Association between primary hyperparathyroidism and thyroid disease. Role of preoperative PTH

Abstract

BACKGROUND: The association between patients with surgically treatable thyroid disease and patients affected by PHPT is not just accidental.

MATERIALS: We report 591 patients who underwent total thyroidectomy in our center. Data, collected during the preoperative period according to our protocol for candidates to total thyroidectomy, included: type of thyroid disease, sex, age, type of surgical procedure, preoperative PTH and plasmatic calcium level. Calcium plasmatic level has been monitored at 24 hours after surgery, on day 6 and monthly for 6 months.

RESULTS: On 591 cases, PTH above the normal range were present in 19.1% (113 patients), all asymptomatic for PHPT. 30 were males (26.6%) and 83 females (73.4%), with a mean age of 62.97 ± 12.51 years and 57.38 ± 15.09 years ( p=0.19). The mean preoperative PTH and calcium plasmatic level were 104.4 ± 21.96 pg/ml and 119.7 ± 37.93 pg/ml (p=0.39) and 9.21 ± 0.59 mg/dL e 9.37 ± 0.87 mg/dl (p=0.45) respectively. Intraoperative exploration proved a pathological parathyroid gland in 12 on 113 cases. In 9 of the 12 patients with parathyroid adenoma, hypocalcaemia developed. It resolved in 7 days for 4 patients and within 30 days for the others. No hypocalcaemia has been recorded at a 6 months follow up for the 97 considered (4 were lost at follow up).

CONCLUSION: Preoperative PTH measurement for all patients undergoing total thyroidectomy may offer a concrete tool to screen and identify the above-described category of patients, with no additional cost for further radiological investigations, because this class of patients will be submitted to bilateral cervical exploration associated with a total thyroidectomy.