Primary hyperparathyroidism with a history of head and neck irradiation: The consequences of associated thyroid tumors
Primary hyperparathyroidism with a history of head and neck irradiation: The consequences of associated thyroid tumors
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DOI：
10.1016/j.surg.2011.07.046
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发表时间：
2011-10-01
期刊：
影响因子：
3.8
通讯作者：
Yen, Tina W. F.
中科院分区：
文献类型：
--
作者：
Wilson, Stuart D.;Doffek, Kara M.;Yen, Tina W. F.
背景资料。原发性甲状旁腺功能亢进症(HPT)和有头颈部照射病史的患者有关甲状腺肿瘤的信息很少。本研究的目的是研究有甲状旁腺切除术放射病史的原发性HPT患者的甲状腺病理。对1,020名甲状旁腺切除术患者的前瞻性数据库进行了分析。连续确诊HPT患者916例。对放射史、颈部超声结果、甲状腺手术和病理进行评估。将有放射病史的患者与无放射病史的患者进行比较。在916例HPT患者中，49例(5%)有放射病史，更有可能有结节性甲状腺疾病(95%对52%)，接受过甲状腺切除术(29%对4%)，或同时进行甲状腺切除术(49%对26%)。49例中有9例(24%)患有甲状腺癌。在867例无放射病史的患者中，259例接受了甲状腺切除术(32例既往，227例合并)，32例(12%)有甲状腺癌。接受甲状旁腺切除术的原发性HPT患者的结节性甲状腺疾病明显增多：近1/2的患者同时行甲状腺切除术，近1/4的患者合并甲状腺癌。高分辨率超声在甲状旁腺切除术前检测相关的甲状腺病理，并允许外科医生计划甲状腺切除术的范围。(《外科》2011；150：869-77。)
Background. Information on thyroid tumors is scant in patients with primary hyperparathyroidism (HPT) and history of head and neck irradiation. The study objective was to investigate thyroid pathology in primary HPT patients with irradiation history presenting for parathyroidectomy.Methods. A prospective database of 1,020 parathyroidectomy patients was analyzed. 916 consecutive HPT patients were identified.. History of radiation, neck ultrasound results, thyroid operations, and pathology was assessed. Patients with radiation history were compared to those with no radiation.Results. Of the 916 HPT patients, 49 (5%) had a history of radiation and were more likely to have nodular thyroid disease (95% vs 52%), undergone a prior thyroidectomy (29% vs 4%), or had concurrent thyroidectomy (49% vs 26%). Nine of 49 (24%) had thyroid cancer. Of the 867 patients with no history of radiation, 259 underwent thyroid resection (32 prior and 227 concurrent) and 32 (12%) had thyroid cancer.Conclusion. Primary HPT patients with head and neck irradiation presenting for parathyroidectomy had marked increase in nodular thyroid disease: nearly 1 in 2 had concurrent thyroidectomy, and nearly 1 in 4 had thyroid carcinoma. High resolution ultrasound prior to parathyroidectomy detects associated thyroid pathology and allows the surgeon to plan the extent of thyroid resection. (Surgery 2011;150: 869-77.)