PDF icon Download PDF
Horm Metab Res 2016; 48(10): 673-676
DOI: 10.1055/s-0042-115645
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Screening for Hyperparathyroidism by Measurement of Calcium in Patients Undergoing Thyroid Surgery: A Prospective Study

P. W. Rosário
1   Postgraduate Program, Santa Casa de Belo Horizonte, Minas Gerais, Brazil and Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
,
G. F. Mourão
1   Postgraduate Program, Santa Casa de Belo Horizonte, Minas Gerais, Brazil and Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
,
M. R. Calsolari
1   Postgraduate Program, Santa Casa de Belo Horizonte, Minas Gerais, Brazil and Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
› Author Affiliations
Further Information

Publication History

received 04 November 2015

accepted 08 August 2016

Publication Date:
02 September 2016 (online)

Also available ateRef
   Permissions and Reprints
Preview

Abstract

This study screened for asymptomatic primary hyperparathyroidism (PHPT) by measuring calcium (Ca) before thyroid surgery. The study was prospective. A total of 676 patients without a suspicion of PHPT were studied. PHPT was defined as elevated Ca (in 2 measurements) in the presence of PTH>25 pg/ml and in the absence of hypocalciuria. PHPT was diagnosed in 5 patients (0.74%), all of them women. One of the 5 patients with PHPT had no indication for parathyroidectomy (PTx) according to current guidelines. Parathyroid adenoma was easily identified during perioperative assessment of thyroid surgery in 3 patients. In the other 2 patients (0.3%), localization of the adenoma required specific exploration, which was only performed because of the preoperative diagnosis of PHPT. Normalization of Ca and PTH was achieved in all 5 patients. In conclusion, in patients without a clinical or ultrasonographic suspicion of PHPT, approximately 300 individuals should be screened before thyroid surgery to avoid one reoperation (PTx) due to PHPT, which does not seem to be cost-effective.

