Screening for primary hyperparathyroidism before thyroid surgery: A prospective study

Denizot, A.; Dadoun, F.; Meyer-Dutour, A; Alliot, Patrick; Argème, Maxime

doi:10.1067/msy.2002.121379

Cited by 6 publications

(14 citation statements)

References 17 publications

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“…PTx is underused in the management of PHPT in individuals aged 75 and older. 33 PTx is as efficient and safe in older as in younger individuals, so it can be safely proposed to individuals with PHPT whatever their age, avoiding progressive decrease in bone mineral density, long-term surveillance, risk of evolution toward acute hypercalcemia, and possible adverse events of medical treatment for hypercalcemia, but a careful preoperative geriatric assessment should be performed to evaluate the benefits and risks of PTx and to determine eligibility for surgery. 2 The indication for PTx was defined in the 2008 National Institutes of Health Consensus Conference, 26 although medical surveillance may be proposed in asymptomatic or paucisymptomatic older adults with serum calcium levels lower than 2.75 mmol/L, urinary calcium lower than 400 mg/d or 10 mmol/L, normal creatinine clearance and an osteodensitometric T score above À2.5 SD.…”

Section: Discussionmentioning

confidence: 99%

“…28 Routine serum calcium measurement before thyroid surgery has been associated with the detection of PHPT in 10.1% of older and 16.3% of younger individuals. 33 PTx is as efficient and safe in older as in younger individuals, so it can be safely proposed to individuals with PHPT whatever their age, avoiding progressive decrease in bone mineral density, long-term surveillance, risk of evolution toward acute hypercalcemia, and possible adverse events of medical treatment for hypercalcemia, but a careful preoperative geriatric assessment should be performed to evaluate the benefits and risks of PTx and to determine eligibility for surgery. Thyroid lesions frequently coexist with PHPT and may be treated during the same surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of Primary Hyperparathyroidism in Older Adults

Denizot¹,

Grino

Oliver³

2014

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Management of Primary Hyperparathyroidism in Older Adults

Denizot¹,

Grino

Oliver³

2014

J American Geriatrics Society

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“…The 4 parathyroid glands were fully explored in patients with elevated PTH. The exploration was considered complete when either the 4 glands had been seen or when at least one enlarged and one normal parathyroid gland had been identified [16,18]. Parathyroid glands were examined based on their macroscopic appearance.…”

Section: Parathyroidectomymentioning

confidence: 99%

Normocalcemic Primary Hyperparathyroidism in Adults Without a History of Nephrolithiasis or Fractures: A Prospective Study

Rosário

Calsolari

2019

Horm Metab Res

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The prevalence and the diagnostic criterion of “normocalcemic” primary hyperparathyroidism (NPHPT) are still uncertain and there is no consensual definition. This prospective study evaluated the prevalence of NPHPT in 676 adults without a history of fractures or nephrolithiasis and who would be submitted to thyroidectomy, the impact of adopting different cut-off values for 25-hydroxyvitamin D and estimated glomerular filtration rate (eGFR), and the agreement between biochemical diagnosis and the surgical finding of altered parathyroid glands. NPHPT was diagnosed in patients with normal total and ionized calcium and elevated PTH (in 2 measurements) and without a known cause of secondary HPT, including eGFR<40 ml/min/1.73 m2 and 25-hydroxyvitamin D<20 ng/dl. The 4 parathyroid glands were fully explored in these patients. Forty-six patients (6.8%) had a laboratory diagnosis of NPHPT. Altered parathyroid glands were detected in only 4 patients, corresponding to 0.6% of all patients and to 8.7% of those with a biochemical diagnosis of NPHPT. The latter was confirmed in 0/174 men, 1/252 premenopausal women, and 3/250 postmenopausal women. Among the 42 patients with elevated PTH and without altered parathyroid glands, 25 had 25-hydroxyvitamin D between 20 and 30 ng/dl, 7 had eGFR between 40 and 60 ml/min/1.73 m2, and 9 had both. The prevalence of NPHPT was 0.74% in this adult population without a history of nephrolithiasis or fractures. The diagnostic criterion using eGFR>60 ml/min/1.73 m2 and 25-hydroxyvitamin D>30 ng/dl was more appropriate considering the agreement with the surgical finding of altered parathyroid glands.

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“…Of these, one-third needed specific dissection to find the abnormal gland, and it was deemed that these glands would have been missed at “routine” surgery. However, of the 739 patients who had negative screens, 12 were found to have “incidentalomas” and two patients had a missed diagnosis of primary hyperparathyroid disease discovered postoperatively [9]. …”

Section: Screeningmentioning

confidence: 99%

Incidental Parathyroid Disease during Thyroid Surgery: Should We Remove Them?

2011

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Aim. Despite an incidence of parathyroid “incidentalomas” of 0.2%–4.5%, only approximately 135 cases have been reported in the literature. We present eight patients in whom an incidental abnormal parathyroid gland was found during routine thyroid surgery. We have reviewed the literature and postulate whether these glands could represent further evidence of a preclinical stage of primary hyperparathyroidism. Methods. A retrospective analysis of all 236 thyroid operations performed by a single surgeon was performed to identify patients in whom abnormal parathyroid tissue was removed at surgery. Results. 8/236 patients (3.39%) had a single macroscopically abnormal parathyroid gland removed and sent for analysis. Seven patients were found to have histological evidence of a parathyroid adenoma or hyperplasia. None of the patients had abnormal serum calcium detected preoperatively. Postoperatively, four patients had normal calcium, three had temporary hypocalcaemia and one refused followup. No patients had recurrent laryngeal nerve impairment. Conclusions. Despite the risk of removing a histologically normal gland, we believe that when parathyroid “incidentalomas” are found during surgery they should be excised and sent for histological analysis. We have found this to be a safe procedure with minimal morbidity to the patient. As the natural history of primary hyperparathyroidism is better understood, these glands found in normocalcaemic patients may in fact represent the early or preclinical phase of the disease. By removing them at the original operation, the patient is saved redo neck surgery with its high complication rate as or when clinically apparent primary hyperparthryoidism develops in the future.

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Screening for primary hyperparathyroidism before thyroid surgery: A prospective study

Cited by 6 publications

References 17 publications

Surgical Management of Primary Hyperparathyroidism in Older Adults

Surgical Management of Primary Hyperparathyroidism in Older Adults

Normocalcemic Primary Hyperparathyroidism in Adults Without a History of Nephrolithiasis or Fractures: A Prospective Study

Incidental Parathyroid Disease during Thyroid Surgery: Should We Remove Them?

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