intraoperative findings (5.1%), and concern for malignancy (9.2%). Malignancy was diagnosed in 23 patients (4.9%), only 8 of whom had been referred for thyroid evaluation. CONCLUSIONS The majority of patients referred for PTX had evidence of thyroid pathology. For an important minority of these patients, benign and malignant disease was identified that merited surgical treatment at the time of PTX. We recommend comprehensive thyroid evaluation of patients referred for PTX.
Collapse
|
12
|
Vysetti S, Sridhar P, Theckedath B, Gilden JL, Morawiecki P. Synchronous papillary thyroid carcinoma and primary hyperparathyroidism: diagnosis and management issues. Hosp Pract (1995) 2013; 40:16-9. [PMID: 23299031 DOI: 10.3810/hp.2012.10.998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The occurrence of a papillary thyroid carcinoma in a patient with primary hyperparathyroidism is rare. Awareness of this condition will enable clinicians to evaluate for possible thyroid pathology in patients with primary hyperparathyroidism. Both of these endocrine conditions could then be managed with a single surgery involving concomitant resection of the thyroid and parathyroid glands. We report a case of a 53-year-old woman with a parathyroid adenoma and a unilateral papillary thyroid carcinoma, and detail the clinical features, diagnosis, and management.
Collapse
Affiliation(s)
- Suneetha Vysetti
- Department of Medicine, Rosalind Franklin University of Medicine and Sciences, North Chicago, IL, USA
| | | | | | | | | |
Collapse
|
13
|
Abstract
Although thyroid scintigraphy and ultrasound continues to be the mainstay of the diagnostic imaging of the thyroid gland, there have been several recent advances that are of interest to both radiologists and endocrinologists. In this review article, the authors discuss recent progress in imaging of the thyroid by use of radionuclide imaging including single photon-emission computed tomography/positron emission tomography, ultrasonography (USG), USG elastography, computed tomography (CT), magnetic resonance imaging (MRI), and optical coherence tomography.
Collapse
Affiliation(s)
- Vikas Chaudhary
- Department of Radiodiagnosis, Employees’ State Insurance Corporation (ESIC) Model Hospital, Gurgaon-122001, Haryana, India
| | - Shahina Bano
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi, India
| |
Collapse
|
14
|
Agha A, Hornung M, Rennert J, Uller W, Lighvani H, Schlitt HJ, Jung EM. Contrast-enhanced ultrasonography for localization of pathologic glands in patients with primary hyperparathyroidism. Surgery 2012; 151:580-6. [DOI: 10.1016/j.surg.2011.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
|
15
|
Owen RP, Silver CE, Pellitteri PK, Shaha AR, Devaney KO, Werner JA, Rinaldo A, Ferlito A. Parathyroid carcinoma: a review. Head Neck 2011; 33:429-36. [PMID: 20310041 DOI: 10.1002/hed.21376] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Randall P Owen
- Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Mount Sinai School of Medicine, New York, New York, USA
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Levy JM, Kandil E, Yau LC, Cuda JD, Sheth SN, Tufano RP. Can Ultrasound Be Used as the Primary Screening Modality for the Localization of Parathyroid Disease prior to Surgery for Primary Hyperparathyroidism A Review of 440 Cases. ACTA ACUST UNITED AC 2011; 73:116-20. [DOI: 10.1159/000323912] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 12/21/2010] [Indexed: 11/19/2022]
|
17
|
Affiliation(s)
- Joel T Adler
- Intern in General Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | |
Collapse
|
18
|
Pata G, Casella C, Besuzio S, Mittempergher F, Salerni B. Clinical appraisal of 99m technetium-sestamibi SPECT/CT compared to conventional SPECT in patients with primary hyperparathyroidism and concomitant nodular goiter. Thyroid 2010; 20:1121-7. [PMID: 20615139 DOI: 10.1089/thy.2010.0035] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although 99m Technetium-sestamibi scintigraphy with single-photon emission computed tomography (SPECT) and, recently, hybrid SPECT/computed tomography (CT) have been claimed to be the preoperative methods of choice for parathyroid localization in patients with primary hyperparathyroidism (PHPT) and concomitant nodular goiter (NG), they have never been compared in this setting. We aimed at testing the hypothesis that SPECT/CT may be superior to SPECT for parathyroid localization in patients with PHPT and NG. METHODS Thirty-three patients with PHPT and NG (one or more nodular lesions based on cervical ultrasound) who underwent open parathyroidectomy during 2004-2009 were reviewed. All patients had preoperative 99m Tc-sestamibi planar scintigraphy and SPECT (18 patients) or SPECT/CT (15 patients) after cervical ultrasound. Sensitivity, specificity, and positive predictive value (PPV) (for both correct neck side and quadrant identification) were calculated for the two procedures through comparison with intraoperative findings. In addition, operative times were assessed if the surgery was only for PHPT and not for the six patients who also had thyroidectomy. RESULTS The sensitivity of SPECT/CT for correctly identifying the neck side containing an abnormal parathyroid was 93.7% versus 80% for SPECT (p = 0.21, not significant [ns]). The specificity and PPV for this attribute were 92.9% and 93.7%, respectively, for SPECT/CT versus 87.5% and 88.9%, respectively, for SPECT (p = 0.75 and 0.8, ns). SPECT/CT showed higher sensitivity than SPECT (87.5% vs. 55.6%; p = 0.0001) and higher PPV (87.5% vs. 62.5%; p = 0.0022) for correctly identifying the neck quadrant affected by PHPT. The specificity for this was 95.5% for SPECT/CT versus 88.5% for SPECT (p = 0.26, ns). Mean operative time was shorter after SPECT/CT than after SPECT (38 vs. 56 minutes; p = 0.034). One of the patients having SPECT/CT had double adenomas, and two had ectopic parathyroid glands, all of which were recognized preoperatively by this technique. Two of the patients having SPECT had double adenomas, and two had ectopic glands, none of which were recognized preoperatively. No patient had persistent or recurrent PHPT. CONCLUSIONS SPECT/CT is superior to SPECT for preoperative imaging of patients with PHPT and NG. We recommend the routine use of SPECT/CT for work-up of all such patients, particularly if minimally invasive parathyroid surgery is planned.
Collapse
Affiliation(s)
- Giacomo Pata
- Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Piazzale Spedali Civili 1, Brescia, Italy.
| | | | | | | | | |
Collapse
|
19
|
Adler JT, Chen H, Schaefer S, Sippel RS. Does Routine Use of Ultrasound Result in Additional Thyroid Procedures in Patients with Primary Hyperparathyroidism? J Am Coll Surg 2010; 211:536-9. [DOI: 10.1016/j.jamcollsurg.2010.05.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 05/24/2010] [Accepted: 05/24/2010] [Indexed: 11/28/2022]
|