Endocrine Abstracts (2009) 20 P147

Concurrency of primary hyperparathyroidism and thyroid diseases

Kamile Gul1, Reyhan Ersoy1, Birol Korukluoglu2, P Eren Ersoy3, Raci Aydin4, Olcay K Belenli5, Nevzat Serdar Ugras5 & Bekir Cakir1

1Department of Endocrinology and Metabolism, Ankara Ataturk Education and Research Hospital, Ankara, Turkey; 2Department of 2. General Surgery, Ankara Ataturk Education and Research Hospital, Ankara, Turkey; 3Department of 3. General Surgery, Ankara Ataturk Education and Research Hospital, Ankara, Turkey; 4Department of 1. General Surgery, Ankara Ataturk Education and Research Hospital, Ankara, Turkey; 5Department of Pathology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey.

Objective: Thyroid diseases are reported to be in 22–70% of primary hyperparathyroidism (PHPT) patients in different studies. Thyroid pathology is detected during neck exploration in some of these patients. In this study we aimed to investigate thyroid pathology in patients operated for PHPT in our clinic.

Method: About 32 PHPT patients were included in the study. Patients were evaluated with thyroid function tests, antithyroglobulin antibody, antithyroid peroxidase antibody, TSH receptor antibody, thyroid ultrasonography (US), and fine needle aspiration biopsy (FNAB). All patients were operated including neck exploration.

Results: Thyroid US before operation yielded thyroid nodule in 21 patients. 17 patients were euthyroid before operation of which 12 had multinodular goiter (MNG), 3 had nodular goiter (NG) and 2 had postoperative recurrent MNG. One of two hyperthyroid patients had toxic MNG whereas the other had toxic diffuse goiter. Chronic thyroiditis and MNG with thyroiditis were responsible from hypothyroidism in 4 and 3 patients, respectively. Thyroid autoantibodies were high in 7 patients. Summing these, preoperative thyroid pathology was found to be in 27(84%) patients. Preoperatively 33 of 54 nodules were aspirated and all were reported as benign. 24 patients had parathyroidectomy with thyroid operation. Among these patients, it was reported that 3 had papillary microcarcinoma(9%), 7 had chronic lymphocytic thyroiditis(21%) and 15 had nodular hyperplasia (47%) histopathologically. PHPT was due to parathyroid adenoma in 31 patients and carcinoma in 1 patient.

Conclusion: In our study, there was concurrent thyroid pathology in 84% of patients operated for PHPT. We like to draw attention to 3 patients (9%) who had incidental thyroid malignancy postoperatively. With minimal invasive surgical approach used much more common in recent years, during parathyroid operations, thyroid pathologies are not evaluated particularly Therefore, patients should have detailed neck US and FNAB when needed before operation and surgical approach should be determined considering thyroid pathologies.

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