Thyroid and Thymic Exeresis in Surgery of Hyperparathyroidism
M.R. Diaconescu, M. Glod, I. Costea, M. Grigorovici, S. DiaconescuOriginal article, no. 6, 2014
Background: Owing to close anatomical and embryologicalconnexions between the thyroid, parathyroids and thymus,manifold coexisting pathology can be identified during thesurgery of hyperparathyroidism (Hp).Material and Methods: In this retrospective study we reportthe incidence, clinical forms, histology and management ofthyroid and thymic synchronous lesions encountered in aseries of 82 consecutive patients with various types of Hpoperated on in the last three decades. Demography, clinicalrecords, biochemical data, imaging procedures, pathologyreports and surgical protocols were revised.Results: Between 1984-2013, 82 cases of Hp, 20 primary and 62 renal (27 secondary and 35 tertiary), 57 women and 25males (sex ratio: 2.3 1) of 15-72 (mean 46.5) years, underwentsurgery in our clinic. Concomitant thyroid exereses wereperformed in 32 patients (2 subtotal thyroidectomies, 12lobectomies, 8 atypical resections and 10 diagnosis biopsies), foruni- or bilateral (multi)nodular goiters or different “minuteâ€Âlesions. Pathology showed 11 colloid goiters, 3 follicular adenomas,5 nodular hyperplasias and 6 thyroiditis cases, 3 papillarymicrocarcinomas and 4 specimens with normal thyroid tissue.Excision of the fibrofatty retromanubrial tissue in total parathyroidectomiesfor renal Hp (19 cases) revealed one nonmyastenicthymoma, one thymic cyst and thymic remnants in 6 patients.Morbidity in these extended operations was not significantlyincreased, comparing to the parathyroid exploration alone.Discussions and Conclusions: Meticulous pre- and intraoperativeevaluation in all cases of Hp enables the actual shift frombilateral neck exploration to minimally invasive surgery,increasing however the potential risk of missing thyroid orthymic coexistent significant lesions. The surgeon dedicated tothis pathology must be aware of the possibility of encounteringsuch synchronous association and make generous efforts towardstheir complete cure in a single operation.
