Category: Calcium/Bone Disorders
Purpose : To evaluate rates of coexisting thyroid disease in patients undergoing parathyroidectomy (PTX).
Coexisting thyroid pathology in patients undergoing PTX can lead to complexity in operative planning and it can lead to unnecessary thyroidectomy reoperations or incomplete surgery. This can also alter surgical plans and increase complexity of a PTX. Preoperative localization studies such as ultrasounds, CT, Sestamibi scans with or without CT can play a role in avoiding these pitfalls. In the era of minimally invasive PTX without routine bilateral neck exploration there is increased potential of missed thyroid pathology.
This is a retrospective analysis of a prospectively maintained database of 2074 patients undergoing PTX at a single tertiary care referral center between 1993-2017. Fisher-exact test was used to compare categorical data.
Overall, coexisting thyroid pathology was identified in 41% of patients (n=882). 14.4% (127/882) of patients had thyroid cancer. Ultrasound, and Sestamibi with CT identified coexisting thyroid pathology in 38.3 % (435/1134) and 28.1 % (497/1774) of patients, respectively. 22% of patients (n=470) underwent a concomitant thyroidectomy while undergoing a PTX. The rate of concomitant thyroidectomy was lower in patients who had a preoperative ultrasound 11.8% vs. 28%, p-value = 0.021. Unexpected thyroid pathology, first encountered during PTX, required thyroidectomy in 11.3% (230/2074) of patients. y.
Discussion : Concomitant thyroid pathology can be a pitfall in patients undergoing parathyroidectomy and present as challenge for the surgeon. Thyroid pathology is more common in patients with hyperparathyroidism than the general population. Appropriate preoperative thyroid ultrasound and management of identified thyroid nodules must be performed prior to pursuing a parathyroidectomy.
Thyroid pathology coexists in a substantial number of patients and can present as an unexpected finding during PTX. Thyroid ultrasonography is a necessary adjunct in preparation for a PTX to avoid missing thyroid cancer.
Raja Kumaran Rajamanickam– Student Researcher, Emory University School of Medicine, Atlanta, GA, Cumming, Georgia
Neil Saunders– Assistant Professor, Emory University, Atlanta, Georgia
Snehal Patel– Assistant Professor, Emory University, Atlanta, Georgia
Collin Weber– Professor, Emory University, Atlanta, Georgia
Jyotirmay Sharma– Associate Professor, Emory University, Atlanta, Georgia
Emory University School of Medicine, Atlanta, GA
Born on August 14th 1992 in a small town in South India, I grew up pampered by the constant love and support of my parents and three charming sisters. I finished my schooling in my hometown-Tirupattur and worked really hard to get into the most prestigious Medical School in my state - the Madras Medical College. I graduated from Madras Medical College in September 2017. My passion is to become a renowned surgeon. I was the recipient of 2 Gold medals in Surgery in my med school. I was humbled to receive 4 months of hands on clinical experience here in the United States at Icahn School of Medicine at Mount Sinai, New York and at Brigham and Women's Hospital, Boston. Those experiences made my roots of desire of laying the foundations for my surgical career here in the United States go really deep. Got really good scores in my USMLE steps and got ECFMG certified. Currently I am working as a student researcher at Emory University School of Medicine, Atlanta under the mentorship of Dr.Jyotirmay Sharma in the Department of Surgery. I am participating in this year's Match (MATCH 2019) and hope to get placed in a really good general surgery program to kick start my surgical career.
Dr Saunders is an Endocrine Surgeon and he did his fellowship in Surgical Oncology at Ohio State University. His research interests are in thyroid cancer and parathyroid disease.
Dr Patel is an Endocrine Surgeon trained at Emory and University of Pittsburg and has research interests in Thyroid cancer genomics, parathyroid disease and islet cell tumors.
Dr Weber has practiced Endocrine Surgery for over 30 years and performed research in the areas of islet cell transplantation, thyroid cancer and hyperparathyroidism.