SIMULTANEOUS THYROID OPERATION IN PATIENTS UNDERGOING INITIAL NECK EXPLORATION FOR PRIMARY HYPERPARATHYROIDISM

Twenty-three (25 %) out of 92 patients undergoing initial neck explora tion for primary hyperparathyroidism (PHPT) also underwent a simultane ous thyroid operation. Based on a postoperative analysis a simultaneou s thyroid operation was unquestionably indicated in 18 (78 %) cases bu t in the remaining five (18 %) the indications were less well proved. Six (9 %) of the 66 patients subjected only to neck exploration for PH PT and four (17 %) of those with a simultaneous thyroid operation had postoperative complications (P > 0.05). The patients with four inciden tal biopsies and an incidental lobectomy had no complications, but oth erwise complications were evenly distributed among the different thyro id operations. The somewhat higher complication rate in patients under going simultaneous thyroid operation was related to the learning curve of the surgeon. Simultaneous thyroid operation increased the operatin g room costs only by 31 %, and the combined operation was definitely c ost effective as compared with separate parathyroid and thyroid operat ions. It is concluded that in experienced hands, simultaneous thyroid operation is safe, cost effective and recommendable for patients under going initial neck exploration for PHPT, because it avoids the expense and risk associated with neck re-exploration and can reveal unsuspect ed cancer.