Coexistence of subclinical primary hyperparathyroidismus in patients with goitre treated surgically – prospective study

Background: Primary hyperparathyroidismus (PHPT) may coexist with goitre.Measurement of calcium concentration in blood serum is recommended before hyroid operation. However, because of subclinical PHPT with normocalcemia this screening is insufficient for diagnosis of all PHPT cases. Aim of the study: The aim of the study is prospective evaluation of PHPT incidence in patients operated because of goitre. Material and methods: The study was performed in group of 158 patients (145 women, 13 men) operated because of non-toxic goitre (SNN, 115 patients) and toxic goitre (SNT, 43 patients). 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. During operation in patients with higher PTH concentration were searched macroscopic changed parathyroid glands. 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 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%) patients with SNT. Ten patients were applied to following screening 3 months after operation. Among this patients value of Ca, P and  LP out of normal range was ascertained in 8 of 9 patients (88,9 %). In 4 patients was higher PTH concentration. Conclusions: Primary hyperparathyroidismus coexists with similar incidence in patients with SNN and SNT. Standard PHPT screening is proper  ecause of PHPT incidence in up to 10% thyroid operated patients. (Clin. Exp. Med. Lett. 2005; 46(4):45-50)

Keywords: primary hyperparathyroidismus, goitre, coexistence