B. Sunkara1, M. Cohen2, B. Miller2, P. Gauger2, D. Hughes2 1University Of Michigan,Medical School,Ann Arbor, MI, USA 2University Of Michigan,Department Of General Surgery,Ann Arbor, MI, USA
Introduction: The influence of concurrent thyroid pathology on parathyroidectomy for primary hyperparathyroidism (PHPT) has not been established. The hypothesis of this study is that concurrence of thyroid pathology and PHPT will influence various factors in parathyroidectomy.
Methods: This is retrospective cohort study of consecutive parathyroidectomy patients for PHPT. Patients were stratified according to presence or absence of thyroid pathology and then analyzed for effect of specific thyroid pathology on preoperative imaging, intraoperative factors and outcomes of parathyroidectomy.
Results: Of the 1001 patients: 534 (53.4%) had no thyroid pathology, 266 (26.6%) had thyroid nodules, 240 (24.0%) had hypothyroidism, 83 (8.3%) had Hashimoto’s thyroiditis, 39 (3.9 %) had previous thyroid surgery, and 21 (2.1%) had thyroid cancer (some had >1 pathology). The presence of thyroid pathology did not significantly influence intraoperative PTH results or rates of persistent PHPT. The localization accuracy of ultrasound was greater than sestamibi when any thyroid pathology was present (63% vs 50%; p<0.02). Sestamibi was used more frequently in patients with history of thyroidectomy (74% vs 56%; p=0.03) and hypothyroidism (68% vs 56%; p<0.02); however sestamibi was least accurate when hypothyroidism was present (41% vs 52%; p=0.03). Patients without thyroid pathology had a higher rate of successful focused parathyroidectomy (63%) compared to patients with hypothyroidism (53%; p<0.02) and nodules (48%; p<0.02). A bilateral exploration (planned or converted) was performed in 37% of patients without thyroid pathology compared to hypothyroidism (47%; p<0.02), Hashimoto’s (48%; p=0.04) and thyroid nodules (51%; p<0.02). The correlation between thyroid pathology and the total weight of the excised glands is less pronounced with the only significant difference being found in the group with a history of thyroid cancer (0.485gm vs no pathology 0.845gm; p<0.02).
Conclusion: Concurrent thyroid pathology influences use and accuracy of preoperative imaging for PHPT as well as the need for bilateral exploration, but does not affect the overall success rates of parathyroidectomy.