THE ROLE OF THYROID RESECTION DURING REOPERATION FOR PERSISTENT OR RECURRENT HYPERPARATHYROIDISM

Background. The role of ''bind'' thyroid lobectomy in the surgical man agement of patients with persistent or recurrent primary hyperparathyr oidism is not known. We reviewed our experience with reoperation for h yperparathyroidism to determine the utility of blind thyroid resection in this setting. Methods. From 1982 to 1995, 269 patients underwent r eoperation for hyperparathyroidism at our institution. All patients ha d biochemical confirmation of hyperparathyroidism and underwent noninv a sive and if necessary invasive localization studies. Patients who un derwent thyroid lobectomy in an attempt to extirpate the hyperfunction ing parathyroid gland form the basis of this report. Results. Thirty-t wo of 269 patients (12 %) underwent thyroid lobectomy to remove a para thyroid gland. Intrathyroidal parathyroids were confirmed in 19 of 32 patients (59%). In 18 of 19 patients (94 %), preoperative or intraoper ative ultrasonography correctly identified an intrathyroidal lesion su spicious for a parathyroid. Only 1 of 6 patients (17 %) undergoing a b lind thyroidectomy had an intrathyroidal gland identified. Ultrasonogr aphy had a sensitivity of 95 % and a negative predictive value of 99.5 % in detecting an intrathyroidal parathyroid gland. Conclusions. The prevalence of an intrathyrodal parathyroid gland in our series is low (19 of 269, 7 %). Ultrasonography can be used reliably to select patie nts for thyroid resection, reducing the need to perform a blind thyroi d lobectomy and avoiding the potential morbidity of thyroid resection in this clinical setting.