Diagnosis and Treatment for Primary Hyperparathyroidism with Concomitant Thyroid Diseases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SU Lei ,  WANG Xuechen , YAO Yongzhong , SANG Jianfeng.

Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China;

Corresponding author：

WANG Xuechen, Email: wxcglyy@sohu.com

Keywords：

Parathyroid gland; Parathyroid adenoma; Primary hyperparathyroidism; Thyroid; Papillary carcinoma

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Objective To investigate the clinical diagnosis and treatment for primary hyperparathyroidism with concomitant thyroid diseases. Methods The clinical data of 40 cases diagnosed as primary hyperparathyroidism with concomitant thyroid diseases including manifestation, preoperative qualitation and localization, and surgical treatment and results were retrospectively analyzed. Results The 40 cases were composed of 4 parathyroid adenomas with thyroid papillary carcinomas, 28 parathyroid adenomas with nodular goiters, 6 parathyroid adenomas with thyroid adenomas, 1 parathyroid hyperplasia with nodular goiter, and 1 parathyroid carcinoma with thyroid adenoma. The diagnostic sensitivities of localization for primary hyperparathyroidism with concomitant thyroid diseases by ultrasound, by computerized tomography (CT), and by radioisotope (99Tcm) scanning were 82.5% (33/40), 80.0% (32/40) and 90.0% (36/40), respectively, and the combined sensitivity was 97.5% (39/40). The surgical treatments included resection of parathyroid adenoma with subtotal thyroidectomy in 34 cases, resection of parathyroid adenoma with total thyroidectomy in 3 cases, bilateral exploration of parathyroid with subtotal thyroidectomy in 1 case, and unilateral parathyroidectomy with thyroidectomy and neck lymphonodes clearance in 2 cases. Conclusion
For primary hyperparathyroidism with concomitant thyroid diseases, the sensitivity of preoperative localization could be raised by combining ultrasound, CT with radioisotope scanning, and surgical resection is the main treatment, which includes the main operation of resection of parathyroid adenoma with subtotal or total thyroidectomy.

Citation： SU Lei,WANG Xuechen,YAO Yongzhong,SANG Jianfeng.. Diagnosis and Treatment for Primary Hyperparathyroidism with Concomitant Thyroid Diseases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(12): 1290-1293. doi: Copy

1.	李志辉, 朱精强, 魏涛, 等. 甲状旁腺在人体中的分布特点及临床意义(附50 例解剖研究报告) [J]. 中国普外基础与临床杂志, 2008; 15(5): 311-313, 317.
2.	Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: A highly sensitive diagnostic tool for localization of parathyroid adenomas [J]. Surgery, 2000; 128(1): 29-35.
3.	周建平, 李昱骥, 董明芳. 原发性甲状旁腺功能亢进的定位诊断 [J]. 中华普通外科杂志, 2005; 20(4): 227-228.
4.	王旭东, 吴延升, 张文超. 42例甲状旁腺肿瘤的诊断及外科治疗分析 [J]. 中国肿瘤临床, 2007; 34(11): 636-639.
5.	解乃昌, 林进令, 陆云飞. 18例原发性甲状旁腺功能亢进症的诊治分析 [J]. 中国普外基础与临床杂志, 2007; 14(1): 87-88.
6.	Saint Marc O, Cogliandolo A, Pidoto RR, et al. Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia [J]. Am J Surg, 2004; 187(3): 388-393.
7.	王茜, 高伯山, 秦淑玲. MRI及99Tcm-MIBI显像对甲状旁腺机能亢进症的诊断价值 [J]. 中华核医学杂志, 2002; 22(1): 28-30.
8.	田雨霖. 原发性甲状旁腺功能亢进症的诊断与外科治疗 [J]. 中国实用外科杂志, 2008; 28(3): 221-223.
9.	Chen H, Pruhs Z, Starling JR, et al. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy [J]. Surgery, 2005; 138(4): 583-587.
10.	陈瑞新, 郑泽霖. 内镜下甲状腺、甲状旁腺切除手术 [J]. 中国普外基础与临床杂志, 2001; 8(5): 353-354.
11.	Baliski CR, Stewart JK, Anderson DW, et al. Selective unilateral parathyroid exploration: an effective treatment for primary hyperparathyroidism [J]. Am J Surg, 2005; 189(5): 596-600.
12.	Bergenfelz A, Kanngiesser V, Zielke A, et al. Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism [J]. Br J Surg, 2005; 92(2): 190-197.
13.	Riss P, Kaczirek K, Heinz G, et al. A “defined baseline” in PTH monitoring increases surgical success in patients with multiple gland disease [J]. Surgery, 2007; 142(3): 398-404.
14.	Goldstein RE, Carter WM 2nd, Fleming M, et al. Unilateral cervical surgical exploration aided by intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism and equivocal sestamibi scan results [J]. Arch Surg, 2006; 141(6): 552-557.
15.	杨志强, 朱理玮, 王鹏志. 48例甲状旁腺腺瘤和腺癌的临床分析 [J]. 中华肿瘤杂志, 2006; 28(8): 625-627.
16.	Inabnet WB. Intraoperative parathyroid hormone monitoring [J]. World J Surg, 2004; 28(12): 1212-1215.
17.	朱预. 原发性甲状旁腺功能亢进症的治疗 [J]. 中国普外基础与临床杂志, 2004; 11(6): 477-478.
18.	Hundahl SA, Fleming ID, Fremgen AM, et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society [J]. Cancer, 1999; 86(3): 538-544.

