Primary hyperparathyroidism - early diagnosis in patients referred for thyroid surgery

Wahl, R. A.; Hentschel, Franziska; Vorländer, Christian; Schabram, J.

doi:10.1007/s004230000171

Cited by 11 publications

(4 citation statements)

References 11 publications

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“…Our findings demonstrate that MGD was diagnosed in 219 patients, constituting 6% out of all patients being operated on for benign and malignant thyroid lesions at our institution. Furthermore, our study shows that incidental identification of enlarged parathyroid glands is a relatively frequent discovery during thyroid surgery, which is in agreement with other studies demonstrating MGD in 0.2-4.5% of patients (3)(4)(5)(6)(7)(8). It is worth mentioning that Boehm et al suggested radiation exposure to play a certain role as a possible risk factor for the development of hyperparathyroidism as a late adverse effect after the accident at Chernobyl nuclear plant in 1986 (16).…”

Section: Discussionsupporting

confidence: 92%

“…PHPT could be also associated with the multiglandular disease (MGD), which is diagnosed in patients with 2 and more enlarged parathyroid glands. According to data from published series, MGD could be diagnosed as incidental discovery during thyroid surgery in up to 34% of patients to be operated on for benign and malignant thyroid lesions (3)(4)(5)(6)(7)(8)(9). Pathogenesis of MGD and other parathyroid diseases demonstrates various molecular abnormalities, playing role for diagnosis of multiple endocrine neoplasia (MEN) and other hereditary syndromes associated with parathyroid gland lesions (10,11).…”

Section: Introductionmentioning

confidence: 99%

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Multiglandular Parathyroid Gland Disease: an Incidental Discovery in Normocalcemic Patients During Thyroid Surgery

et al. 2017

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Context. Several enlarged parathyroid glands could be found during thyroid surgery in normocalcemic patients without evidence of primary or secondary hyperparathyroidism, indicating multiglandular parathyroid gland disease (MGD). Objective. Clinical role of various levels of serum ionized calcium (Ca 2+) in patients diagnosed with incidental MGD during thyroid surgery remains controversial. The aim of the study was to evaluate the features of PHPT and the clinical role of serum Ca 2+ in normocalcemic patients diagnosed with incidental MGD. Study design. A prospective study of patients with normal preoperative Ca 2+ to be operated on for thyroid diseases in 2010-2013 and diagnosed with MGD during thyroid surgery. Methods. An analysis of clinical data from 3,561 patients to be surgically treated for thyroid diseases revealed 219 (6%) patients with MGD and normal serum Ca 2+. Further data analyses showed patients with MGD and high normal (≥1.25-1.3 mmol/L) serum Ca 2+ (n = 89) and with moderate-low (1.0-1.24 mmol/L) serum Ca 2+ (n = 130). Results. Primary hyperparathyroidism was diagnosed intra-and post-operatively in 48 (54%) patients with high-normal serum Ca 2+ and in 2 (2%) patients with moderate-low serum Ca 2+ (p<0.0001). Parathyroid hormone, serum Ca 2+ as well as urine calcium excretion were elevated in 2 (2%) patients with moderate-low serum Ca 2+ and in 18 (20%) patients with high-normal Ca 2+ at follow-up (p<0.0001). Conclusion. Serum Ca 2+ level within the normal range, but higher than 1.25 mmol/L (high-normal) is associated with primary hyperparathyroidism, which should be considered in patients with visually diagnosed MGD, but without clinical symptoms of hyperparathyroidism.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Multiglandular Parathyroid Gland Disease: an Incidental Discovery in Normocalcemic Patients During Thyroid Surgery

et al. 2017

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“…On the other hand, the coexistence of a non-medullary thyroid carcinoma in patients with primary HPT is unusual, ranging between 2.6% and 6.0% (Burmeister at al. 1997, Sidhu & Campbell 2000, and the prevalence of primary HPT in patients referred for thyroid surgery accounts for only 1% (Wahl et al 2000).…”

Section: Discussionmentioning

confidence: 99%

Hyperfunctioning parathyroid tumours in patients with thyroid nodules. Sensitivity and positive predictive value of high-resolution ultrasonography and 99mTc-sestamibi scintigraphy.