Key words

calcium - primary hyperparathyroidism - thyroidectomy
 

  • References

  • 1 Katz AD, Kong LB. Incidental preclinical hyperparathyroidism identified during thyroid operations. Am Surg 1992; 58: 747-749
    PubMedSearch in Google Scholar
  • 2 Sianesi M, Del Rio P, Arcuri MF, Iapichino G, Giuseppe R. Hyperparathyroidism associated with thyroid pathology. Am J Surg 2003; 185: 58-60
    CrossrefPubMedSearch in Google Scholar
  • 3 Del Rio P, Arcuri MF, Bezer L, Cataldo S, Robuschi G, Sianesi M. Association between primary hyperparathyroidism and thyroid disease. Role of preoperative PTH. Ann Ital Chir 2009; 80: 435-438
    PubMedSearch in Google Scholar
  • 4 Benabbad I, Chraibi A, Iraqi H, Serji B, Mohsine R, Ifrine L, Belkouchi A, Bonnichon P, El Malki HO. Parathyroid incidentaloma. Literature review about three case reports. Ann Endocrinol (Paris) 2011; 72: 30-33
    CrossrefPubMedSearch in Google Scholar
  • 5 Musholt TJ, Clerici T, Dralle H, Frilling A, Goretzki PE, Hermann MM, Kussmann J, Lorenz K, Nies C, Schabram J, Schabram P, Scheuba C, Simon D, Steinmüller T, Trupka AW, Wahl RA, Zielke A, Bockisch A, Karges W, Luster M, Schmid KW. German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg 2011; 396: 639-649
    CrossrefPubMedSearch in Google Scholar
  • 6 Murray SE, Sippel RS, Chen H. Incidence of concomitant hyperparathyroidism in patients with thyroid disease requiring surgery. J Surg Res 2012; 178: 264-267
    CrossrefPubMedSearch in Google Scholar
  • 7 Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kußmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Mühlenberg R, Schober O, Rimmele H, Machens A. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 2013; 398: 347-375
    CrossrefPubMedSearch in Google Scholar
  • 8 Denizot A, Dadoun F, Meyer-Dutour A, Alliot P, Argème M. Screening for primary hyperparathyroidism before thyroid surgery: A prospective study. Surgery 2002; 131: 264-269
    CrossrefPubMedSearch in Google Scholar
  • 9 Rosario PW, Ward LS, Carvalho GA, Graf H, Maciel RM, Maciel LM, Maia AL, Vaisman M. Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus. Arq Bras Endocrinol Metabol 2013; 57: 240-264
    CrossrefPubMedSearch in Google Scholar
  • 10 Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard BaG, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 (Suppl. 01) 1-122
    PubMedSearch in Google Scholar
  • 11 Haugen BR, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, Pacini F, Randolph G, Sawka A, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward D, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26: 1-133
    CrossrefPubMedSearch in Google Scholar
  • 12 NCCN National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Thyroid Carcinoma Version 2 2015 www.nccn.org
    PubMedSearch in Google Scholar
  • 13 Bilezikian JP. Primary hyperparathyroidism. Endocr Pract 2012; 18: 781-790
    CrossrefPubMedSearch in Google Scholar
  • 14 Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts Jr JT. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99: 3561-3569
    CrossrefPubMedSearch in Google Scholar
  • 15 Cusano NE, Bilezikian JP. Parathyroid hormone in the evaluation of hypercalcemia. JAMA 2014; 312: 2680-2681
    CrossrefPubMedSearch in Google Scholar
  • 16 Mischis-Troussard C, Goudet P, Verges B, Cougard P, Tavernier C, Maillefert JF. Primary hyperparathyroidism with normal serum intact parathyroid hormone levels. QJM 2000; 93: 365-367
    CrossrefPubMedSearch in Google Scholar
  • 17 Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-470
    CrossrefPubMedSearch in Google Scholar
  • 18 Ghervan C, Silaghi A, Nemeş C. Parathyroid incidentaloma detected during thyroid sonography - prevalence and significance beyond images. Med Ultrason 2012; 14: 187-189
    PubMedSearch in Google Scholar
  • 19 Ong GS, Walsh JP, Stuckey BG, Brown SJ, Rossi E, Ng JL, Nguyen HH, Kent GN, Lim EM. The importance of measuring ionized calcium in characterizing calcium status and diagnosing primary hyperparathyroidism. J Clin Endocrinol Metab 2012; 97: 3138-3145
    CrossrefPubMedSearch in Google Scholar
  • 20 Niedźwiecki S, Kuzdak K, Kaczka K, Pomorski L. Normocalcemic, subclinical, asymptomatic primary hyperparathyroidism in patients with goiter or papillary thyroid cancer - preliminary report. Normocalcemic primary hyperparathyroidism and thyroid pathology. Wiad Lek 2007; 60: 228-230
    PubMedSearch in Google Scholar
  • 21 Lundgren E, Rastad J, Thrufjell E, Akerström G, Ljunghall S. Population-based screening for primary hyperparathyroidism with serum calcium and parathyroid hormone values in menopausal women. Surgery 1997; 121: 287-294
    CrossrefPubMedSearch in Google Scholar
  • 22 Carnaille BM, Pattou NF, Oudar C, Lecomte-Houcke M, Rocha J, Proye C. Parathyroid incidentalomas in normocalcemic patients during thyroid surgery. World J Surg 1996; 20: 830-834
    CrossrefPubMedSearch in Google Scholar
  • 23 Kadowaki MH, Fulton N, Schark C, Ryan JW, Yousefzadeh DK, Fedorak I, Kaplan EL. Difficulties of parathyroidectomy after previous thyroidectomy. Surgery 1989; 106: 1018-1023
    PubMedSearch in Google Scholar
  • 24 Profanter C, Klingler A, Strolz S, Wetscher GJ, Prommegger R, Bodner E, Riccabona G. Surgical therapy for primary hyperparathyroidism in patients with previous thyroid surgery. Am J Surg 1999; 178: 374-376
    CrossrefPubMedSearch in Google Scholar
  • 25 Wells Jr. SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. Revised american thyroid association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015; 25: 567-610
    CrossrefPubMedSearch in Google Scholar