Screening for Coexistence of Hyperparathyroidism in Patients who are Candidate for Thyroidectomy

Re-exploration of the neck after pervious neck surgery such as thyroidectomy may be too difficult. So diagnosis of coexisting pathologies before the first surgical intervention makes the operation more convenient and decreases morbidity and costs. Thyroid function tests and serum Ca and PTH measurement were done in all patients who were candidate for thyroid surgery in Mashhad University of Medical Sciences from Jan 2004 to Jan 2006.MIBI scan was also performed in those with high Ca or PTH. Parathyroid glands exploration was done during surgery and grossly abnormal glands were sent for pathologic study. Among 150 patients, 20% were male and 80% were female. Cervical mass was seen in 98%, hyperthyroidism signs were reported in 6.7% and dyspnea in 4%. Multinodular goiter (55.4%) and papillary carcinoma (26%) were common pathologies. Parathyroid mass was detected in 5 patients (33%) during surgery which was parathyroid adenoma in 4 cases (80%). In patients with and without parathyroid adenoma, the rate of hypercalcemia were 100% and 95.2%, hypophosphatemia 100% and 97.9%, increased PTH 100% and 30.1%, intraoperative parathyroid mass palpation 100% and 0.7%, and positive parathyroid scan 100% and 30.8% respectively. We suggest that hypercalcemia and hypophosphatemia are not useful indicators for prediction of parathyroid adenoma in patients with thyroid mass but increased PTH, intraoperative parathyroid palpation and parathyroid scan are accurate indicators for prediction of parathyroid adenoma in this regard.