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Ultrasonography of the neck may reveal thyroid nodules including cancers in patients with primary hyperparathyroidism
The background of the study. Many patients with primary hyperparathyroidism, usually caused by a benign parathyroid tumor, are now treated by minimally invasive parathyroidectomy rather than extensive neck exploration. In this study, patients with primary hyperparathyroidism were evaluated preoperatively by thyroid ultrasonography to determine the frequency of concomitant thyroid nodules.
How the study was done. The study subjects were 85 patients with primary hyperparathyroidism caused by parathyroid adenomas. Ultrasonography and technetium-99m sestamibi scanning of the neck region were done in all patients; these tests revealed parathyroid adenomas in nearly all patients.
The results of the study. Preoperative neck ultrasonography revealed thyroid nodules in 21 patients (25 percent). The nodules were malignant in 9 patients (11 percent); 7 patients had a papillary cancer, 1 a follicular cancer, and 1 a lymphoma. The cancers ranged from 0.5 to 8.0 cm in longest dimension. The nodule was benign in 12 patients (14 percent); 5 of these had an adenoma and 7 a multinodular goiter. All diagnoses were confirmed by pathological examination of the nodule.
The conclusions of the study. In patients with primary hyperparathyroidism, ultrasonography of the neck before surgery may not only localize a parathyroid adenoma, but also may reveal thyroid nodules that should be biopsied before parathyroid surgery is performed.
The original article. Ogawa T, Kammori M, Tsuji E, Kanauchi H, Kurabayashi R, Terada K, Mimura Y, Kaminishi M. Preoperative evaluation of thyroid pathology in patients with primary hyperparathyroidism. Thyroid 2007;17:59-62.
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