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The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism
S K Libutti1, D L Bartlett, N T jaskowiak
1Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1502, USA.
Surgery
|January 14, 1998
Summary
Blind thyroid lobectomy is rarely needed for persistent hyperparathyroidism. Ultrasonography reliably identifies intrathyroidal parathyroid glands, reducing unnecessary thyroid surgery.
Area of Science:
- Endocrinology
- Surgical Oncology
- Medical Imaging
Background:
- Persistent or recurrent primary hyperparathyroidism often necessitates reoperation.
- The role of "blind" thyroid lobectomy in managing these cases remains unclear.
Purpose of the Study:
- To evaluate the utility of blind thyroid lobectomy in reoperations for hyperparathyroidism.
- To determine the prevalence of intrathyroidal parathyroid glands in patients undergoing reoperation.
Main Methods:
- A review of 269 patients who underwent reoperation for hyperparathyroidism between 1982 and 1995.
- Inclusion of patients who underwent thyroid lobectomy to remove a hyperfunctioning parathyroid gland.
- Analysis of localization studies, including ultrasonography, for identifying intrathyroidal lesions.
Main Results:
- Twelve percent (32/269) of patients underwent thyroid lobectomy for parathyroid removal.
- Intrathyroidal parathyroid glands were confirmed in 59% (19/32) of these patients.
- Ultrasonography demonstrated high sensitivity (95%) and negative predictive value (99.5%) in detecting intrathyroidal glands, while blind thyroidectomy had a low identification rate (17%).
Conclusions:
- Intrathyroidal parathyroid glands are found in a small percentage (7%) of reoperation cases.
- Ultrasonography is a reliable tool for selecting patients for thyroid resection.
- This imaging modality can minimize the need for blind thyroid lobectomy, thereby reducing potential surgical morbidity.