Improving of diagnosis and treatment of primary hyperparathyroidism in patients with thyroid pathology
No 2-3 (2018), Clinical medicine
No 2-3 (2018)

Improving of diagnosis and treatment of primary hyperparathyroidism in patients with thyroid pathology

Clinical medicine
https://doi.org/10.31612/2616-4868.2-5.2018.11
Published October 25, 2018
S. A. Sheptukha
State Institution of Science «Research and Practical Centre of Preventive and Clinical Medicine» State Administrative Department, Kyiv, Ukraine
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Keywords

primary hyperparathyroidism, parathyroid glands, thyroid diseases, combined pathology, simultaneous surgery

How to Cite

Sheptukha, S. A. (2018). Improving of diagnosis and treatment of primary hyperparathyroidism in patients with thyroid pathology. Clinical and Preventive Medicine, (2-3), 93-102. https://doi.org/10.31612/2616-4868.2-5.2018.11
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Abstract

The aim of the study. Improving the effectiveness of diagnosis and treatment of primary hyperparathyroidism against a background of various surgical pathologies of the thyroid gland.

Materials and methods. The basis of the study was the results of the analysis of the clinical material of 6,193 patients operated on a variety of thyroid diseases during 2006-2012.

Results. According to the research model 4180 patients – retrospective group; 2013 persons – prospective group. It has been proved that the removal of increased PTG was needed because of the high probability of latent PHPT at upper-normal indices of ionized blood calcium (1.25-1.32 mmol/L). Algorithm of preoperative screening for PHPT allowed the significant increase in determining diseases (from 3.6% in the retrospective group within 2006-2010 years to 5.9% in the prospective group within 2011-2012 years) (p<0.05) according to the results of the 1st retrospective group. During this period of time, PHPT, composing 6% of all identified cases, was at least developed in 9 of 4180 (0.2%) patients who were underwent to thyroid surgery in the retrospective group. There were no cases of relapses or persistence of PHPT during follow-up in the prospective group (p<0.05). Sonography (sensitivity 76%) remains the most advisable method of topical diagnosis. 99mTs-sestamibi scintigraphy allowed to localize the pathologically changed PTG in 44 of 54 cases (81%). Necessity of neck computer tomography (72% sensitivity) was appeared in 52 cases. The choice of surgical approach was determined by results of topical diagnosis, comorbidity and previous thyroid interventions: Kocher standard incision, small medial incision or direct mini-incision over the parathyroid tumour. Simultaneous TG and PTG operations cause an increased risk of hypocalcemia (83-92%).

Conclusions. Hypercalcemia screening significantly increases the efficiency of preoperative diagnosis of primary hyperparathyroidism among patients with thyroid gland surgery.

https://doi.org/10.31612/2616-4868.2-5.2018.11
ARTICLE PDF (Українська)

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