Simultaneous thyroid operation in patients undergoing initial neck exploration for primary hyperparathyroidism

Twenty-three (25%) out of 92 patients undergoing initial neck exploration for primary hyperparathyroidism (PHPT) also underwent a simultaneous thyroid operation. Based on a postoperative analysis a simultaneous thyroid operation was unquestionably indicated in 18 (78%) cases but in the remaining five (18%) the indications were less well proved. Six (9%) of the 66 patients subjected only to neck exploration for PHPT and four (17%) of those with a simultaneous thyroid operation had postoperative complications (P > 0.05). The patients with four incidental biopsies and an incidental lobectomy had no complications, but otherwise complications were evenly distributed among the different thyroid operations. The somewhat higher complication rate in patients undergoing simultaneous thyroid operation was related to the learning curve of the surgeon. Simultaneous thyroid operation increased the operating room costs only by 31%, and the combined operation was definitely cost effective as compared with separate parathyroid and thyroid operations. It is concluded that in experienced hands, simultaneous thyroid operation is safe, cost effective and recommendable for patients undergoing initial neck exploration for PHPT, because it avoids the expense and risk associated with neck re-exploration and can reveal unsuspected cancer.