Preoperative Localization and Intraoperative Parathyroid Hormone Assay in Korean Patients with Primary Hyperparathyroidism

BACKGROUND: The intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT. METHODS: We retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and 99mTc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted. RESULTS: The sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% false-negative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration. CONCLUSION: The IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.

The Surgical Treatment of Locally Invasive Thyroid Papillary Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroid papillary carcinoma usually progresses slowly and invades the surrounding tissues infrequently. About 10% of thyroid papillary carcinoma takes to local invasion that include larynx, pharynx, esophagus, and trachea. However, when invasion occurs, it becomes the source of significant morbidity and mortality to the patient. The main cause of death in thyroid papillary carcinoma is inappropriate treatment of local invasion. This study was designed to investigate the frequency and structure of local invasion, type of surgical treatment, complication and recurrence of locally invasive thyroid papillary carcinoma. SUBJECTS AND METHOD: Between August 1996 and July 2004, 114 patients were diagnosed with thyroid papillary carcinoma and were treated surgically at the Department of Otorhinolaryngology-head & neck surgery, Inha Univ. Hospital. Preoperative evaluation included needle aspiration biopsy, thyroid function test, computerized tomography and/or magnetic resonance imaging. Study was done retrospectively. RESULTS: Local invasion in thyroid papillary carcinoma was observed in 24% (27/114) of the thyroid papillary carcinoma. The most common invasion site was the recurrent laryngeal nerve. Total thyroidectomy was performed in all patients and was combined with radical procedures that included laryngectomy, pharyngectomy or with conservative procedures that included tracheal shaving and so on. Locoregional recurrence was observed in 19% of the cases and the most common site of local invasion was cervical lymph node. One case (4%) of patients died of locoregional recurrence. CONCLUSION: Thyroid papillary carcinoma frequently invades the surrounding structure. We believe that precise preoperative evaluation and treatment including primary resection specific to preoperative evaluation, the management of cervical lymph node metastasis and postoperative radioactive iodine therapy may all contribute to decreasing the mortality and morbidity of locally invasive thyroid papillary carcinoma.