Lumachi¹,

Marzola²,

Zucchetta³

et al. 2003

Endocrine-Related Cancer

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A series of 112 consecutive patients with primary hyperparathyroidism who underwent both high-resolution neck ultrasonography (US) and Tc-pertechnetate subtraction scintigraphy (SS) prior to successful parathyroidectomy was reviewed. There were 29 (25.9%) men and 83 (74.1%) women, with a median age of 58 years (range 13-78 years). Patients were divided into two groups, according to the preoperative US findings: group A (87 patients, 77.7%) without thyroid diseases, and group B (25 patients, 22.3%) with either multinodular goitre or a solitary nontoxic thyroid nodule. In group B patients partial or total thyroidectomy was also performed, according to the intraoperative findings and frozen-section examination results. Final histopathology showed 99 (88.4%) solitary parathyroid (PT) adenomas and 3 (2.7%) PT carcinomas, while 10 (8.9%) patients had a multiglandular disease. The sensitivity and positive predictive value (PPV) were (group A vs group B) 79.8% vs 70.8% (P = 0.25) and 95.7% vs 94.4% (P = 0.58) for US, and 83.3% vs 87.0% (P = 0.47) and 95.9% vs 90.9% (P = 0.32) for SS respectively. Better but similar (P = not significant) results were obtained in patients with solitary PT tumours: 81.5% vs 77.8% (US) and 85.0 vs 94.1% (SS) sensitivity; 97.1% vs 93.3% (US) and 95.8% vs 88.9% (SS) PPV. Overall, the combination of US and SS was 92.9% sensitive (group A = 93.1%, group B = 92.0%; P = 0.55), and the PPV reached 100% in each group. In conclusion, in patients with primary hyperparathyroidism the results of both US and SS are independent of coexistent thyroid disease, especially in patients with solitary PT tumours.

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“…We have previously reported the coexistence of thyroiditis and thyroid nodules with parathyroid disorders [4,5] and the development of PHPT after radioactive iodine-131 (RAI) treatment for Graves' hyperthyroidism [6,7]. Wahl et al [8] found that the prevalence of PHPT was about 1% among 5450 patients referred for thyroid surgery, which can create a challenge in the clinical decision making and management of these patients. It is optimal to deal with both problems in one operative procedure if surgery is required [1].…”

Section: Introductionmentioning

confidence: 99%

Hypercalcemia Caused By Concomitant Graves g Disease and Primary Hyperparathyroidism

Wang

2018

JETR

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Here, we present the clinical course, laboratory results and management and review pertinent literature for a rare case of concomitant Graves' disease and primary hyperparathyroidism associated with hypercalcemia. A 71 years old African American woman presented with generalized fatigue, polyuria, polydipsia, and poor appetite for a few weeks. On admission, laboratory values showed serum calcium level of 12.3mg/dL, albumin of 3.6g/dL, iPTH of 37pg/mL, PTH related peptide of 0.2pmol/L, 25(OH) vitamin D of 65ng/mL, TSH of 0.01uIU/mL, and free T4 of 7.1ng/dL. I-123 uptake and scan of the thyroid showed 44% homogeneous uptake at 24 hours. The patient was initially diagnosed with hypercalcemia related to hyperthyroidism. She received intravenous hydration and was treated with 25.9mCi of I-131 2 months later. The serum calcium remained 10.4-10.7mg/ dL (range, 8.6-10.4mg/dL) after freeT4 normalized to 1.58ng/dL. Repeat labs revealed serum ionized calcium of 5.9mg/dL, iPTH of 65pg/mL and 24-hour urinary calcium of 166.4mg, which is consistent with primary hyperparathyroidism. Hypercalcemia in Graves' hyperthyroidism should warrant a thorough investigation for concomitant primary hyperparathyroidism.

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Primary hyperparathyroidism - early diagnosis in patients referred for thyroid surgery

Cited by 11 publications

References 11 publications

Multiglandular Parathyroid Gland Disease: an Incidental Discovery in Normocalcemic Patients During Thyroid Surgery

Multiglandular Parathyroid Gland Disease: an Incidental Discovery in Normocalcemic Patients During Thyroid Surgery

Hyperfunctioning parathyroid tumours in patients with thyroid nodules. Sensitivity and positive predictive value of high-resolution ultrasonography and 99mTc-sestamibi scintigraphy.

Hypercalcemia Caused By Concomitant Graves g Disease and Primary Hyperparathyroidism

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