The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism

Steven K. Libutti, David L. Bartlett, Nora T. Jaskowiak, Monica Skarulis, Stephen J. Marx, Allen M. Spiegel, Douglas L. Fraker, John L. Doppman, Thomas J. Shawker, H. Richard Alexander

Research output: Contribution to journalArticle

Abstract

Background. The role of 'blind' thyroid lobectomy in the surgical management of patients with persistent or recurrent primary hyperparathyroidism is not known. We reviewed our experience with reoperation for hyperparathyroidism to determine the utility of blind thyroid resection in this setting. Methods. From 1982 to 1995, 269 patients underwent reoperation for hyperparathyroidism at our institution. All patients had biochemical confirmation of hyperparathyroidism and underwent noninvasive and if necessary invasive localization studies. Patients who underwent thyroid lobectomy in an attempt to extirpate the hyperfunctioning parathyroid gland form the basis of this report. Results. Thirty-two of 269 patients (12%) underwent thyroid lobectomy to remove a parathyroid gland. Intrathyroidal parathyroids were confirmed in 19 of 32 patients (59 %). In 18 of 19 patients (94 %), preoperative or intraoperative ultrasonography correctly identified an intrathyroidal lesion suspicious for a parathyroid. Only 1 of 6 patients (17%) undergoing a blind thyroidectomy had an intrathyroidal gland identified. Ultrasonography had a sensitivity of 95 % and a negative predictive value of 99.5 % in detecting an intrathyroidal parathyroid gland. Conclusions. The prevalence of an intrathyroidal parathyroid gland in our series is low (19 of 269, 7%). Ultrasonography can be used reliably to select patients for thyroid resection, reducing the need to perform a blind thyroid lobectomy and avoiding the potential morbidity of thyroid resection in this clinical setting.

Original languageEnglish (US)
Pages (from-to)1183-1188
Number of pages6
JournalSurgery
Volume122
Issue number6
DOIs
StatePublished - Dec 1997

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Hyperparathyroidism
Reoperation
Thyroid Gland
Parathyroid Glands
Ultrasonography
Primary Hyperparathyroidism
Thyroidectomy
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Libutti, S. K., Bartlett, D. L., Jaskowiak, N. T., Skarulis, M., Marx, S. J., Spiegel, A. M., ... Alexander, H. R. (1997). The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism. Surgery, 122(6), 1183-1188. https://doi.org/10.1016/S0039-6060(97)90225-7
Libutti, Steven K. ; Bartlett, David L. ; Jaskowiak, Nora T. ; Skarulis, Monica ; Marx, Stephen J. ; Spiegel, Allen M. ; Fraker, Douglas L. ; Doppman, John L. ; Shawker, Thomas J. ; Alexander, H. Richard. / The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism. In: Surgery. 1997 ; Vol. 122, No. 6. pp. 1183-1188.
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title = "The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism",
abstract = "Background. The role of 'blind' thyroid lobectomy in the surgical management of patients with persistent or recurrent primary hyperparathyroidism is not known. We reviewed our experience with reoperation for hyperparathyroidism to determine the utility of blind thyroid resection in this setting. Methods. From 1982 to 1995, 269 patients underwent reoperation for hyperparathyroidism at our institution. All patients had biochemical confirmation of hyperparathyroidism and underwent noninvasive and if necessary invasive localization studies. Patients who underwent thyroid lobectomy in an attempt to extirpate the hyperfunctioning parathyroid gland form the basis of this report. Results. Thirty-two of 269 patients (12{\%}) underwent thyroid lobectomy to remove a parathyroid gland. Intrathyroidal parathyroids were confirmed in 19 of 32 patients (59 {\%}). In 18 of 19 patients (94 {\%}), preoperative or intraoperative ultrasonography correctly identified an intrathyroidal lesion suspicious for a parathyroid. Only 1 of 6 patients (17{\%}) undergoing a blind thyroidectomy had an intrathyroidal gland identified. Ultrasonography had a sensitivity of 95 {\%} and a negative predictive value of 99.5 {\%} in detecting an intrathyroidal parathyroid gland. Conclusions. The prevalence of an intrathyroidal parathyroid gland in our series is low (19 of 269, 7{\%}). Ultrasonography can be used reliably to select patients for thyroid resection, reducing the need to perform a blind thyroid lobectomy and avoiding the potential morbidity of thyroid resection in this clinical setting.",
author = "Libutti, {Steven K.} and Bartlett, {David L.} and Jaskowiak, {Nora T.} and Monica Skarulis and Marx, {Stephen J.} and Spiegel, {Allen M.} and Fraker, {Douglas L.} and Doppman, {John L.} and Shawker, {Thomas J.} and Alexander, {H. Richard}",
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Libutti, SK, Bartlett, DL, Jaskowiak, NT, Skarulis, M, Marx, SJ, Spiegel, AM, Fraker, DL, Doppman, JL, Shawker, TJ & Alexander, HR 1997, 'The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism', Surgery, vol. 122, no. 6, pp. 1183-1188. https://doi.org/10.1016/S0039-6060(97)90225-7

