Department of Endocrinology and Metabolism, Ankara Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey.
Endocr Pract. 2010 Jan-Feb;16(1):7-13. doi: 10.4158/EP09138.OR.
To evaluate the occurrence of thyroid disease in patients undergoing parathyroidectomy for primary hyperparathyroidism.
In this case series, records of all patients with a diagnosis of primary hyperparathyroidism who underwent parathyroidectomy between January 2005 and December 2008 in our clinic were analyzed retrospectively. Preoperatively, all patients were evaluated with ultrasonography and parathyroid scintigraphy; when needed, thyroid scintigraphy and ultrasound-guided fine-needle aspiration biopsy (FNAB) were used. All patients underwent standard neck exploration. Postoperative histopathologic findings of thyroid tissue were classified as nodular/multinodular hyperplasia, Hashimoto thyroiditis, papillary thyroid carcinoma, or normal.
Fifty-one women and 9 men were included. In the 60 patients, preoperative ultrasonography revealed thyroiditis (without nodules) in 13 (22%), a solitary nodule in 9 (15%) (coexistent with thyroiditis in 7 patients), multinodular goiter in 24 (40%) (coexistent with thyroiditis in 5 patients), and normal findings in 14 (23%). Rates of thyroiditis and nodular goiter were 42% and 55%, respectively. Collectively, prevalence of thyroid disease was 77%. Total thyroidectomy was performed in 27 patients, and hemithyroidectomy was performed in 15 patients. Indications for total thyroidectomy were nondiagnostic or suspicious FNAB results in 5 patients, hyperthyroidism in 4 patients, ultrasonography findings in 11 patients, and intraoperatively recognized suspicious nodularity in 7 patients. Postoperatively, thyroid carcinoma was diagnosed in 9 patients (15%).
Thyroid disease, particularly thyroid carcinoma, is common in patients with primary hyperparathyroidism. This association should be considered when selecting the surgical procedure. Intraoperative evaluation of the thyroid is as important as preoperative evaluation with ultrasonography and FNAB in patients with thyroid disease and primary hyperparathyroidism.
评估甲状旁腺切除术治疗原发性甲状旁腺功能亢进症患者的甲状腺疾病发生率。
在本病例系列研究中，回顾性分析了 2005 年 1 月至 2008 年 12 月期间在我院接受甲状旁腺切除术的所有原发性甲状旁腺功能亢进症患者的病历。所有患者术前均行超声检查和甲状旁腺闪烁扫描；必要时行甲状腺闪烁扫描和超声引导下细针抽吸活检（FNAB）。所有患者均行标准颈部探查。术后甲状腺组织的组织病理学发现分为结节/多结节性增生、桥本甲状腺炎、甲状腺乳头状癌或正常。
共纳入 60 例患者，其中 51 例女性，9 例男性。在 60 例患者中，术前超声检查发现 13 例（22%）甲状腺炎（无结节）、9 例（15%）单发结节（7 例合并甲状腺炎）、24 例（40%）多结节性甲状腺肿（5 例合并甲状腺炎）和 14 例（23%）正常。甲状腺炎和结节性甲状腺肿的发生率分别为 42%和 55%。甲状腺疾病总患病率为 77%。27 例行全甲状腺切除术，15 例行半甲状腺切除术。5 例患者因 FNAB 结果不明确或可疑、4 例患者因甲状腺功能亢进、11 例患者因超声检查结果、7 例患者因术中发现可疑结节而行全甲状腺切除术。术后 9 例（15%）诊断为甲状腺癌。
原发性甲状旁腺功能亢进症患者中甲状腺疾病，特别是甲状腺癌较为常见。在选择手术方式时应考虑到这种关联。对于甲状腺疾病合并原发性甲状旁腺功能亢进症患者，术中评估与超声和 FNAB 术前评估同样重要。
