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Paper 12 (1145)
HYPERTHYROIDISM AFTER PARATHYROIDECTOMY
Background: Parathyroidectomy for primary hyperparathyroidism is a frequently performed surgical procedure and usually is not associated with significant morbidity. There have been a few case reports in the literature that describe a transient thyrotoxicosis after resection of a parathyroid adenoma. In our institution, we have recently treated four patients who have developed significant thyrotoxicosis requiring antithyroid medication after parathyroidectomy. We hypothesized that hyperthyroidism following parathyroidectomy is an underreported phenomenon and the course may become more severe than previously recognized.
The 26th Annual Meeting of the American
Association of Endocrine Surgeons
April 3rd- 5th,2005 - Paradisus Riviera Cancun.
Michael Stang MD, John Yim MD and Sally Carty MD
University of Pittsburgh, Pittsburgh, PA
Methods: Under an IRB-approved protocol, we performed a retrospective analysis of 184 consecutive, evaluable patients from 1998 to 2004 undergoing parathyroid exploration for primary hyperparathyroidism without concurrent thyroid surgery. The majority of patients received initially unilateral exploration with conversion to bilateral exploration as appropriate.
Results: The incidence of biochemical hyperthyroidism status post parathyroidectomy in 184 consecutive patients is 28%. Eleven of 184 patients (6%) reported hyperthyroid symptoms at 1 week after surgery. Four of 184 patients progressed to overt, severe and persistent hyperthyroidism requiring anti-thyroid medication (2%). Of 124 patients that had both pre-operative TSH and post-operative TSH levels measured, 91 (73%) had a decrease of their TSH level in the post-operative period with mean preoperative TSH of 1.94 compared to mean TSH of 1.18 post-operatively (P<0.0001). The Results: were independent of age, operative time, bilateral exploration, anatomic features, surgical technique and parathyroid adenoma weight.
Conclusions: Propensity for hyperthyroidism may be widely underappreciated after routine parathyroid surgery. Surgical technique is not contributory. Symptomatic thyrotoxicosis can occur. As such, patients undergoing parathyroid exploration require preoperative counseling and postoperative surveillance for hyperthyroidism.