Surgical therapy for primary hyperparathyroidism in patients with previousthyroid surgery

BACKGROUND: In patients with primary hyperparathyroidism (HPTH) and previou s thyroid operations, complications of parathyroidectomy are more frequent than in patients undergoing initial neck surgery. The aim of this study was to investigate the value of preoperative imaging with regard to its influe nce on the surgical strategy. METHODS: We retrospectively analyzed 17 patients with primary HPTH and prev ious thyroid surgery. Preoperatively 16 patients underwent sonography and/o r scintigraphy. RESULTS: Sonography had an overall accuracy to correctly localize enlarged parathyroid glands of 80%, and scintiscanning had overall accuracy of 78.6% . The accuracy of localization was increased up to 84.6% if both diagnostic procedures were applied. In patients with normal thyroid residues the accu racy of sonography was 85.7%, and it was 100% if scintiscanning was used. CONCLUSIONS: Preoperative localization techniques in patients with primary HPTH and previous thyroid surgery have high accuracy. This allows for an im aging-directed operative strategy, thus preventing unnecessary bilateral ne ck explorations, which carry a high risk of recurrent laryngeal nerve injur y. (C) 1999 by Excerpta Medica, Inc.