Document Detail


Screening for primary hyperparathyroidism before thyroid surgery: A prospective study.
MedLine Citation:
PMID:  11894030     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Misdiagnosed primary hyperparathyroidism (PHPT) during thyroid surgery may lead to a difficult reoperation. Because PHPT is often asymptomatic, calcium measurements have been recommended before thyroid surgery, but no study has focused on the results of a prospective PHPT screening. METHODS: The prospective study of 748 patients consisted of 2-step screening of calcium measurement in all patients (normal range, 2.2 to 2.6 mmol/L, 8.8 to 10.4 mg/dL). If the calcium level was greater than 2.49 mmol/L (9.9 mg/dL), parathyroid hormone level (PTH; normal range, 11 to 65 pg/mL) and second calcium measurements were obtained. Positive screening was defined by 2 calcium levels greater than 2.49 mmol/L (9.9 mg/dL) and PTH level greater than 49 pg/mL. In patients with negative screening, we evaluated the number of parathyroid incidentalomas. In patients with positive screening, we rated parathyroid adenomas discovered as "easily accessible" or "requiring specific dissection." We assumed that the former could have been incidentally found by a surgeon unaware of calcium value. The cost estimation was based on French national health system databases. RESULTS: In the 9 patients with positive screening, 9 had parathyroid adenomas, 3 of them requiring specific dissection. In the 739 patients with negative screening, 12 had surgical incidentalomas and 2 had postoperative PHPT diagnosis. CONCLUSIONS: Our screening was not exhaustive, but it avoided a reoperation for missed PHPT in 3 patients. Population screening cost less than 3 reoperations. Other strategies, more exhaustive and/or cost-effective, should be investigated.
Authors:
Anne Denizot; Frédéric Dadoun; Anne Meyer-Dutour; Pierre Alliot; Maxime Argème
Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Surgery     Volume:  131     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-03-14     Completed Date:  2002-04-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  264-9     Citation Subset:  AIM; IM    
Affiliation:
Service de Chirurgie Générale and Service des maladies métaboliques et nutrition, Centre Hospitalier et Universitaire de Marseille, Marseille, France.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Calcium / blood
Child
Female
Health Care Costs
Humans
Hyperparathyroidism / blood,  diagnosis*
Male
Mass Screening / economics,  methods*,  standards*
Middle Aged
Postoperative Period
Prospective Studies
Thyroid Gland / surgery*
Chemical
Reg. No./Substance:
7440-70-2/Calcium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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