Madill Elizabeth M, Cooray Shamil D, Bach Leon A
Department of Endocrinology and Diabetes , The Alfred Hospital, Melbourne, Victoria , Australia.
Department of Endocrinology and Diabetes, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine (Alfred)Monash University, Melbourne, Victoria, Australia.
Endocrinol Diabetes Metab Case Rep. 2016;2016. doi: 10.1530/EDM-16-0049. Epub 2016 Jul 28.
Thyrotoxicosis is an under-recognised but clinically important complication of parathyroidectomy. We report a case of a 37-year-old man with tertiary hyperparathyroidism who initially developed unexplained anxiety, diaphoresis, tachycardia, tremor and hyperreflexia one day after subtotal parathyroidectomy. Thyroid biochemistry revealed suppressed thyroid stimulating hormone and elevated serum free T4 and free T3 levels. Technetium-99m scintigraphy scan confirmed diffusely decreased radiotracer uptake consistent with thyroiditis. The patient was diagnosed with thyrotoxicosis resulting from palpation thyroiditis. Administration of oral beta-adrenergic antagonists alleviated his symptoms and there was biochemical evidence of resolution fourteen days later. This case illustrates the need to counsel patients about thyroiditis as one of the potential risks of parathyroid surgery. It also emphasises the need for biochemical surveillance in patients with unexplained symptoms in the post-operative period and may help to minimise further invasive investigations for diagnostic clarification.
Thyroiditis as a complication of parathyroidectomy surgery is uncommon but represents an under-recognised phenomenon.It is thought to occur due to mechanical damage of thyroid follicles by vigorous palpation.Palpation of the thyroid gland may impair the physical integrity of the follicular basement membrane, with consequent development of an inflammatory response.The majority of patients are asymptomatic, however clinically significant thyrotoxicosis occurs in a minority.Patients should be advised of thyroiditis/thyrotoxicosis as a potential complication of the procedure.Testing of thyroid function should be performed if clinically indicated, particularly if adrenergic symptoms occur post-operatively with no other cause identified.
甲状腺毒症是甲状旁腺切除术后一种未被充分认识但临床上很重要的并发症。我们报告一例37岁患有三发性甲状旁腺功能亢进的男性患者，他在甲状旁腺次全切除术后一天最初出现不明原因的焦虑、多汗、心动过速、震颤和反射亢进。甲状腺生化检查显示促甲状腺激素降低，血清游离T4和游离T3水平升高。锝-99m闪烁扫描证实放射性示踪剂摄取弥漫性降低，符合甲状腺炎表现。该患者被诊断为触诊性甲状腺炎导致的甲状腺毒症。口服β-肾上腺素能拮抗剂治疗缓解了他的症状，14天后有生化指标显示病情缓解。这个病例表明需要告知患者甲状腺炎是甲状旁腺手术的潜在风险之一。它还强调了对术后出现不明原因症状的患者进行生化监测的必要性，这可能有助于减少为明确诊断而进行的进一步侵入性检查。
甲状腺炎作为甲状旁腺切除手术的并发症并不常见，但却是一种未被充分认识的现象。据认为它是由于用力触诊对甲状腺滤泡造成机械损伤所致。甲状腺的触诊可能会损害滤泡基底膜的物理完整性，从而引发炎症反应。大多数患者无症状，然而少数患者会出现具有临床意义的甲状腺毒症。应告知患者甲状腺炎/甲状腺毒症是该手术的潜在并发症。如果有临床指征，应进行甲状腺功能检测，特别是术后出现肾上腺素能症状且未发现其他原因时。
