THE IMPORTANCE
OF DETECTING UNSUSPECTED CONCOMITANT HYPERPARATHYROIDISM BEFORE SURGERY FOR
THYROID DISEASES
Thyroid diseases
and primary hyperparathyroidism (PHPT) are among the most common endocrine
disorders. In patients with thyroid diseases, concomitant PHPT is present in a small
but significant percentage (~ 5 %); this incidence is higher in patients with
thyroid disease than in the general population (mechanism unknown). Preoperative
recognition of unsuspected concomitant PHPT in patients with thyroid diseases
requiring surgery is clinically important, since ideally in these patients parathyroidectomy
can safely be performed during thyroid surgery, through the same incision. Performing
a single definitive surgery has several advantages, such as avoidance of a
second surgery which is expected to be more difficult (due to postoperative
scaring) and associated with increased morbidity, thereby diminishing cost of
treatment and patient discomfort. These considerations emphasize the importance
of measuring preoperative serum calcium and parathormone levels in patients
scheduled for thyroid surgery, a practice however not widely adopted. Without preoperative
diagnosis of unsuspected concomitant PHPT, parathyroid pathology can easily be
missed during thyroid surgery (in particular during lobectomies). In contrast,
preoperative diagnosis of unsuspected concomitant PHPT (based on preoperative routine
measurement of serum calcium and parathormone levels) allows an improved
operative planning leading to a single definitive surgery to treat both thyroid
and parathyroid pathologies.
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