MANAGEMENT OF HYPERPARATHYROIDISM IN AN ENDEMIC GOITER AREA

In an endemic goiter area patients with hyperparathyroidism (HPTH) fre quently also have thyroid abnormalities. In a retrospective study of 9 5 patients with HPTH we assessed the diagnostic accuracy of imaging te chniques (ultrasonography or radionuclide scanning) for preoperative l ocalization of parathyroid adenomas. Altogether 86% of our patients ha d goiter, requiring thyroid resections in 37%. For 19 patients the par athyroid exploration was the second or third cervical operation, most of them due to goiter. We found that the overall rate of transient and permanent recurrent nerve paralysis is considerably increased id pati ents with previous neck surgery (26% vs. 7%). The combination of ultra sonography and radionuclide scanning can lead surgeons to the site of parathyroid lesions responsible for HPTH in 85% of cases, although fre quent nodular goiters can produce pitfalls for correct imaging in iodi ne-deficient countries. In endemic goiter areas preoperative Localizat ion studies can be recommended in patients with primary HPTH-for evalu ation of thyroid pathology possibly leading to resection or its accura cy in localizing parathyroid adenomas. These studies also seem justifi ed in patients with previously unsuccessful neck explorations for HPTH .