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Related Experiment Videos

Screening for primary hyperparathyroidism before thyroid surgery: A prospective study.

Anne Denizot1, Frédéric Dadoun, Anne Meyer-Dutour

  • 1Service de Chirurgie Générale and Service des maladies métaboliques et nutrition, Centre Hospitalier et Universitaire de Marseille, Marseille, France.

Surgery
|March 15, 2002
PubMed
Summary

Prospective screening for primary hyperparathyroidism (PHPT) before thyroid surgery identified 9 cases, avoiding 3 reoperations. Population screening proved more cost-effective than treating missed PHPT cases.

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Health Economics

Background:

  • Misdiagnosed primary hyperparathyroidism (PHPT) during thyroid surgery can necessitate complex reoperations.
  • PHPT often presents asymptomatically, highlighting the need for pre-surgical screening.
  • No prior studies have prospectively evaluated PHPT screening before thyroid surgery.

Purpose of the Study:

  • To assess the effectiveness and cost-efficiency of a prospective 2-step screening protocol for PHPT in patients undergoing thyroid surgery.
  • To determine the rate of incidentally discovered parathyroid pathologies during thyroid surgery.
  • To evaluate the potential to prevent reoperations for missed PHPT.

Main Methods:

  • A prospective study screened 748 patients using a 2-step calcium and parathyroid hormone (PTH) measurement protocol.

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  • Positive screening was defined by elevated calcium and PTH levels.
  • Patients were categorized based on screening results, incidentalomas, and adenoma accessibility for cost analysis.

    • Main Results:

    • The screening identified 9 patients with PHPT, with 3 requiring specific dissection.
    • Among 739 patients with negative screening, 12 had surgical incidentalomas and 2 were diagnosed with PHPT postoperatively.
    • The cost of population screening was less than the cost of three reoperations for missed PHPT.

    Conclusions:

    • Prospective PHPT screening, while not exhaustive, successfully identified cases that could have led to reoperation.
    • Population-based screening for PHPT before thyroid surgery is a cost-effective strategy.
    • Further investigation into more exhaustive and cost-effective screening strategies is warranted.