RESUMO
OBJECTIVE: Our objective was to determine prevalence of incidental thyroid pathology during surgical treatment of primary hyperparathyroidism and to compare sensitivity and specificity of surgical neck exploration with histologic study of resected thyroid gland to confirm unsuspected pathologies. MATERIAL AND METHODS: This was prospective cohort study performed at the Specialty Hospital's Department of Endocrine Surgery at the Mexican Institute of Social Security's (IMSS's) Centro Médico de Occidente in Guadalajara, Jalisco State between 1995 and 2003. All were submitted to bilateral neck exploration under general anesthesia. According to the surgeon's criteria, any suspected thyroid anomaly was resected for transoperative frozen sections as well as definite histopathologic study. RESULTS: Preoperatively from a total of 44 cases of hyperparathyroidism, only four cases with thyroid anomalies were detected with neck ultrasound and/or computer tomography (CT) scan; additionally, 13 patients had thyroid anomalies found during neck exploration according to surgeon criteria. All were biopsied. Final study revealed thyroid disease in 16 cases; three had well-differentiated thyroid carcinoma and the remaining 13 patients had different benign entities. In one case, the thyroid specimen was considered normal. Sensitivity and specificity of surgeon criteria were 100 and 96%, respectively, to establish thyroid disease during neck exploration for another purpose. CONCLUSIONS: Association of hyperparathyroidism and benign and malignant thyroid disease is a common phenomenon. Independently of the ability of preoperative imaging procedures to detect unsuspected findings, we suggest exploration neck bilaterally and resection of any suspicious lesion.
Assuntos
Hiperparatireoidismo/cirurgia , Achados Incidentais , Esvaziamento Cervical , Doenças da Glândula Tireoide/diagnóstico , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/cirurgia , Adenoma/complicações , Adenoma/cirurgia , Adulto , Idoso , Cálcio/sangue , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/cirurgia , Estudos de Coortes , Feminino , Humanos , Hiperparatireoidismo/complicações , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/cirurgia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/cirurgia , Cuidados Pré-Operatórios , Estudos Prospectivos , Sensibilidade e Especificidade , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Tireotropina/sangue , Tiroxina/sangue , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Our objective was to determine the frequency of surgical reinterventions for recurrence or disease persistence after elective surgical procedures of the neck. METHODS: We used a transversal and comparative study, accomplished during a 6-year period. Emergency initial surgical procedures were excluded. The patients were divided according to the type of hospital where the initial surgical procedure was performed--those treated at a specialized medical center and those operated on in general hospitals. The variables evaluated were preoperative and pathological diagnosis, previous surgical procedures, and the time between the primary surgery and the definitive procedure. RESULTS: Three hundred sixty-two cases were included. Of these, 27 patients (7.45%) required surgical reinterventions. Time elapsed between the first and the definitive procedure was 1 to 19 years. Diagnostic concordance between the initial and final diagnosis was 89%. According to the type of hospital where the initial procedure was performed (specialized vs. general hospitals), we observed the following reintervention frequencies: parathyroid, 12.2% vs. 12.2% (p = 0.6); thyroid, 1.63% vs. 5.88% (p <0.05); thyroglossal duct cyst, 1.65% vs. 5.83% (p = 0.41), respectively. CONCLUSIONS: The specialized hospital admits patients with multiple problems, poor response, or inadequate therapeutic indication. For thyroid pathologies the odds ratio established a probability of 6.8 for major reintervention in those patients treated in non-specialized hospitals.