Concomitant thyroid lesions in patients with primary hyperparathyroidism

Concomitant thyroid pathologies in patients with primary hyperparathyroidism (PHPT) present a challenge in the clinical and surgical decision-making for these patients. In this study, we aimed to evaluate concomitant thyroid pathologies in patients who underwent operations for PHPT to determine the sensitivity (Sn) of neck ultrasonography (US) and Tc99m sestamibi scintigraphy in detecting parathyroid adenoma. We also aimed to determine the clinical impact of preoperative neck US in patients with PHPT.

One hundred thirty-eight patients with PHPT were included in this retrospective study. All patients underwent preoperative Tc99m sestamibi scintigraphy and/or thyroid US. Nodules of ≥1 cm or <1 cm with suspicious US features underwent fine needle aspiration biopsy (FNAB).

Preoperative thyroid US revealed that 93.5% of patients with PHPT had thyroid abnormalities and 66.7% of patients had at least one thyroid nodule. Postoperative histopathology results showed that 79.2% of patients had benign thyroid disease and 20.8% of patients had malignant thyroid disease. In the detection of parathyroid adenoma, US had 89.1% Sn and Tc99m sestamibi scintigraphy had 82.6% Sn.

We recommend the routine use of US in combination with Tc99m sestamibi scintigraphy, especially in endemic goiter regions, to detect any concomitant thyroid disease and thus determine the best surgical strategy for patients with PHPT.