C. M. Kiernan1, C. Schlegel1, S. Kavalukas1, C. Isom1, M. F. Peters1, C. C. Solorzano1 1Vanderbilt University Medical Center,Nashville, TN, USA
Introduction:
Concomitant thyroid pathology has been reported in 17-84% of patients with primary sporadic hyperparathyroidism (HPT). However, it remains unclear whether the perioperative risks of concomitant thyroidectomy are greater than those of parathyroidectomy alone. This study examines the frequency of coexisting thyroid disease, concomitant thyroidectomy rates and complications of patients who underwent parathyroidectomy for HPT.
Methods:
A retrospective review of prospectively collected data on 709 patients who underwent parathyroidectomy for HPT over a 5-year period at a high volume center was performed. Patients who underwent parathyroidectomy were compared to patients who underwent parathyroidectomy with a concomitant thyroid procedure (total thyroidectomy or thyroid lobectomy). Patients who underwent previous parathyroid or thyroid operations were excluded. Chi-square, fisher’s exact, student’s t-test and Wilcoxon rank-sum test were utilized to compare cohorts.
Results:
641 patients met inclusion criteria. 49% of patients had thyroid disease on preoperative ultrasound and 20% of such patients were deemed to require a concomitant thyroid procedure. 574 patients (90%) underwent parathyroidectomy alone and 67 patients (10%) underwent parathyroidectomy with a concomitant thyroidectomy. There were no differences in age, gender, ASA class, preoperative calcium, PTH, or vitamin D levels between groups. When compared to parathyroidectomy alone, parathyroidectomy with a concomitant thyroid procedure was associated with longer operative times (median 57 vs. 91mins, p<0.01), increased rate of overnight stay (17% vs. 69%, p <0.01), and increased rate of transient hypocalcemia (3% vs. 15%, p<0.01). There were no differences in the rate of postoperative emergency department visits (3% vs. 6%, p=0.15), readmissions (1% vs. 3%, p=0.09) or permanent hypoparathyroidism (0.5% vs. 0%, p=0.55). Overall, there were 5 operative failures, all occurred in the parathyroidectomy alone group. There were no postoperative hematomas or recurrent laryngeal nerve injuries in either group.
Conclusion:
In this study, parathyroidectomy with a concomitant thyroid procedure was associated with longer operative times, increased rate of overnight stay and increased transient hypocalcemia. However, a concomitant thyroid procedure during parathyroidectomy for HPT did not increase the risk of recurrent laryngeal nerve injury, postoperative hematoma, permanent hypoparathyroidism or immediate operative failure.
