The Analysis Of Possible Clinical Correlation Between Primary Hyperparathyroidism And Thyroid Diseases

Objective:To investigate the correlation of clinical diagnosis and treatment for primary hyperparathyroidism (PHPT) and thyroid diseases, and analyze the possible factors of misdiagnosis, so that we can improve the sensitivity of screening and the accuracy of localization, and to choose the rational treatment, in order to get rid of unnecessary secondary operation.Methods:We collected 123 admission cases which were diagnosed as PHPT from 2009 to 2014 in Qilu Hospital of Shandong University. Then we analyzed the general conditions, histories, lab examinations, image data, surgical treatments, pathology diagnosis and characteristics of concomitant thyroid disease retrospectively, using the SPSS 18.0 version for statistical data analysis and regarding p<0.05 as significant.Results:In 123 cases which were diagnosed as PHTP by the lab examinations, the sex ratio counted 1:2.32,15～83 (51.46±12.39)y, and age over 45y taked up 72.36%. In 77 cases which did thyroid function tests, about 76.62% met the normal reference standard. The different examination methods, such as ultrasound, computerized tomography (CT) and radioisotope (99mTc-MIBI) scanning, their localization sensitivities were 71.30% (82/115),74.39%(61/82) and 87.21% (75/86) respectively. 103 cases accepted surgery in total,23 in 97 cases did not find parathyroid lesion by ultrasound, in which 10 were missed and 13 were misdiagnosed as thyroid nodules or neoplasm. The negative rate of parathyroid lesions in PHPT by ultrasound was confirmed to be different between the thyroid-positive group and the thyroid-negative group statistically, which was analyzed byx2 test. There were 39 cases had surgeries for both glands. Pathology diagnosed parathyroid adenomas with papillary thyroid carcinomas (PTC) for 5 cases, parathyroid adenomas with nodular goiters for 30 cases, parathyroid adenomas with Hashimoto’s thyroiditis for 3 cases and parathyroid hyperplasia with nodular goiter for 1 case only. By Fisher’s exact probabilities in fourfold table, we found that the clinical factors associated with PHPT had no significant relationship with the malignancy thyroid disease accompanied.Conclusion:PHPT doesn’t show any specific clinical manifestations, it involves different system, so as to missed the early diagnosis and treatment. Owing to its unique characteristics of embryonic development, the parathyroids’anatomical position changes a lot, so that PHPT is easily misdiagnosed as thyroid lesions by ultrasound screening, which increased the missed lesions and location difficulty. It is not clinically rare for PHPT with concomitant thyroid diseases. Preoperative image examinations should combine anatomical and functional localizations, in order to improve diagnostic sensitivity, avoid clinical misdiagnosis and find the rational surgical treatment. In the operation, making the exploration of thyroid lesions as routine can improve the success rate of surgery, avoid the trouble of secondary operation, and reduce the surgical risk of overall treatment finally.