The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism. / Libutti, Steven K.; Bartlett, David L.; Jaskowiak, Nora T.; Skarulis, Monica; Marx, Stephen J.; Spiegel, Allen M.; Fraker, Douglas L.; Doppman, John L.; Shawker, Thomas J.; Alexander, H. Richard.

In: Surgery, Vol. 122, No. 6, 12.1997, p. 1183-1188.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism

AU - Libutti, Steven K.

AU - Bartlett, David L.

AU - Jaskowiak, Nora T.

AU - Skarulis, Monica

AU - Marx, Stephen J.

AU - Spiegel, Allen M.

AU - Fraker, Douglas L.

AU - Doppman, John L.

AU - Shawker, Thomas J.

AU - Alexander, H. Richard

PY - 1997/12

Y1 - 1997/12

N2 - Background. The role of 'blind' thyroid lobectomy in the surgical management of patients with persistent or recurrent primary hyperparathyroidism is not known. We reviewed our experience with reoperation for hyperparathyroidism to determine the utility of blind thyroid resection in this setting. Methods. From 1982 to 1995, 269 patients underwent reoperation for hyperparathyroidism at our institution. All patients had biochemical confirmation of hyperparathyroidism and underwent noninvasive and if necessary invasive localization studies. Patients who underwent thyroid lobectomy in an attempt to extirpate the hyperfunctioning parathyroid gland form the basis of this report. Results. Thirty-two of 269 patients (12%) underwent thyroid lobectomy to remove a parathyroid gland. Intrathyroidal parathyroids were confirmed in 19 of 32 patients (59 %). In 18 of 19 patients (94 %), preoperative or intraoperative ultrasonography correctly identified an intrathyroidal lesion suspicious for a parathyroid. Only 1 of 6 patients (17%) undergoing a blind thyroidectomy had an intrathyroidal gland identified. Ultrasonography had a sensitivity of 95 % and a negative predictive value of 99.5 % in detecting an intrathyroidal parathyroid gland. Conclusions. The prevalence of an intrathyroidal parathyroid gland in our series is low (19 of 269, 7%). Ultrasonography can be used reliably to select patients for thyroid resection, reducing the need to perform a blind thyroid lobectomy and avoiding the potential morbidity of thyroid resection in this clinical setting.

AB - Background. The role of 'blind' thyroid lobectomy in the surgical management of patients with persistent or recurrent primary hyperparathyroidism is not known. We reviewed our experience with reoperation for hyperparathyroidism to determine the utility of blind thyroid resection in this setting. Methods. From 1982 to 1995, 269 patients underwent reoperation for hyperparathyroidism at our institution. All patients had biochemical confirmation of hyperparathyroidism and underwent noninvasive and if necessary invasive localization studies. Patients who underwent thyroid lobectomy in an attempt to extirpate the hyperfunctioning parathyroid gland form the basis of this report. Results. Thirty-two of 269 patients (12%) underwent thyroid lobectomy to remove a parathyroid gland. Intrathyroidal parathyroids were confirmed in 19 of 32 patients (59 %). In 18 of 19 patients (94 %), preoperative or intraoperative ultrasonography correctly identified an intrathyroidal lesion suspicious for a parathyroid. Only 1 of 6 patients (17%) undergoing a blind thyroidectomy had an intrathyroidal gland identified. Ultrasonography had a sensitivity of 95 % and a negative predictive value of 99.5 % in detecting an intrathyroidal parathyroid gland. Conclusions. The prevalence of an intrathyroidal parathyroid gland in our series is low (19 of 269, 7%). Ultrasonography can be used reliably to select patients for thyroid resection, reducing the need to perform a blind thyroid lobectomy and avoiding the potential morbidity of thyroid resection in this clinical setting.

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