[Prospective study on incidence of primary hyperparathyroidism in patients with goiter].
Sleutelwoorden
Abstract
Primary hyperparathyroidismus (PHPT) may coexist with goitre. Measurement of calcium concentration in blood serum is recommended before goiter operation. However, because of subclinical PHPT with normocalcemia this screening is insufficient for diagnosis of all PHPT cases.
OBJECTIVE
of the study is prospective evaluation of PHPT incidence in patients operated because of goitre.
METHODS
The study was performed in group of 158 patients (145 women, 13 men) operated because of non-toxic goitre --115 patients--(SNN) and toxic--43 patients--(SNT). Calcium concentration (Ca), phosphorus concentration (P) and alkaline phosphatase activity (ALP) have been measured in all patients a day before operation. When this parameters has been out of normal range, parathormone concentration (PTH) was measured. PHPT was diagnosed, when PTH has been higher then normal range. Following Ca, P, ALP and PTH measurement was performed 3 months after operation to confirm or exclude the diagnosis of PHPT RESULTS: Values of Ca, P and ALP was out of normal range in 47 (37 with SNN and 10 with SNT) of 158 patients (29,7%). Higher PTH concentration (average 101,5 pg/ml) was in 16 of 47 patients (10, 1% of 158 patients). There was no hypercalcemia in any patient with PHPT PHPT was diagnosed in 12 (10,4%) patients with SNN and 4 (9,3%) with SNT. 12 patients were applied to following screening 3 months after operation. Among this patients value of Ca, P and ALP out of normal range was ascertained in 8 patients (66,7%). In 4 patients was higher PTH concentration. Increased PTH concentration and CA, P ALP concentration in normal range was observed in 1 patient three months after operation. In 5 of 12 (41,7%) patients was confirmed remaining PHPT although operation (average PTH 87,1 pg/ml).
CONCLUSIONS
Primary hyperparathyroidismus coexist with similar incidence in patients with SNN and SNT Standard PHPT screening is proper because of PHPT incidence in up to 10% thyroid operated patients.