1. 李志辉, 朱精强, 魏涛, 等. 甲状旁腺在人体中的分布特点及临床意义(附50 例解剖研究报告) [J]. 中国普外基础与临床杂志, 2008; 15(5): 311-313, 317.
2. Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: A highly sensitive diagnostic tool for localization of parathyroid adenomas [J]. Surgery, 2000; 128(1): 29-35.
3. 周建平, 李昱骥, 董明芳. 原发性甲状旁腺功能亢进的定位诊断 [J]. 中华普通外科杂志, 2005; 20(4): 227-228.
4. 王旭东, 吴延升, 张文超. 42例甲状旁腺肿瘤的诊断及外科治疗分析 [J]. 中国肿瘤临床, 2007; 34(11): 636-639.
5. 解乃昌, 林进令, 陆云飞. 18例原发性甲状旁腺功能亢进症的诊治分析 [J]. 中国普外基础与临床杂志, 2007; 14(1): 87-88.
6. Saint Marc O, Cogliandolo A, Pidoto RR, et al. Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia [J]. Am J Surg, 2004; 187(3): 388-393.
7. 王茜, 高伯山, 秦淑玲. MRI及99Tcm-MIBI显像对甲状旁腺机能亢进症的诊断价值 [J]. 中华核医学杂志, 2002; 22(1): 28-30.
8. 田雨霖. 原发性甲状旁腺功能亢进症的诊断与外科治疗 [J]. 中国实用外科杂志, 2008; 28(3): 221-223.
9. Chen H, Pruhs Z, Starling JR, et al. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy [J]. Surgery, 2005; 138(4): 583-587.
10. 陈瑞新, 郑泽霖. 内镜下甲状腺、甲状旁腺切除手术 [J]. 中国普外基础与临床杂志, 2001; 8(5): 353-354.
11. Baliski CR, Stewart JK, Anderson DW, et al. Selective unilateral parathyroid exploration: an effective treatment for primary hyperparathyroidism [J]. Am J Surg, 2005; 189(5): 596-600.
12. Bergenfelz A, Kanngiesser V, Zielke A, et al. Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism [J]. Br J Surg, 2005; 92(2): 190-197.
13. Riss P, Kaczirek K, Heinz G, et al. A “defined baseline” in PTH monitoring increases surgical success in patients with multiple gland disease [J]. Surgery, 2007; 142(3): 398-404.
14. Goldstein RE, Carter WM 2nd, Fleming M, et al. Unilateral cervical surgical exploration aided by intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism and equivocal sestamibi scan results [J]. Arch Surg, 2006; 141(6): 552-557.
15. 杨志强, 朱理玮, 王鹏志. 48例甲状旁腺腺瘤和腺癌的临床分析 [J]. 中华肿瘤杂志, 2006; 28(8): 625-627.
16. Inabnet WB. Intraoperative parathyroid hormone monitoring [J]. World J Surg, 2004; 28(12): 1212-1215.
17. 朱预. 原发性甲状旁腺功能亢进症的治疗 [J]. 中国普外基础与临床杂志, 2004; 11(6): 477-478.
18. Hundahl SA, Fleming ID, Fremgen AM, et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society [J]. Cancer, 1999; 86(3): 538-544.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment for Primary Hyperparathyroidism with Concomitant Thyroid Diseases

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